Download PDF
Semin Speech Lang 2019; 40(03): 213-226
DOI: 10.1055/s-0039-1688979
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical Decision Making with Head and Neck Cancer Patients with Dysphagia

Heather Starmer
1   Department of Otolaryngology – Head and Neck Surgery, Stanford University, Palo Alto, California
2   Head and Neck Speech and Swallowing Rehabilitation, Stanford Cancer Center, Palo Alto, California
,
Jeffrey Edwards
3   Clinical Speech-Language Pathologist, Stanford Cancer Center, Palo Alto, California
› Author Affiliations
Further Information

Publication History

Publication Date:
03 June 2019 (online)

    Permissions and Reprints

Abstract

Dysphagia is a common challenge faced by patients with head and neck cancer. Management of these patients is quite distinct from many other dysphagia etiologies due to the nature of surgical removal of organs critical to swallowing, the ability to provide preventative therapies, and the variable risk for complications related to dysphagia. Thus, clinicians providing care to the head and neck cancer population need to understand these differences when employing clinical decision making. In addition, changes in the demographics of head and neck cancer, related predominantly to the epidemic of oropharyngeal cancer associated with the human papillomavirus, have further transformed both the types of patients and the types of treatments offered. These epidemiologic factors further complicate the decision-making process for clinicians. This article provides a framework for decision making in the surgical and nonsurgical patient with head and neck cancer.

Keywords

dysphagia - head and neck cancer - radiation therapy - radiation-associated dysphagia - rehabilitation - swallowing therapy

Disclosures

Neither author has any financial or nonfinancial disclosures.


 

