scholarly journals Effects of Prophylactic Swallowing Exercises on Dysphagia and Quality of Life in Patients with Head and Neck Cancer Receiving (Chemo) Radiotherapy

2019 ◽  
Author(s):  
Anna Guillen-Sola ◽  
Neus Bofill-Soler ◽  
Ester Marco ◽  
Oscar Pera-Cegarra ◽  
Palmira Foro
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Head And Neck ◽  
Randomized Study ◽  
Clinical Variable ◽  
Swallowing Function ◽  
Submental Muscles ◽  
Swallowing Dysfunction ◽  
Oropharyngeal Exercises

Abstract Background: Squamous carcinoma of the head and neck (HNC) has a high incidence in our context. Although therapeutic radiotherapy protocols try to preserve swallowing function and essential speech organs, dysphagia is a frequent symptom in the acute and long-term phases, due to the toxic effects of therapies needed to confront the illness. Some studies have shown prophylactic oropharyngeal exercises to be quite useful in improving swallowing function after completion of chemo-radiation therapy (CRT) protocols; others have focused on their use to prevent or minimize post-CRT swallowing dysfunction. Patients’ quality of life deteriorates greatly during CRT, with a peak of maximum intensity during the days immediately after finishing CRT treatment. Afterwards, function gradually improves, although scope or timeframe remains undetermined. Available evidence suggests that exercise therapy prior to oncological treatment could potentially improve deglutition and quality of life; however, a randomized study is needed to confirm this observation. Design/Methods: The Redyor singe-blind randomized clinical trial is designed to compare the effect of prophylactic oropharyngeal exercises on quality of life, dysphagia, and sustainability to the length of rehabilitative treatment. At enrollment, participants will be randomly assigned to one of two treatment groups. Both groups follow the protocol described here, although one group begins the training 2 weeks before initiating CRT and the other group just after finishing the therapy. Both groups will complete standard swallow therapy for training submental muscles involved and 3 sets of 5 inspiratory and expiratory repetitions using the Orygen Dual® valve, with a progressive weekly increase in workload. Discussion: This ongoing clinical trial, registered in 2016, is based on the hypothesis that undergoing a pre-radiotherapy rehabilitation (pre-habilitation) program will have greater benefits (less decrease in quality of life, less delay in swallowing parameters, and less severe dysphagia) compared to post-CRT rehabilitation. The primary objective is to assess dysphagia severity and evaluate quality of life due to swallowing dysfunction in HNC patients. Secondary objectives are to assess the correlation between a clinical variable and instrumental parameters in this period

scholarly journals Effects of Prophylactic Swallowing Exercises on Dysphagia and Quality of Life in Patients with Head and Neck Cancer Receiving (Chemo) Radiotherapy. The Redyor Study: Protocol for a Randomized Clinical Trial.

2019 ◽  
Author(s):  
Anna Guillen-Sola ◽  
Neus Bofill-Soler ◽  
Ester Marco ◽  
Oscar Pera-Cegarra ◽  
Palmira Foro
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Head And Neck ◽  
Randomized Clinical Trial ◽  
Clinical Variable ◽  
Swallowing Function ◽  
Submental Muscles ◽  
Swallowing Dysfunction ◽  
Oropharyngeal Exercises

Abstract Background: Squamous carcinoma of the head and neck (HNC) has a high incidence in our context. Although therapeutic radiotherapy protocols try to preserve swallowing function and essential speech organs, dysphagia is a frequent symptom in the acute and long-term phases, due to the toxic effects of therapies needed to confront the illness. Some studies have shown prophylactic oropharyngeal exercises to be quite useful in improving swallowing function after completion of chemo-radiation therapy (CRT) protocols; others have focused on their use to prevent or minimize post-CRT swallowing dysfunction. Patients’ quality of life deteriorates greatly during CRT, with a peak of maximum intensity during the days immediately after finishing CRT treatment. Afterwards, function gradually improves, although scope or timeframe remains undetermined. Available evidence suggests that exercise therapy prior to oncological treatment could potentially improve deglutition and quality of life; however, a randomized study is needed to confirm this observation. Design/Methods: The Redyor singe-blind randomized clinical trial is designed to compare the effect of prophylactic oropharyngeal exercises on quality of life, dysphagia, and sustainability to the length of rehabilitative treatment. At enrollment, participants will be randomly assigned to one of two treatment groups. Both groups follow the protocol described here, although one group begins the training 2 weeks before initiating CRT and the other group just after finishing the therapy. Both groups will complete standard swallow therapy for training submental muscles involved and 3 sets of 5 inspiratory and expiratory repetitions using the Orygen Dual® valve, with a progressive weekly increase in workload. Discussion: This ongoing clinical trial, registered in 2016, is based on the hypothesis that undergoing a pre-radiotherapy rehabilitation (pre-habilitation) program will have greater benefits (less decrease in quality of life, less delay in swallowing parameters, and less severe dysphagia) compared to post-CRT rehabilitation. The primary objective is to assess dysphagia severity and evaluate quality of life due to swallowing dysfunction in HNC patients. Secondary objectives are to assess the correlation between a clinical variable and instrumental parameters in this period

