Dysphagia Treatment for Patients With Head and Neck Cancer Undergoing Radiation Therapy

A Meta-analysis Review

Elissa Greco, Tijana Simic, Jolie Ringash, George Tomlinson, Yoko Inamoto, Rosemary Martino

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Purpose: Patients undergoing radiation therapy with or without chemotherapy (C/RT) for head and neck cancer (HNC) often develop dysphagia. Interventions from speech-language pathologists aim to maintain or improve swallow physiology and function. However, it is unclear which interventions provide the greatest benefit. We performed a systematic review to assess the benefit of exercise therapy on swallow physiology, function, and related quality of life (QOL). Methods and Materials: We searched 7 electronic databases up to July 12, 2017, for all primary studies of any language or design that included the following: a behavioral swallowing intervention for patients with HNC treated with curative C/RT, a comparison group, and outcomes related to swallow physiology, function, and/or QOL. Two blinded raters judged the abstracts and full articles, with discrepancies resolved by a third rater. Critical appraisal was completed using the Cochrane Risk of Bias. Descriptive analyses were conducted for all outcomes and meta-analyses for outcomes that were identical in type and time relative to C/RT. Results: Of 1937 unique abstracts retrieved, 20 studies qualified. Of these, 12 were randomized controlled trials. Across the studies, dysphagia treatments varied by exercise type and start time (ie, before or during C/RT, n = 14; immediately after C/RT, n = 1; >3 months after C/RT, n = 5). After treatment, the outcomes measured varied by domain, tools, and follow-up schedule (ie, immediately after, n = 6; within 3 months after, n = 9, >3 months after, n = 12). All articles had risks of bias and most often lacked report of sample size calculations (n = 18), controlled clinician–participant interaction time across groups (n = 13), and treatment details to allow duplication (n = 9). The meta-analysis revealed physiological or functional, but not QOL, benefits after interventions with early and late start times. Conclusions: Given that benefit was identified with both early and late interventions, future high-quality trials are needed to clarify the most effective time, type, and intensity of behavioral dysphagia interventions for these HNC patients.

Original languageEnglish
Pages (from-to)421-444
Number of pages24
JournalInternational Journal of Radiation Oncology Biology Physics
Volume101
Issue number2
DOIs
Publication statusPublished - 01-06-2018

Fingerprint

Head and Neck Neoplasms
Deglutition Disorders
Meta-Analysis
radiation therapy
Deglutition
Radiotherapy
cancer
physiology
Quality of Life
physical exercise
Language
Therapeutics
Exercise Therapy
chemotherapy
schedules
Sample Size
therapy
Appointments and Schedules
Randomized Controlled Trials
Databases

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Greco, Elissa ; Simic, Tijana ; Ringash, Jolie ; Tomlinson, George ; Inamoto, Yoko ; Martino, Rosemary. / Dysphagia Treatment for Patients With Head and Neck Cancer Undergoing Radiation Therapy : A Meta-analysis Review. In: International Journal of Radiation Oncology Biology Physics. 2018 ; Vol. 101, No. 2. pp. 421-444.
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Dysphagia Treatment for Patients With Head and Neck Cancer Undergoing Radiation Therapy : A Meta-analysis Review. / Greco, Elissa; Simic, Tijana; Ringash, Jolie; Tomlinson, George; Inamoto, Yoko; Martino, Rosemary.

In: International Journal of Radiation Oncology Biology Physics, Vol. 101, No. 2, 01.06.2018, p. 421-444.

Research output: Contribution to journalReview article

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T1 - Dysphagia Treatment for Patients With Head and Neck Cancer Undergoing Radiation Therapy

T2 - A Meta-analysis Review

AU - Greco, Elissa

AU - Simic, Tijana

AU - Ringash, Jolie

AU - Tomlinson, George

AU - Inamoto, Yoko

AU - Martino, Rosemary

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N2 - Purpose: Patients undergoing radiation therapy with or without chemotherapy (C/RT) for head and neck cancer (HNC) often develop dysphagia. Interventions from speech-language pathologists aim to maintain or improve swallow physiology and function. However, it is unclear which interventions provide the greatest benefit. We performed a systematic review to assess the benefit of exercise therapy on swallow physiology, function, and related quality of life (QOL). Methods and Materials: We searched 7 electronic databases up to July 12, 2017, for all primary studies of any language or design that included the following: a behavioral swallowing intervention for patients with HNC treated with curative C/RT, a comparison group, and outcomes related to swallow physiology, function, and/or QOL. Two blinded raters judged the abstracts and full articles, with discrepancies resolved by a third rater. Critical appraisal was completed using the Cochrane Risk of Bias. Descriptive analyses were conducted for all outcomes and meta-analyses for outcomes that were identical in type and time relative to C/RT. Results: Of 1937 unique abstracts retrieved, 20 studies qualified. Of these, 12 were randomized controlled trials. Across the studies, dysphagia treatments varied by exercise type and start time (ie, before or during C/RT, n = 14; immediately after C/RT, n = 1; >3 months after C/RT, n = 5). After treatment, the outcomes measured varied by domain, tools, and follow-up schedule (ie, immediately after, n = 6; within 3 months after, n = 9, >3 months after, n = 12). All articles had risks of bias and most often lacked report of sample size calculations (n = 18), controlled clinician–participant interaction time across groups (n = 13), and treatment details to allow duplication (n = 9). The meta-analysis revealed physiological or functional, but not QOL, benefits after interventions with early and late start times. Conclusions: Given that benefit was identified with both early and late interventions, future high-quality trials are needed to clarify the most effective time, type, and intensity of behavioral dysphagia interventions for these HNC patients.

AB - Purpose: Patients undergoing radiation therapy with or without chemotherapy (C/RT) for head and neck cancer (HNC) often develop dysphagia. Interventions from speech-language pathologists aim to maintain or improve swallow physiology and function. However, it is unclear which interventions provide the greatest benefit. We performed a systematic review to assess the benefit of exercise therapy on swallow physiology, function, and related quality of life (QOL). Methods and Materials: We searched 7 electronic databases up to July 12, 2017, for all primary studies of any language or design that included the following: a behavioral swallowing intervention for patients with HNC treated with curative C/RT, a comparison group, and outcomes related to swallow physiology, function, and/or QOL. Two blinded raters judged the abstracts and full articles, with discrepancies resolved by a third rater. Critical appraisal was completed using the Cochrane Risk of Bias. Descriptive analyses were conducted for all outcomes and meta-analyses for outcomes that were identical in type and time relative to C/RT. Results: Of 1937 unique abstracts retrieved, 20 studies qualified. Of these, 12 were randomized controlled trials. Across the studies, dysphagia treatments varied by exercise type and start time (ie, before or during C/RT, n = 14; immediately after C/RT, n = 1; >3 months after C/RT, n = 5). After treatment, the outcomes measured varied by domain, tools, and follow-up schedule (ie, immediately after, n = 6; within 3 months after, n = 9, >3 months after, n = 12). All articles had risks of bias and most often lacked report of sample size calculations (n = 18), controlled clinician–participant interaction time across groups (n = 13), and treatment details to allow duplication (n = 9). The meta-analysis revealed physiological or functional, but not QOL, benefits after interventions with early and late start times. Conclusions: Given that benefit was identified with both early and late interventions, future high-quality trials are needed to clarify the most effective time, type, and intensity of behavioral dysphagia interventions for these HNC patients.

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