  • References

  • 1 Moore EJ, Olsen KD, Kasperbauer JL. Transoral robotic surgery for oropharyngeal squamous cell carcinoma: a prospective study of feasibility and functional outcomes. Laryngoscope 2009; 119 (11) 2156-2164
    CrossrefPubMedGoogle Scholar
  • 2 Roe JW, Carding PN, Dwivedi RC. , et al. Swallowing outcomes following intensity modulated radiation therapy (IMRT) for head & neck cancer - a systematic review. Oral Oncol 2010; 46 (10) 727-733
    CrossrefPubMedGoogle Scholar
  • 3 Lim GC, Holsinger FC, Li RJ. Transoral endoscopic head and neck surgery: the contemporary treatment of head and neck cancer. Hematol Oncol Clin North Am 2015; 29 (06) 1075-1092
    CrossrefPubMedGoogle Scholar
  • 4 McConnel FM, Logemann JA, Rademaker AW. , et al. Surgical variables affecting postoperative swallowing efficiency in oral cancer patients: a pilot study. Laryngoscope 1994; 104 (1, Pt 1): 87-90
    PubMedGoogle Scholar
  • 5 Marur S, Forastiere AA. Head and neck squamous cell carcinoma: update on epidemiology, diagnosis, and treatment. Mayo Clin Proc 2016; 91 (03) 386-396
    CrossrefPubMedGoogle Scholar
  • 6 Deschler DG, Richmon JD, Khariwala SS, Ferris RL, Wang MB. The “new” head and neck cancer patient-young, nonsmoker, nondrinker, and HPV positive: evaluation. Otolaryngol Head Neck Surg 2014; 151 (03) 375-380
    CrossrefPubMedGoogle Scholar
  • 7 Chen AM, Li J, Beckett LA. , et al. Differential response rates to irradiation among patients with human papillomavirus positive and negative oropharyngeal cancer. Laryngoscope 2013; 123 (01) 152-157
    CrossrefPubMedGoogle Scholar
  • 8 Blanchard P, Volk RJ, Ringash J, Peterson SK, Hutcheson KA, Frank SJ. Assessing head and neck cancer patient preferences and expectations: a systematic review. Oral Oncol 2016; 62: 44-53
    CrossrefPubMedGoogle Scholar
  • 9 Messing BP, Ward EC, Lazarus C. , et al. Establishing a multidisciplinary head and neck clinical pathway: an implementation evaluation and audit of dysphagia-related services and outcomes. Dysphagia 2019; 34 (01) 89-104
    CrossrefPubMedGoogle Scholar
  • 10 Starmer HM, Ayoub N, Byward C. , et al. The impact of developing a speech and swallow rehab program: improving patient satisfaction and multidisciplinary care. Laryngoscope 2017; 127 (11) 2578-2581
    CrossrefPubMedGoogle Scholar
  • 11 Starmer H, Sanguineti G, Marur S, Gourin CG. Multidisciplinary head and neck cancer clinic and adherence with speech pathology. Laryngoscope 2011; 121 (10) 2131-2135
    CrossrefPubMedGoogle Scholar
  • 12 Starmer H, Gourin C, Lua LL, Burkhead L. Pretreatment swallowing assessment in head and neck cancer patients. Laryngoscope 2011; 121 (06) 1208-1211
    CrossrefPubMedGoogle Scholar
  • 13 Clarke P, Radford K, Coffey M, Stewart M. Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016; 130 (Suppl. 02) S176-S180
    PubMedGoogle Scholar
  • 14 Webster KT, Tippett D, Simpson M. , et al. Speech-language pathology care and short- and long-term outcomes of oropharyngeal cancer treatment in the elderly. Laryngoscope 2018; 128 (06) 1403-1411
    CrossrefPubMedGoogle Scholar
  • 15 Starmer HM, Quon H, Simpson M. , et al. Speech-language pathology care and short- and long-term outcomes of laryngeal cancer treatment in the elderly. Laryngoscope 2015; 125 (12) 2756-2763
    CrossrefPubMedGoogle Scholar
  • 16 Starmer HM. Dysphagia in head neck cancer: Conservative management vs Risk-guided decision-making. Dysphagia Cafe. October 2016 . Available at: https://dysphagiacafe.com/2016/10/28/dysphagia-head-neck-cancer-conservative-management-vs-risk-guided-decision-making/ . Accessed January 14, 2019
    PubMedGoogle Scholar
  • 17 Newell R, Ziegler L, Stafford N, Lewin RJ. The information needs of head and neck cancer patients prior to surgery. Ann R Coll Surg Engl 2004; 86 (06) 407-410
