Treatment for head and neck cancer often results in significant swallowing problems because of reduced range of motion of the larynx, tongue base and pharyngeal walls. Therapy procedures to improve range of motion including swallowing maneuvers have been shown in pilot data to be efficacious in patients with reduced range of motion. In this project, we propose to compare two rehabilitation programs introduced for one month beginning at 1 month post-treatment in a randomized longitudinal design involving 198 patients who have been treated for head and neck cancer with chemoradiation, supraglottic laryngectomy, anterior resection with primary or skin graft closure, anterior resection with distal or free flap closure, posterior resection with primary or skin graft closure, or posterior resection with distal or free flap closure: 1) aggressive range of motion with postural sensory therapy and 2) postural sensory therapy. After the one-month of therapy, patients in both therapy arms will receive a one-month rest period followed by a one-month therapy refresher at month 3 post-treatment. We hypothesize that the patients randomized to range of motion with postural sensory therapy will exhibit significantly more oral intake at 2 months post cancer treatment, will maintain their gains better after 1 month rest and will have a more normal diet at 4 months post-treatment and significantly better pharyngeal flexibility at 4, 6 and 12 months after tumor treatment completion as measured by the duration and width of cricopharyngeal opening during swallows of various volumes than patients receiving postural sensory therapy. We also hypothesize that patients in the range of motion program will maintain tongue base, hyoid, laryngeal and cricopharyngeal range of motion at 4, 6 and 12 months after completion of their tumor treatment and that it will be significantly better than that of patients who were on the postural sensory programs. Cost-effectiveness is a critical factor in today's health care system. We believe that patients in the range of motion/postural sensory group will exhibit less cost for medically needed services at 4, 6 and 12 months after completion of tumor treatment (immediately after, 2 and 8 months after completion of swallowing therapy) than patients in the postural sensory therapy group.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA095576-02
Application #
6622871
Study Section
Special Emphasis Panel (ZRG1-BBBP-7 (01))
Program Officer
Jeffery, Diana D
Project Start
2002-04-01
Project End
2007-03-31
Budget Start
2003-04-01
Budget End
2004-03-31
Support Year
2
Fiscal Year
2003
Total Cost
$725,450
Indirect Cost
Name
Northwestern University at Chicago
Department
Other Health Professions
Type
Schools of Arts and Sciences
DUNS #
160079455
City
Evanston
State
IL
Country
United States
Zip Code
60201
Logemann, Jerilyn A (2014) Critical Factors in the Oral Control Needed for Chewing and Swallowing. J Texture Stud 45:173-179
Pauloski, Barbara Roa; Logemann, Jerilyn A; Rademaker, Alfred W et al. (2013) Effects of enhanced bolus flavors on oropharyngeal swallow in patients treated for head and neck cancer. Head Neck 35:1124-31
Pauloski, Barbara Roa; Rademaker, Alfred W; Logemann, Jerilyn A et al. (2011) Relation of mucous membrane alterations to oral intake during the first year after treatment for head and neck cancer. Head Neck 33:774-9
Pauloski, Barbara Roa; Rademaker, Alfred W; Kern, Mark et al. (2009) The Feasibility of Establishing Agreement Between Laboratories for Measures of Oropharyngeal Structural Movements. J Med Speech Lang Pathol 17:9-19
Pauloski, Barbara R (2008) Rehabilitation of dysphagia following head and neck cancer. Phys Med Rehabil Clin N Am 19:889-928, x