Although not seen as commonly as other aggressive forms, head and neck cancer is a devastating disease that has tremendous implications on the overall health of the patient. Dysphagia is a common consequence of treatment for head and neck cancer hnc. Treatments for head and neck cancer can affect the health of the teeth, gums, lining of the mouth and salivary glands. Exercise based therapy for the treatment of dysphagia.
This information describes swallowing problems that can be caused by radiation. A case with a longterm use of acupuncture during and post radiation therapy was presented, with discussions of evidence from clinical trials. Prevention and treatment of dysphagia and aspiration after. Now the vast majority of people with head and neck cancer complete treatment at msk without a feeding tube. One in 17 people will develop some form of dysphagia in their lifetime, including 50 to 75 percent of stroke patients and 60 to 70. Dysphagia management in head and neck cancers a manual and. History of pre cancer oral intake that was limited due to a swallowing problem. Thus, a large proportion of head and neck cancer patients will be treated primarily with radiationchemoradiation. Improvement of swallowing function and earlier restoration of eating. The epub format uses ebook readers, which have several ease of reading.
Swallowing function in patients with head and neck cancer. What you need to know about swallowing this information describes swallowing problems that can be caused by radiation therapy to the head and neck. Jul 15, 2014 with expanded coverage of current theory and clinical practice, head and neck cancer. Until recently, many people with head and neck cancer had feeding tubes put in place to help avoid the complications of radiation treatment. Examining dysphagia from the perspectives of head and neck cancer. While these treatment approaches are organ sparing, dysphagia remains a common issue after treatment leading to poorer quality of life, health status, and lifespan 69. All of the book s royalties will be donated to the head and neck cancer alliance. The management of dysphagia after treatment for cancers of the head and neck begins with an. Oropharyngeal dysphagia in head and neck cancer the oral. Please note that ancillary content such as documents, audio, and video, etc. Failure of cricopharyngeal myotomy to improve dysphagia. Cough, expiratory training, and chronic aspiration after head. Prophylacticdysphagia intervention for patients with head. Other studies also showed significant rates of pre treatment dysphagia and aspiration summarized in table 2.
Head and neck cancer treatment memorial sloan kettering. Background head and neck cancer treatment with highdose chemoradiation may cause xerostomia and affect the patients perception of swallowing ability. The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage of the cancer, and the persons age and general health. Dysphagia cafes mission is to be a quality, consistent, reliable and easily accessible resource community for every dysphagia clinician worldwide. Dysphagia and problems related to swallowing are common following treatment for head and neck cancers. Swallowing disorders after treatment for oral and oropharyngeal cancer. Speech and swallowing rehabilitation of the patient with head and. Neuromuscular electrical stimulation nmes is a highly sought after but poorly studied treatment for dysphagia among patients with head and neck cancer with dysphagia. Overall, this is an excellent book on an important topic in cancer that medical. A case series was examined to describe the pathophysiology and outcomes in dysphagic hnc survivors referred for modified barium swallow mbs studies. Head and neck cancer is a group of cancers that starts in the mouth, nose, throat, larynx, sinuses, or salivary glands. Prophylactic swallow therapy for patients with head and neck.
The treatment plan is how you will most impact the swallowing. Any current or previous neurological disease which may adversely affect swallowing. Head and neck cancers include cancers in the larynx voice box, throat, lips, mouth, nose, and salivary glands. Treatment, rehabilitation, and outcomes, second edition, continues to be an essential textbook and clinical reference for the head and neck cancer rehabilitation team. Changing trends in head and neck cancer hnc merit an understanding of the late effects of therapy, but few studies examine dysphagia beyond 2 years of treatment. The basics a large proportion of these cases are due to dysphagia arising from a variety of causes, primarily stroke, degenerative neurological diseases, and head and neck cancer. Dysphagia management in head and neck cancers springerlink. The group have been active in researching the late effects of head and neck cancer treatment on swallowing over the past 15 years and have obtained competitive funding through the nhmrc, australian and new zealand head and neck cancer society, st george sutherland medical research foundation and translational cancer research network.