    CrossrefPubMedGoogle Scholar
  • 18 Ward EC, Hobson TK, Conroy A. Pre- and post-operative counselling and information dissemination: perceptions of patients undergoing laryngeal surgery and their spouses. Asia Pac J Speech Lang Hear 2003; 8 (01) 44-68
    PubMedGoogle Scholar
  • 19 Carnaby-Mann G, Crary MA, Schmalfuss I, Amdur R. “Pharyngocise”: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys 2012; 83 (01) 210-219
    CrossrefPubMedGoogle Scholar
  • 20 Hutcheson KA, Bhayani MK, Beadle BM. , et al. Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it. JAMA Otolaryngol Head Neck Surg 2013; 139 (11) 1127-1134
    CrossrefPubMedGoogle Scholar
  • 21 Crary MA, Carnaby Mann GD, Groher ME, Helseth E. Functional benefits of dysphagia therapy using adjunctive sEMG biofeedback. Dysphagia 2004; 19 (03) 160-164
    PubMedGoogle Scholar
  • 22 Logemann JA. Evaluation and Treatment of Swallowing Disorders. San Diego, CA: College-Hill Press; 1998
    Google Scholar
  • 23 Kraaijenga SAC, Molen LV, Stuiver MM. , et al. Efficacy of a novel swallowing exercise program for chronic dysphagia in long-term head and neck cancer survivors. Head Neck 2017; 39 (10) 1943-1961
    CrossrefPubMedGoogle Scholar
  • 24 Virani A, Kunduk M, Fink DS, McWhorter AJ. Effects of 2 different swallowing exercise regimens during organ-preservation therapies for head and neck cancers on swallowing function. Head Neck 2015; 37 (02) 162-170
    CrossrefPubMedGoogle Scholar
  • 25 Goldsmith T, Jacobson MC. Managing the late effects of chemoradiation on swallowing: bolstering the beginning, minding the middle, and cocreating the end. Curr Opin Otolaryngol Head Neck Surg 2018; 26 (03) 180-187
    CrossrefPubMedGoogle Scholar
  • 26 Hutcheson KA, Yuk M, Hubbard R. , et al. Delayed lower cranial neuropathy after oropharyngeal intensity-modulated radiotherapy: a cohort analysis and literature review. Head Neck 2017; 39 (08) 1516-1523
    CrossrefPubMedGoogle Scholar
  • 27 Neve M, Jameson MB, Govender S, Hartopeanu C. Impact of geriatric assessment on the management of older adults with head and neck cancer: a pilot study. J Geriatr Oncol 2016; 7 (06) 457-462
    CrossrefPubMedGoogle Scholar
  • 28 Kisser U, Adderson-Kisser C, Coenen M. , et al. The development of an ICF-based clinical guideline and screening tool for the standardized assessment and evaluation of functioning after head and neck cancer treatment. Eur Arch Otorhinolaryngol 2017; 274 (02) 1035-1043
    CrossrefPubMedGoogle Scholar
  • 29 Starmer HM, Gourin CG. Is speech language pathologist evaluation necessary in the nonoperative treatment of head and neck cancer?. Laryngoscope 2013; 123 (07) 1571-1572
    CrossrefPubMedGoogle Scholar
  • 30 Patterson J, Wilson JA. The clinical value of dysphagia preassessment in the management of head and neck cancer patients. Curr Opin Otolaryngol Head Neck Surg 2011; 19 (03) 177-181
    CrossrefPubMedGoogle Scholar
  • 31 Chen AY, Frankowski R, Bishop-Leone J. , et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg 2001; 127 (07) 870-876
    PubMedGoogle Scholar
  • 32 Crary MA, Mann GDC, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil 2005; 86 (08) 1516-1520
    CrossrefPubMedGoogle Scholar
  • 33 Lazarus CL, Husaini H, Jacobson AS. , et al. Development of a new lingual range-of-motion assessment scale: normative data in surgically treated oral cancer patients. Dysphagia 2014; 29 (04) 489-499
    CrossrefPubMedGoogle Scholar
  • 34 Martin-Harris B, Brodsky MB, Michel Y. , et al. MBS measurement tool for swallow impairment--MBSImp: establishing a standard. Dysphagia 2008; 23 (04) 392-405
    CrossrefPubMedGoogle Scholar
