Molly K Barnhart1,2, Rachelle A Robinson3, Virginia A Simms3, Elizabeth C Ward4,5, Bena Cartmill5,6, Sophie J Chandler3, Robert I Smee7,8. 1. Speech Pathology Department, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, Sydney, NSW, 2031, Australia. Molly.Barnhart@health.nsw.gov.au. 2. School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia. Molly.Barnhart@health.nsw.gov.au. 3. Speech Pathology Department, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, Sydney, NSW, 2031, Australia. 4. School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia. 5. Centre for Functioning and Health Research, Queensland Health, Buranda, Brisbane, QLD, 4102, Australia. 6. Speech Pathology, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia. 7. Comprehensive Cancer Centre, POWH, Sydney, NSW, 2031, Australia. 8. The Clinical Teaching School, University New South Wales, Kensington, NSW, Australia.
Abstract
PURPOSE: Patients who receive (chemo)radiotherapy [(C)RT] for head and neck cancer (HNC) experience multiple treatment effects. However, the presence and recovery of treatment toxicities and how these impact on oral intake over time post-treatment are not fully understood. The primary aim of this study was to examine patient perceptions of the toxicities present and which are barriers to oral intake, up to 3 years post (C)RT. The secondary aim was to identify mealtime strategies used to optimise oral intake. METHODS: A prospective cohort of 96 patients after completion of (C)RT for HNC reported the presence of toxicities, if they were barriers to oral intake, and use of any mealtime strategies at the end of treatment (EoT), and at 3, 6, 12, 24, and 36 months post-treatment. RESULTS: All toxicities and reported barriers changed over time (p < 0.05) except trismus. Odynophagia, reduced appetite, and fatigue improved (p < 0.05) by 3 months. Significantly less patients reported xerostomia and dysgeusia as barriers to oral intake at 3 months despite no improvement in their presence. No change in the presence of any toxicity or its impact on oral intake occurred from 12 to 36 months, with exception of dentition problems which significantly increased at 36 months. Alternating food/fluids was the most frequently used mealtime swallowing strategy at all time points beyond the EoT. CONCLUSIONS: The dysphagia and associated toxicities HNC patients experience are chronic in nature. Rehabilitation should include mealtime strategies and support with adjusting to the changing presence and impact of toxicities on oral intake.
PURPOSE:Patients who receive (chemo)radiotherapy [(C)RT] for head and neck cancer (HNC) experience multiple treatment effects. However, the presence and recovery of treatment toxicities and how these impact on oral intake over time post-treatment are not fully understood. The primary aim of this study was to examine patient perceptions of the toxicities present and which are barriers to oral intake, up to 3 years post (C)RT. The secondary aim was to identify mealtime strategies used to optimise oral intake. METHODS: A prospective cohort of 96 patients after completion of (C)RT for HNC reported the presence of toxicities, if they were barriers to oral intake, and use of any mealtime strategies at the end of treatment (EoT), and at 3, 6, 12, 24, and 36 months post-treatment. RESULTS: All toxicities and reported barriers changed over time (p < 0.05) except trismus. Odynophagia, reduced appetite, and fatigue improved (p < 0.05) by 3 months. Significantly less patients reported xerostomia and dysgeusia as barriers to oral intake at 3 months despite no improvement in their presence. No change in the presence of any toxicity or its impact on oral intake occurred from 12 to 36 months, with exception of dentition problems which significantly increased at 36 months. Alternating food/fluids was the most frequently used mealtime swallowing strategy at all time points beyond the EoT. CONCLUSIONS: The dysphagia and associated toxicities HNCpatients experience are chronic in nature. Rehabilitation should include mealtime strategies and support with adjusting to the changing presence and impact of toxicities on oral intake.
Entities:
Keywords:
Barriers; Dysphagia; Head and neck cancer; Oral intake; Toxicities
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