Efficacy of electrical stimulation for dysphagia in head. There are a number of things you can do to help cope. Treatment, rehabilitation, and outcomes ebook written by elizabeth c. Jan 26, 2016 cough, expiratory training, and chronic aspiration after head and neck radiotherapy the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Slps serve an important role in pretreatment counseling to prepare these patients for the potential development of dysphagia during and post. The first part is called radiation associated dysphagia rad part 1. Safe, successful swallowing depends on complex events affected by head and neck cancers and their treatment. Management of swallowing in the treated head and neck cancer patient cathy l. Swallowing difficulties dysphagia, which affect 60 75% of patients treated for head and neck cancer hnc, arise both from the presence of a tumour, and as a consequence of its treatment. Treatments for hnc can have a major deleterious impact on functions such as swallowing and voice. The american cancer society reports there were approximately 52,610 new cases of head and neck cancers in 2012 in the united states. The stories in the book describe more than the events that took place since 2009. It describes the diverse group of malignant tumors that can occur in the head and neck region. Radiotherapy for cancer in the head or neck area can cause swelling and soreness in the throat.
Head and neck cancer affects twice as many men as women. It also provides theoretical and clinical knowledge for therapists managing head and neck cancer patients and describes key. The use of cricopharyngeal myotomy in patients with confirmed dysphagia who have undergone surgery for head and neck cancer may yield different results from those observed in this study. After hearing the words, you have head and neck cancer, it is not hard to believe that patients do not immediately think of the implications that treatment will likely have on their swallowing.
Head and neck cancer hnc has an annual incidence of 630,000 worldwide, with 40% of cases locally advanced 2, 3, 4. Dysphagia has been acknowledged as a potentially dose. Normal swallowing many muscles and nerves work together to help you swallow see figure 1. Sep 21, 2016 safe, successful swallowing depends on complex events affected by head and neck cancers and their treatment. In many head and neck cancer patients, dysphagia, malnutrition and aspiration pneumonia are found and significantly impact on quality of life. Future practice portal pages on head and neck cancer and on craniofacial anomalies will further discuss prosthetics and appliances. Oct 28, 2016 there is growing awareness of a small subset of head and neck cancer patients who develop progressive postradiation dysphagia rad years following treatment. She has authored or coauthored over 5 original articles, book chapters with a predominant emphasis on head and neck cancer treatment. This region includes the mouth, tongue, palate, gums, salivary glands, tonsils, throat pharynx, voice box larynx, nose and sinuses. The attending head and neck surgeons, medical and radiation.
Written by a team of internationally recognized experts from the medical and allied health communities, this book addresses core issues related to patient management, recovery, and outcomes following surgical and nonsurgical treatment of head and neck cancer. Other research activities include collaborating with dr. Rehabilitation of dysphagia following head and neck cancer. The prevalence of head and neck cancer hnc survivors is on the rise. However, it is unclear which interventions provide the greatest benefit. A lesser known evil, but almost just as common, is trismus. Malignancies involving structures of the head and neck frequently impact the most fundamental aspects of human existence, namely, those functions related to voice and speech production, eating, and swallowing. At least 75% of head and neck cancers are caused by tobacco and alcohol use. Acute toxicities such as mucositis and edema commonly disrupt normal swallowing during treatment, but improve. There are few studies evaluating pretreatment swallowing function in a large group of patients with head and neck cancer. Head and neck cancer is a general term for a range of cancers that start in the tissue or lymph nodes in the head and neck area.
Late dysphagia after radiotherapybased treatment of head and neck cancer. Head and neck cancer and its treatment frequently cause changes in both speech and swallowing, which affect the patients quality of life and ability to function in society. The role of myofascial release and manual therapy in dysphagia treatment. Head and neck cancer hnc and its therapy are associated with acute and late. Dysphagia evaluation and treatment after head and neck. Swallowing disorders after treatment for head and neck cancer.
