Swallowing Exercises and Oral Nutrition Are Critical During Treatment for Oral Cancer

Patients with oral cancers who receive oral nutrition and practice swallowing exercises throughout their treatment are able to maintain a significantly better long-term diet, according to the results of a study published in JAMA Otolaryngology Head and Neck Surgery.

Oropharyngeal cancer is a type of head and neck cancer. The oropharynx is the part of the throat that includes the soft palate, the base of the tongue, and the tonsils. Pharyngeal cancers are often referred to as oral cancer. Treatment for oral cancer typically involves radiation or chemotherapy plus radiation. This treatment can lead to a condition called dysphagia, or difficulty swallowing. In severe cases, dysphagia can result in dietary restriction and malnutrition that requires long-term dependence on a feeding tube.

Some researchers have speculated that the best way to cope with dysphagia is to practice proactive swallowing exercises. The idea is to use it or lose it—so that the oral musculature doesn’t waste away.

To evaluate the effect of swallowing exercises and maintaining oral intake, researchers conducted a study that included 497 patients who underwent treatment with radiation or chemoradiation for pharyngeal cancer. They found that patients who maintained oral intake of food during treatment and adhered to swallowing exercises were able to maintain a better long-term diet after treatment was complete. Overall, 366 patients (74%) maintained oral intake throughout treatment—167 of these (34%) had partial oral intake and 199 (40%) had complete oral intake.

Some patients had consultations with a speech pathologist and 286 of these 388 (or 58% of the total patient population) reported adherence to swallowing exercises. After completing treatment, 81 percent of patients were able to resume a regular diet. During a median follow-up of 22 months, the researchers found that significantly more patients who maintained full oral intake and/or practiced swallowing exercises during treatment were able to consume a regular diet:

  • 65 percent of patients who did not have oral intake of food and did not practice swallowing exercises were able to consume a regular diet after treatment.
  • 77 to 84 percent of patients who had partial oral intake and some swallowing exercise were able to consume a regular diet after treatment.
  • 92 percent of patients who maintained full oral intake and practiced swallowing exercises were able to consume a regular diet after treatment.

The researchers concluded that oral intake and swallowing exercises were both positively associated with a better long-term diet after treatment for oral cancer. They found that patients who either eat or practice swallowing exercises fare better than patients who do neither. What’s more, patients who do both—eat and practice swallowing exercises—have the highest rate of return to a regular diet and the shortest duration of dependence on a feeding tube.

Reference:

Hutcheson KA, Bhayani  MK, Beadle BM, et al. Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: Use it or lose it. JAMA Otolaryngology Head and Neck Surgery. Published online September 19, 2013. doi:10.1001/jamaoto.2013.4715.

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