Victor M. Duarte, MD, resident, department of head and neck surgery, David E. Geffen School of Medicine, University of California, Los Angeles. His study was published in Otolaryngology—Head and Neck Surgery.
You take a bite and you chew, but you just can’t swallow. The food stays in your mouth, turning to mush…or it gets stuck in your throat and makes you choke…or it finally goes down, but it hurts. This happens again and again, with every bite, until you’re afraid to eat or drink at all.
That scenario is all too real for patients with head and neck cancers (cancer of the throat, larynx, oral cavity, salivary gland or paranasal sinuses). Radiation is often a part of the typical treatment for head and neck cancers—and the majority of such patients who receive radiation develop dysphagia (swallowing difficulties). Often they end up on a diet of puréed foods or even just liquids…in extreme cases, they need feeding tubes.
You can imagine the terrible impact that this has on patients’ quality of life, not to mention their nutritional status. And sadly, the swallowing problems often remain for the rest of their lives.
Very good news: Specially designed mouth and throat exercises (including gargling!) help decrease these terrible problems, an exciting new study shows—but only if the exercises are started in time.
Patients with head and neck cancers often are sent for “swallowing rehab” after radiation treatment, once dysphagia has developed. But for the new study, researchers wanted to see whether swallowing problems could be prevented or minimized if patients performed targeted exercises before and during their cancer treatment.
The study included 85 patients with head and neck cancer who were about to be treated with either radiation alone or chemotherapy plus radiation. Two weeks before beginning their cancer treatment, the participants were instructed in the swallow preservation protocol. Taught by a speech-language pathologist, the protocol consisted of a series of exercises designed to maintain range of motion of the mouth and neck muscles involved in swallowing and to counter the effects of the fibrosis (scar tissue formation and stiffening) that often occurs after radiation.
Exercises included gargling…sticking out the tongue…effortful swallowing (“swallowing hard”)…“chug-a-lugging” several ounces of liquid all at once…and more. Participants were advised to repeat each exercise 10 times per session (except the chug-a-lug) and to complete three sessions per day, starting two weeks prior to treatment and continuing for two months after treatment ended. During treatment, participants also were encouraged to continue eating and drinking as they normally would—even if it hurt to swallow or if they experienced a distorted, unpleasant taste (a common side effect of chemotherapy).
Participants kept records to track how frequently they performed the exercises. Of the 85 participants, 57 were considered compliant with the program because they completed at least one full set of exercises each day. The remaining 28 patients, who did not do at least one complete set of exercises daily, were deemed noncompliant. One month after treatment ended, here’s where things stood…
A regular chewable diet (not purée or liquid) was being managed by 54% of compliant patients…but just 21% of noncompliant patients could chew regular food.
A feeding tube was required for only 23% of compliant patients…compared with 54% of noncompliant patients.
Abnormal esophageal narrowing (stenosis) occurred in just 7% of the compliant group…as opposed to 32% of the noncompliant group.
All in all, the benefits for the people who really followed the advice were tremendous!
Now, you might think that the people who were noncompliant (and who had worse outcomes) tended to be noncompliant because their conditions were worse to begin with and/or because they suffered greater side effects from treatment—either or both of which could make the exercises more difficult. However, that wasn’t the case, the researchers said. There were no significant differences between the compliant and noncompliant groups in terms of tumor stage, treatment type, radiation dose or the diet they could tolerate pretreatment…nor were there any significant differences in the two groups’ pain levels after treatment.
Bottom line: Should you or a loved one ever need radiation for head or neck cancer, ask your doctor about starting swallow therapy before your treatment and continuing right through your post-treatment period whether or not you are having swallowing difficulties. Your doctor can refer you to a speech-language pathologist with expertise in swallow therapy…or you can find such a therapist through the American Speech-Language-Hearing Association.
Important: Cancer treatment isn’t the only cause of dysphagia. If you have trouble swallowing, read “The Hidden Threat of Swallowing Problems: Simple Steps That Can Make Eating and Drinking Safer.”