  • 35 Carnaby GD, Crary MA. Development and validation of a cancer-specific swallowing assessment tool: MASA-C. Support Care Cancer 2014; 22 (03) 595-602
    CrossrefPubMedGoogle Scholar
  • 36 Dijkstra PU, Huisman PM, Roodenburg JLN. Criteria for trismus in head and neck oncology. Int J Oral Maxillofac Surg 2006; 35 (04) 337-342
    CrossrefPubMedGoogle Scholar
  • 37 Starmer HM. Dysphagia in head and neck cancer: prevention and treatment. Curr Opin Otolaryngol Head Neck Surg 2014; 22 (03) 195-200
    CrossrefPubMedGoogle Scholar
  • 38 Simental AA, Carrau RL. Assessment of swallowing function in patients with head and neck cancer. Curr Oncol Rep 2004; 6 (02) 162-165
    CrossrefPubMedGoogle Scholar
  • 39 Kao SS, Peters MD, Krishnan SG, Ooi EH. Swallowing outcomes following primary surgical resection and primary free flap reconstruction for oral and oropharyngeal squamous cell carcinomas: a systematic review. Laryngoscope 2016; 126 (07) 1572-1580
    CrossrefPubMedGoogle Scholar
  • 40 Pauloski BR, Logemann JA, Rademaker AW. , et al. Speech and swallowing function after oral and oropharyngeal resections: one-year follow-up. Head Neck 1994; 16 (04) 313-322
    CrossrefPubMedGoogle Scholar
  • 41 Ohkoshi A, Ogawa T, Nakanome A. , et al. Predictors of chewing and swallowing disorders after surgery for locally advanced oral cancer with free flap reconstruction: a prospective, observational study. Surg Oncol 2018; 27 (03) 490-494
    CrossrefPubMedGoogle Scholar
  • 42 Holmes S. A service evaluation of cough reflex testing to guide dysphagia management in the postsurgical adult head and neck patient population. Curr Opin Otolaryngol Head Neck Surg 2016; 24 (03) 191-196
    CrossrefPubMedGoogle Scholar
  • 43 Guidera AK, Kelly BN, Rigby P, MacKinnon CA, Tan ST. Early oral intake after reconstruction with a free flap for cancer of the oral cavity. Br J Oral Maxillofac Surg 2013; 51 (03) 224-227
    CrossrefPubMedGoogle Scholar
  • 44 McAuley D, Barry T, McConnell K, Smith J, Stenhouse J. Early feeding after free flap reconstruction for oral cancer. Br J Oral Maxillofac Surg 2015; 53 (07) 618-620
    CrossrefPubMedGoogle Scholar
  • 45 Kinzinger MR, Bewley AF. Perioperative care of head and neck free flap patients. Curr Opin Otolaryngol Head Neck Surg 2017; 25 (05) 405-410
    CrossrefPubMedGoogle Scholar
  • 46 Theunissen EA, Timmermans AJ, Zuur CL. , et al. Total laryngectomy for a dysfunctional larynx after (chemo)radiotherapy. Arch Otolaryngol Head Neck Surg 2012; 138 (06) 548-555
    CrossrefPubMedGoogle Scholar
  • 47 Hutcheson KA, Alvarez CP, Barringer DA, Kupferman ME, Lapine PR, Lewin JS. Outcomes of elective total laryngectomy for laryngopharyngeal dysfunction in disease-free head and neck cancer survivors. Otolaryngol Head Neck Surg 2012; 146 (04) 585-590
    CrossrefPubMedGoogle Scholar
  • 48 Albergotti WG, Jordan J, Anthony K. , et al. A prospective evaluation of short-term dysphagia after transoral robotic surgery for squamous cell carcinoma of the oropharynx. Cancer 2017; 123 (16) 3132-3140
    CrossrefPubMedGoogle Scholar
  • 49 Logemann JA, Gibbons P, Rademaker AW. , et al. Mechanisms of recovery of swallow after supraglottic laryngectomy. J Speech Hear Res 1994; 37 (05) 965-974
    CrossrefPubMedGoogle Scholar
  • 50 Wasserman T, Murry T, Johnson JT, Myers EN. Management of swallowing in supraglottic and extended supraglottic laryngectomy patients. Head Neck 2001; 23 (12) 1043-1048
    CrossrefPubMedGoogle Scholar
  • 51 Ward EC, van As-Brooks CJ. Head and Neck Cancer: Treatment, Rehabilitation, and Outcomes. Plural Publishing; 2014
    Google Scholar
  • 52 Forastiere AA, Goepfert H, Maor M. , et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003; 349 (22) 2091-2098
    CrossrefPubMedGoogle Scholar