scholarly journals Dysphagia and Its Impact on Quality of Life of Head and Neck Cancer Patients: Institution Based Cross sectional Study

2020 ◽  
Author(s):  
Tseganesh Asefa Yifru ◽  
Sezer Kisa ◽  
Negalegn Getahun Dinegde ◽  
Niguse Tadele Atnafu
Keyword(s):  
Quality Of Life ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Low Income ◽  
Swallowing Function ◽  
Advanced Tumor ◽  
Swallowing Problems

Abstract Objective: Assessing swallowing function using symptom-specific questionnaires on head and neck cancer (HNC) patients and supporting impaired swallowing to improve quality of life (QoL) of patients is recommended in different studies. However, there is no data that shows the effect of dysphagia on quality of life of Ethiopian patients. Hence, this study assessed the effect of dysphagia on quality of life domains of the MD Anderson Dysphagia inventory (MDADI) among head and neck cancer patients.Results: The study sample consisted of mostly male (53.90%), employed (70.6%), single (57.80 %) and completed some level of formal education (66.60 %) with mean age of 42.58 years (SD ± 14.08 years) and medical expense for about 69.6% of patients was covered by the government. Most of the patients were suffering from advanced stage HNC (59.80%) and squamous cell carcinoma (62.70%) and the most prevalent tumor location was nasal cavity/ nasopharyngeal carcinoma (40.20%). The mean MDADI composite score was 53.29 (SD± 15.85). Being female, low income, suffering from laryngeal/ hypo pharyngeal cancer, suffering from advanced tumor and those undergoing a single modality therapy were key determinants of poor QoL related to swallowing problems in HNC patients.

Evolution of self‐perceived swallowing function, tongue strength and swallow‐related quality of life during radiotherapy in head and neck cancer patients

Head & Neck ◽  
2019 ◽  
Vol 41 (7) ◽  
pp. 2197-2207 ◽  
Author(s):  
Leen Van den Steen ◽  
Dirk Van Gestel ◽  
Olivier Vanderveken ◽  
Jan Vanderwegen ◽  
Cathy Lazarus ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Tongue Strength ◽  
Swallowing Function ◽  
Related Quality

scholarly journals Opioid therapy vs. multimodal analgesia in head and neck Cancer (OPTIMAL-HN): study protocol for a randomized clinical trial

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sondos Zayed ◽  
Pencilla Lang ◽  
Lucas C. Mendez ◽  
Nancy Read ◽  
Jinka Sathya ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Randomized Clinical Trial ◽  
Multimodal Analgesia ◽  
Opioid Therapy ◽  
Opioid Analgesia ◽  
Opioid Use

Abstract Background Radiation-induced mucositis (RIM) pain confers substantial morbidity for head and neck cancer (HNC) patients undergoing radiotherapy alone (RT) or chemoradiotherapy (CRT), often reducing treatment compliance. However, no standard currently exists for the treatment of RIM, and high dose opioid therapy, with its associated side effects and increased risk for chronic opioid use, remains the cornerstone of HNC pain management. The goal of this randomized clinical trial is to compare multimodal analgesia using analgesic medications with different mechanisms of action, to the institutional standard of opioid analgesia alone, in order to ascertain the optimal analgesic regimen for the management of RIM pain in HNC patients. Methods In this open-label, single-institution, non-inferiority, randomized clinical trial, sixty-two patients with mucosal head and neck malignancies treated with curative-intent radiation will be randomized in a 1:1 ratio, stratified by RT or CRT, between Arm 1: opioid analgesia alone as per the institutional standard, or Arm 2: multimodal analgesia using Pregabalin, Acetaminophen, and Naproxen, in addition to opioids, if required. The primary endpoint is the average 11-Numeric Rating Scale (11-NRS) score for pain during the last week of radiation treatment. Secondary endpoints include: average weekly opioid use, duration of opioid requirement, average daily 11-NRS score for pain, average weekly opioids dispensed, quality of life, hospitalizations for analgesic medication-induced complications, time to feeding tube insertion, weight loss, toxicity, treatment interruptions, and death within 3 months of completing RT treatment. Patients are eligible once analgesia is required for moderate 4/10 pain. Discussion This study will assess the efficacy and safety of multimodal analgesia and its impact on opioid requirements, clinical outcomes, and quality of life, as a potential new standard treatment for RIM pain in HNC patients undergoing definitive RT or CRT. Trial registration ClinicalTrials.gov Identifier: NCT04221165. Date of registration: January 9, 2020. Appendix 2 reports the World Health Organization trial registration dataset.

