Cancer is a leading cause of long-term disability in the USA. Head and neck cancer rates are increasing and their associated morbidity is among the highest. Treatment related morbidities have a negative impact on quality of life, pose increased threats to health status, and demand a greater utilization of health care resources. Given this scenario, patients with head/neck cancer represent a high impact, high morbidity sub group requiring special consideration. One of the most common negative outcomes is difficulty swallowing (dysphagia). Nearly all head/neck cancer patients treated with radiotherapy (with or without chemotherapy) experience some degree of dysphagia during or following their cancer treatment. Other frequent morbidities include oral pain, oral dryness, and taste deviations. Unfortunately, relationships between these common clinical complaints (dysphagia and oral morbidities) are unclear and it is not known if they have a causative and/or maintenance effect on impaired oropharyngeal function. Currently, information addressing oral pain, oral dryness, and taste functions are not routinely integrated into dysphagia management or intervention programs. In the proposed study we evaluate the role of pain and pain avoidance strategies in the development and maintenance of dysphagia, xerostomia, and taste deficits in a cohort of 60 patients with head/neck cancer treated with radiotherapy. We propose to develop a 'fear of swallowing'scale and use this scale to develop graded exposure hierarchies as a fear-avoidance intervention for persistent dysphagia in this population. Subjects will undergo baseline assessments for oral pain, fear of pain avoidance strategies, oral dryness, taste, and swallowing ability to provide objective data detailing the incidence and characteristics of oropharyngeal functions subsequent to radiotherapy. Subjects will be monitored during radiotherapy and be re- examined at the end of treatment and at 3, and 6 months post treatment. We hypothesize that oropharyngeal pain will facilitate reduced frequency of swallowing which will associate with the severity of dysphagia, taste deficit, and xerostomia. Furthermore, patients with high fear-avoidance profiles will demonstrate more persistent deficits in these oral functions. The goals are: 1) To evaluate relationships between oropharyngeal pain and dysphagia in this population both at the conclusion of medical treatment and up to 6 months post- treatment. 2) To evaluate relationships between severity of swallowing deficit and xerostomia and taste loss up to 6 months following medical treatment. 3) To evaluate a novel intervention approach to dysphagia in this population based on resolution of fear-avoidance strategies that contribute to reduced movement. Successful completion of this study will challenge traditional approaches to dysphagia management in head/neck cancer survivors. Results will be invaluable in earlier identification of persistent dysphagic deficits, prevention o dysphagic morbidity, and the integration of oral morbidity assessment to effective dysphagia management strategies for this population.
Patients with head/neck cancer are living longer but suffer significant morbidity. This proposal seeks to understand and define relationships between critical oral complications and swallowing deficits in these patients. Results will support the development and application of effective management strategies, prevention of morbidity and improved health status.
| Crary, Michael A; Carnaby, Giselle D (2014) Adoption into clinical practice of two therapies to manage swallowing disorders: exercise-based swallowing rehabilitation and electrical stimulation. Curr Opin Otolaryngol Head Neck Surg 22:172-80 |