  • 53 Hanasoge S, Magliocca KR, Switchenko JM. , et al. Clinical outcomes in elderly patients with human papillomavirus-positive squamous cell carcinoma of the oropharynx treated with definitive chemoradiation therapy. Head Neck 2016; 38 (06) 846-851
    CrossrefPubMedGoogle Scholar
  • 54 O'Neill CB, Baxi SS, Atoria CL. , et al. Treatment-related toxicities in older adults with head and neck cancer: a population-based analysis. Cancer 2015; 121 (12) 2083-2089
    CrossrefPubMedGoogle Scholar
  • 55 Jackson LK, Ridner SH, Deng J. , et al. Internal lymphedema correlates with subjective and objective measures of dysphagia in head and neck cancer patients. J Palliat Med 2016; 19 (09) 949-956
    CrossrefPubMedGoogle Scholar
  • 56 Starmer HM, Yang W, Raval R. , et al. Effect of gabapentin on swallowing during and after chemoradiation for oropharyngeal squamous cell cancer. Dysphagia 2014; 29 (03) 396-402
    CrossrefPubMedGoogle Scholar
  • 57 Yang W, McNutt TR, Dudley SA. , et al. Predictive factors for prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement and use in head and neck patients following intensity-modulated radiation therapy (IMRT): treatment concordance, discrepancies, and the role of gabapentin. Dysphagia 2016; 31 (02) 206-213
    CrossrefPubMedGoogle Scholar
  • 58 Jensen SB, Pedersen AM, Vissink A. , et al; Salivary Gland Hypofunction/Xerostomia Section, Oral Care Study Group, Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO). A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer 2010; 18 (08) 1039-1060
    CrossrefPubMedGoogle Scholar
  • 59 Silander E, Jacobsson I, Bertéus-Forslund H, Hammerlid E. Energy intake and sources of nutritional support in patients with head and neck cancer--a randomised longitudinal study. Eur J Clin Nutr 2013; 67 (01) 47-52
    CrossrefPubMedGoogle Scholar
  • 60 Bossola M. Nutritional interventions in head and neck cancer patients undergoing chemoradiotherapy: a narrative review. Nutrients 2015; 7 (01) 265-276
    CrossrefPubMedGoogle Scholar
  • 61 Mekhail TM, Adelstein DJ, Rybicki LA, Larto MA, Saxton JP, Lavertu P. Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube?. Cancer 2001; 91 (09) 1785-1790
    CrossrefPubMedGoogle Scholar
  • 62 Oozeer NB, Corsar K, Glore RJ, Penney S, Patterson J, Paleri V. The impact of enteral feeding route on patient-reported long term swallowing outcome after chemoradiation for head and neck cancer. Oral Oncol 2011; 47 (10) 980-983
    CrossrefPubMedGoogle Scholar
  • 63 Langmore S, Krisciunas GP, Miloro KV, Evans SR, Cheng DM. Does PEG use cause dysphagia in head and neck cancer patients?. Dysphagia 2012; 27 (02) 251-259
    CrossrefPubMedGoogle Scholar
  • 64 Chen AM, Li BQ, Lau DH. , et al. Evaluating the role of prophylactic gastrostomy tube placement prior to definitive chemoradiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 2010; 78 (04) 1026-1032
    CrossrefPubMedGoogle Scholar
  • 65 Strom T, Trotti AM, Kish J. , et al. Risk factors for percutaneous endoscopic gastrostomy tube placement during chemoradiotherapy for oropharyngeal cancer. JAMA Otolaryngol Head Neck Surg 2013; 139 (11) 1242-1246
    CrossrefPubMedGoogle Scholar
  • 66 Corry J, Poon W, McPhee N. , et al. Prospective study of percutaneous endoscopic gastrostomy tubes versus nasogastric tubes for enteral feeding in patients with head and neck cancer undergoing (chemo)radiation. Head Neck 2009; 31 (07) 867-876
    CrossrefPubMedGoogle Scholar
  • 67 Ward MC, Bhateja P, Nwizu T. , et al. Impact of feeding tube choice on severe late dysphagia after definitive chemoradiotherapy for human papillomavirus-negative head and neck cancer. Head Neck 2016; 38 (Suppl. 01) E1054-E1060
    CrossrefPubMedGoogle Scholar