However, intervention for this population varies in terms of timing, intensity, and types of treatments prescribed. Evaluation and management of oropharyngeal dysphagia in head and neck. This logically organized, evidencebased resource reflects the latest advancements in dysphagia in an approachable and userfriendly manner to help you master the clinical evaluation and diagnostic decisionmaking processes. Medbridge actually has a 2part course on head and neck cancer by kate hutcheson. This accounts for approximately 3 percent of all cancers in the u. People who are diagnosed with hpvpositive oropharyngeal cancer may be treated differently than people with oropharyngeal cancers that are hpvnegative. Effects of postural change on aspiration in head and neck surgical patients. Acupuncture as a novel therapy has been used in the management of symptoms associated with head and neck cancer treatment.
Course alerthead and neck cancer dysphagia ramblings. Dysphagia management in head and neck cancers a manual. History of oropharyngeal swallowing disorder prior to cancer. Additionally, paula has published numerous articles, book chapters, and coauthored books, including swallowing intervention in oncology and the easytoswallow, easytochew cookbook.
Manual therapy is the use of massage and stretching exercises to increase blood flow and muscle movement in the neck, throat, jaw, and mouth, which may help to improve swallowing ability and range of motion in participants who have had treatment for head and neck cancer. She is honorary member of european society for therapeutic radiology and oncology estro. In head and neck cancer patients, dysphagia may be caused by surgical ablation of muscular, septemberoctober 2002, vol. Specific recommendations are made to promote maintenance and recovery of swallowing function. This book employs a twopart approach to treating patients with head and neck cancer. The effect of adherence to swallowing exercises on swallowing outcomes in head and neck cancer patients treated with radiotherapy. Head and neck cancer rehabilitation adrian cristian md mhcm chief, cancer rehabilitation medicine miami cancer institute disclosures book royaltiesdemos medical publishers goal of presentation describe role of cancer rehabilitation in the care of the person with hnc describe common hnc related impairments and their treatment through. Thus, curative hnc treatments are often aggressive and require combined modalities such as radiation therapy rt with or without chemotherapy crt aimed at maximizing locoregional control and functional organ preservation. Ideally, people with head and neck cancer should see a dentist, working with their health care team, at least two weeks before starting any treatment.
Management of swallowing in the treated head and neck cancer. Dysphagia treatment for patients with head and neck cancer. Download for offline reading, highlight, bookmark or take notes while you read head and neck cancer. Dysphagia, swallowing, chemoradiation, prophylactic exercises, quality of life. Though there are books available on dysphagia management and associated neurological conditions, this is the only atlas that comprehensively discusses dysphagia related to the head and neck cancers. Listing a study does not mean it has been evaluated by the u. Manual therapy in treating fibrosisrelated late effect. Patients with head and neck cancer hnc suffer from difficulty in swallowing termed dysphagia due to the disease process itself and surgical and nonsurgical treatment of cancer 1. Speech and swallowing rehabilitation of the patient with. When you eat and drink, food and liquids mix with your saliva.
Difficulty swallowing radiotherapy cancer research uk. Poor functional outcomes are strongly correlated with distress, low quality of life, difficulties returning to work and socializing. Xerostomia, oral mucositis, surgical reconstruction, impaired wound healing, dysgeusia, irradiated tissue and dysphagia. Depending on the type of cancer, medical checkups could include exams of the stoma, if one has been created, and of the mouth, neck, and throat. Patients with head and neck cancer face multiple, often severe. Jeri logemann on numerous national cancer institute clinical swallowing protocols in head and neck cancer. Late effects of organ preservation treatment on swallowing.
This treatment option is most often used with patients following treatment for head and neck cancer. Intensitymodulated radiotherapy of head and neck cancer aiming to reduce dysphagia. Dysphagia assessment and its management are difficult and require a. Symptoms for head and neck cancer may include a lump or sore that does not heal, a sore throat that does not go away, trouble swallowing, or a change in the voice. Many patients with late rad will have accommodated to their dysphagia over the years, and due to good functional reserve, they may have limited complications as a result. Furthermore, dysphagia can have serious medical consequences such as malnutrition.