scholarly journals QUALIDADE DE VIDA EM DEGLUTIÇÃO E CÂNCER DE CABEÇA E PESCOÇO: REVISÃO DE LITERATURA

2017 ◽  
Vol 8 (1) ◽  
pp. 26
Author(s):  
Manoela Carrera ◽  
Alena Ribeiro Alves Peixoto Medrado ◽  
Gabriela Botelho Martins ◽  
Hayana Ramos Lima ◽  
Raquel De Santana Oliveira Marques ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck Cancer ◽  
Deglutition Disorders ◽  
Head And Neck ◽  
Neck Cancer ◽  
Treatment Modality ◽  
Well Being ◽  
Swallowing Function ◽  
Advanced Stages

Objective: This study aimed to review the literature on the quality of life related to swallowing of patients with head and neck cancer. Methods: We searched for studies describing the physiology of swallowing and aspects involved in dysphagia, such as definition, causes and their impact on quality of life. We used the electronic databases Pubmed, Medline, Scielo, books, as well as articles identified in the references. Results: Deglutition disorders may occur due to disease and / or treatment modality, persisting during or after termination of treatment. The frequency and severity of dysphagia will depend on the modality of treatment used, location and stage of the tumor, when involved in structures that participate in swallowing. Patients with tumors in more advanced stages and located in the pharynx try to present worsening of swallowing function. Such factors may directly affect swallowing and quality of life of the patient, especially in family, social and lifestyle relationships. Conclusion: Although it does not replace clinical and instrumental evaluations, investigating the quality of life in swallowing may contribute to assess specific aspects of patient well-being that are not contemplated.

Comparison of treatment costs for pembrolizumab versus methotrexate, docetaxel, or cetuximab for recurrent or metastatic head-and-neck squamous cell carcinoma based on KEYNOTE-040 clinical trial.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18524-e18524 ◽  
Author(s):  
Justin Yeh ◽  
Achuta Guddati
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Overall Survival ◽  
Side Effects ◽  
Head And Neck ◽  
Squamous Cell ◽  
Published Data ◽  
Total Cost ◽  
The Cost

e18524 Background: Pembrolizumab has been approved by the FDA for the treatment of recurrent and refractory squamous cell cancer of the Head and Neck. This approval was based on the favorable results noted in the pembrolizumab arm of the KEYNOTE-040 clinical trial which compared pembrolizumab with the standard of care (methotrexate/cetuximab/docetaxel). This study aims to compare the financial aspects of these treatment arms in the setting of their relative clinical advantages in terms of increased overall survival by applying current pricing of the drugs and treatment for side effects. Methods: Data published from the KEYNOTE-040 study was used to generate a model incorporating the cost of each drug in both arms. The incidence of side effects was also extracted from the published data. The cost of treatment of side effects was extracted from previously published data and used for cost estimation in the model. The number of years added in terms of overall survival was calculated for the entire experimental arm and the cost of each such year was calculated. This model assumes that all drugs were supplied at the cost indicated at the retail price advertised by their producers. The cost was adjusted for inflation to the current year. Results: Based on current pricing, 248 patients in the control arm which involved methotrexate /cetuximab /docetaxel incurred an estimated total cost of $2,918,185 over 24 months. The total cost for the pembrolizumab arm based on current pricing was $36,744,819 for 247 patients over 24 months. The cost of management of adverse effects was $383,910 vs. $18,728 (Std. of care vs. Pembrolizumab). The total cost averaged over all patients in both arms was $13,314 vs. $ 148,840. There is an inverse relationship between drug cost and management of adverse side effects in both arms. Conclusions: Treatment with pembrolizumab confers an increase in overall survival but the cost of the incremental gain appears to be high. The model makes several assumptions including the distribution of cost over the patient population in both arms and extrapolates it to the cost in US dollars. It is very likely that the quality of life was superior in the pembrolizumab arm but it was not incorporated into our model. Justification of the continued use of pembrolizumab must be weighed against the long term survival benefits accrued by its usage in the context of a different and possibly better quality of life.

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