  • 68 Pohar S, Demarcantonio M, Whiting P, Crandley E, Wadsworth J, Karakla D. Percutaneous endoscopic gastrostomy tube dependence following chemoradiation in head and neck cancer patients. Laryngoscope 2015; 125 (06) 1366-1371
    CrossrefPubMedGoogle Scholar
  • 69 Kramer S, Newcomb M, Hessler J, Siddiqui F. Prophylactic versus reactive PEG tube placement in head and neck cancer. Otolaryngol Head Neck Surg 2014; 150 (03) 407-412
    CrossrefPubMedGoogle Scholar
  • 70 Christianen ME, Verdonck-de Leeuw IM, Doornaert P. , et al. Patterns of long-term swallowing dysfunction after definitive radiotherapy or chemoradiation. Radiother Oncol 2015; 117 (01) 139-144
    CrossrefPubMedGoogle Scholar
  • 71 Awan MJ, Mohamed AS, Lewin JS. , et al. Late radiation-associated dysphagia (late-RAD) with lower cranial neuropathy after oropharyngeal radiotherapy: a preliminary dosimetric comparison. Oral Oncol 2014; 50 (08) 746-752
    CrossrefPubMedGoogle Scholar
  • 72 Perry A, Lee SH, Cotton S, Kennedy C. Therapeutic exercises for affecting post-treatment swallowing in people treated for advanced-stage head and neck cancers. Cochrane Database Syst Rev 2016; 8 (08) CD011112
    PubMedGoogle Scholar
  • 73 Langmore SE, McCulloch TM, Krisciunas GP. , et al. Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: a randomized clinical trial. Head Neck 2016; 38 (Suppl. 01) E1221-E1231
    CrossrefPubMedGoogle Scholar
  • 74 Crary MA, Carnaby GD, LaGorio LA, Carvajal PJ. Functional and physiological outcomes from an exercise-based dysphagia therapy: a pilot investigation of the McNeill Dysphagia Therapy Program. Arch Phys Med Rehabil 2012; 93 (07) 1173-1178
    CrossrefPubMedGoogle Scholar
  • 75 Martin-Harris B, McFarland D, Hill EG. , et al. Respiratory-swallow training in patients with head and neck cancer. Arch Phys Med Rehabil 2015; 96 (05) 885-893
    CrossrefPubMedGoogle Scholar
  • 76 Lazarus C, Logemann JA, Gibbons P. Effects of maneuvers on swallowing function in a dysphagic oral cancer patient. Head Neck 1993; 15 (05) 419-424
    CrossrefPubMedGoogle Scholar
  • 77 Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA. Super-supraglottic swallow in irradiated head and neck cancer patients. Head Neck 1997; 19 (06) 535-540
    CrossrefPubMedGoogle Scholar
  • 78 Hutcheson KA, Barrow MP, Plowman EK. , et al. Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: a case series. Laryngoscope 2018; 128 (05) 1044-1051
    CrossrefPubMedGoogle Scholar
  • 79 Hutcheson KA, Kelly S, Barrow MP. , et al. Offering more for persistent dysphagia after head and neck cancer: the evolution of boot camp swallowing therapy. Presented at COSM Spring Meeting, Boston, MA; 2015
    PubMedGoogle Scholar
  • 80 Langmore SE, Terpenning MS, Schork A. , et al. Predictors of aspiration pneumonia: how important is dysphagia?. Dysphagia 1998; 13 (02) 69-81
    CrossrefPubMedGoogle Scholar
  • 81 Hutcheson KA, Nurgalieva Z, Zhao H. , et al. Two-year prevalence of dysphagia and related outcomes in head and neck cancer survivors: an updated SEER-Medicare analysis. Head Neck 2019; 41 (02) 479-487
    PubMedGoogle Scholar
  • 82 Best Sr SR, Ha PK, Blanco RG. , et al. Factors associated with pharyngoesophageal stricture in patients treated with concurrent chemotherapy and radiation therapy for oropharyngeal squamous cell carcinoma. Head Neck 2011; 33 (12) 1727-1734
    CrossrefPubMedGoogle Scholar
  • 83 Wang JJ, Goldsmith TA, Holman AS, Cianchetti M, Chan AW. Pharyngoesophageal stricture after treatment for head and neck cancer. Head Neck 2012; 34 (07) 967-973
    CrossrefPubMedGoogle Scholar
  • 84 Hutcheson KA, Barrow MP, Barringer DA. , et al. Dynamic Imaging Grade of Swallowing Toxicity (DIGEST): scale development and validation. Cancer 2017; 123 (01) 62-70
    CrossrefPubMedGoogle Scholar