Patients undergoing radiation therapy with or without chemotherapy crt for head and neck cancer hnc often develop dysphagia. Regular followup care is very important after treatment for head and neck cancer to make sure that the cancer has not returned, or that a second primary new cancer has not developed. All patients treated for a head and neck cancer should have access to a dysphagia specialist and to an instrumental investigation in order to establish adequate treatment. Though there are books available on dysphagia management and associated neurological. You might have difficulty swallowing dysphagia during and after radiotherapy to your head or neck. Management of swallowing in the treated head and neck. Treatment for head and neck cancer can cause swallowing problems, called dysphagia disfayjuh. Head and neck cancer includes laryngeal cancer and oral cancer. Head and neck cancer course part 2 dysphagia ramblings. Prairie dogs is a humorous code name for cancer, given to him by one of his doctors. Head and neck cancer rehabilitation presentation 42818. The exact nature and severity of the post treatment changes depend on the location of the tumor, the choice of treatment, and the availability and use of speech and swallowing therapy during the first 3. Managing head and neck cancerinduced trismus dysphagia cafe.
Many muscles and nerves work together to help you swallow see figure 1. Conservative management vs riskguided decisionmaking. Prophylactic dysphagia intervention ii abstract many patients with head and neck cancer suffer from dysphagia caused by organ preserving regimens of chemoradiation therapy. Dysphagia management in head and neck cancers bookshare.
Clinical management in adults and children, 2nd edition. Treatment for head and neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of treatments. Swallowing and speech rehabilitation for head and neck cancer. Start here to find information on head and neck cancer treatment in adults and children, causes and prevention, screening, research, and statistics. May 04, 2015 this comprehensive online course will provide the participant an indepth examination of head and neck cancer, its presentation, functional sequelae, evaluation approaches, treatment options, and provide an evidencebased approach of optimal patterns of care for head and neck patients with swallowing dysfunction. Dysphagia is a major patient concern after cancer treatment due to the detrimental impact on patients quality of life qol. Clinical care and rehabilitation in head and neck cancer.
Jan 10, 2017 swallowing difficulties dysphagia, which affect 60 75% of patients treated for head and neck cancer hnc, arise both from the presence of a tumour, and as a consequence of its treatment. Dysphagia in head and neck cancer patients treated with. Interventions from speechlanguage pathologists aim to maintain or improve swallow physiology and function. Head and neck cancer is a general term used by doctors. Patients with head and neck cancer and more severe swallowing disorders may still benefit from cricopharyngeal myotomy. One problem that has garnered attention is dysphagia associated with radiationbased functionsparing techniques. These symptoms include pain, fatigue, dry mouth, dysphagia and neuropathy.
Abnormalities in voice production, and in some instances its complete loss, are common following treatment for laryngeal voice box cancer. Objective to define the sitespecific swallowing dysfunctions of patients with head and neck cancer with respect to tumor site and stage by videofluoroscopic oropharyngeal motility opm study prior to initiation of treatment design retrospective survey setting academic university institution patients a consecutive sample of 79 patients with stage iii or iv head and neck cancer. Radiation oncologists and medical oncologists treating hnc must be. Although not seen as commonly as other aggressive forms, head and neck cancer is a devastating disease that has tremendous implications on the overall health of the patient, as well as their appearance and quality of life. This study investigated the efficacy of nmes in this patient population. Dysphagia is a major patient concern after cancer treatment due to the detrimental impact on patients quality of life qol 3. The primary treatment goal of dysphagia in head and neck cancer patients is to maintain functional oral feeding and prevent aspiration and thoracic complications. Oct 25, 2018 dysphagia and problems related to swallowing are common following treatment for head and neck cancers. At msk, we pay careful attention to swallowing therapy and symptom management. Efficacy of electrical stimulation and exercise for dysphagia.