The Effect of Prophylactic Swallowing Exercises on Head and Neck Cancer Patients

NCT01349309 | Completed

• 1 other identifier: GCO # 07-0462
• Study Type: interventional
• Target: 26
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to find out if doing prophylactic or preventative swallowing exercises from the start of cancer treatment can improve the ability to swallow when the treatment is completed and beyond.

Conditions

Dysphagia

Keywords

Prophylactic Swallowing Exercises; Head and Neck Cancer; Dysphagia

Outcome Measures

Primary Outcomes (12)

• Performance Status Scale for Head and Neck Cancer Patients and Functional Oral Intake Scale (PSS-H&N).

  This is a quick, clinician rated instrument consisting of three subscales: normalcy of diet, public eating and intelligibility of speech. This scale has been proven reliable across raters and sensitive to functional differences across a broad spectrum of head and neck cancer patients. The Performance Status Scale for Head and Neck Cancer Patients (PSS-H\&N) questionnaire will be completed at the start of the cancer treatment, at the completion of the treatment and at 3, 6, 12 and 24 months after treatment.

  This will be completed at the start of the cancer treatment. Participants will be followed for up to 24 months after treatment.

• Performance Status Scale for Head and Neck Cancer Patients and Functional Oral Intake Scale (PSS-H&N).

  This is a quick, clinician rated instrument consisting of three subscales: normalcy of diet, public eating and intelligibility of speech. This scale has been proven reliable across raters and sensitive to functional differences across a broad spectrum of head and neck cancer patients. The Performance Status Scale for Head and Neck Cancer Patients (PSS-H\&N) questionnaire will be completed at the start of the cancer treatment, at the completion of the treatment and at 3, 6, 12 and 24 months after treatment.

  This will be completed at the completion of treatment. Participants will be followed for up to 24 months after treatment.

• Performance Status Scale for Head and Neck Cancer Patients and Functional Oral Intake Scale (PSS-H&N).

  This is a quick, clinician rated instrument consisting of three subscales: normalcy of diet, public eating and intelligibility of speech. This scale has been proven reliable across raters and sensitive to functional differences across a broad spectrum of head and neck cancer patients. The Performance Status Scale for Head and Neck Cancer Patients (PSS-H\&N) questionnaire will be completed at the start of the cancer treatment, at the completion of the treatment and at 3, 6, 12 and 24 months after treatment.

  This will be completed at 3 months post treatment. Participants will be followed for up to 24 months after treatment.

• Performance Status Scale for Head and Neck Cancer Patients and Functional Oral Intake Scale (PSS-H&N).

  This is a quick, clinician rated instrument consisting of three subscales: normalcy of diet, public eating and intelligibility of speech. This scale has been proven reliable across raters and sensitive to functional differences across a broad spectrum of head and neck cancer patients. The Performance Status Scale for Head and Neck Cancer Patients (PSS-H\&N) questionnaire will be completed at the start of the cancer treatment, at the completion of the treatment and at 3, 6, 12 and 24 months after treatment.

  This will be completed at 6 months post treatment. Participants will be followed for up to 24 months after treatment.

• Performance Status Scale for Head and Neck Cancer Patients and Functional Oral Intake Scale (PSS-H&N).

  This is a quick, clinician rated instrument consisting of three subscales: normalcy of diet, public eating and intelligibility of speech. This scale has been proven reliable across raters and sensitive to functional differences across a broad spectrum of head and neck cancer patients. The Performance Status Scale for Head and Neck Cancer Patients (PSS-H\&N) questionnaire will be completed at the start of the cancer treatment, at the completion of the treatment and at 3, 6, 12 and 24 months after treatment.

  This will be completed at 12 months post treatment. Participants will be followed for up to 24 months after treatment.

• Performance Status Scale for Head and Neck Cancer Patients and Functional Oral Intake Scale (PSS-H&N).

  This is a quick, clinician rated instrument consisting of three subscales: normalcy of diet, public eating and intelligibility of speech. This scale has been proven reliable across raters and sensitive to functional differences across a broad spectrum of head and neck cancer patients. The Performance Status Scale for Head and Neck Cancer Patients (PSS-H\&N) questionnaire will be completed at the start of the cancer treatment, at the completion of the treatment and at 3, 6, 12 and 24 months after treatment.

  This will be completed at 24 months post treatment. Participants will be followed for up to 24 months after treatment.

• Functional Oral Intake Scale (FOIS)

  A seven point scale of diet tolerance.

  This will be completed at the start of the cancer treatment. Participants will be followed for up to 24 months after treatment.

• Functional Oral Intake Scale (FOIS)

  A seven point scale of diet tolerance.

  This will be completed at the completion of treatment. Participants will be followed for up to 24 months after treatment.

• Functional Oral Intake Scale (FOIS)

  A seven point scale of diet tolerance.

  This will be completed at 3 post treatment. Participants will be followed for up to 24 months after treatment.

• Functional Oral Intake Scale (FOIS)

  A seven point scale of diet tolerance.

  This will be completed at 6 months post treatment. Participants will be followed for up to 24 months after treatment.

• Functional Oral Intake Scale (FOIS)

  A seven point scale of diet tolerance.

  This will be completed at 12 months post treatment. Participants will be followed for up to 24 months after treatment.

• Functional Oral Intake Scale (FOIS)

  A seven point scale of diet tolerance.

  This will be completed at 24 months post treatment. Participants will be followed for up to 24 months after treatment.

Study Arms (2)

Swallowing Exercise Group

EXPERIMENTAL

Swallowing Exercise Group: This arm will undergo the protocol that involves intensive swallowing exercises to begin at the start of the cancer treatment. Those patients randomized to the intensive therapy protocol will be required to participate in weekly swallowing therapy sessions either in person or over the phone and perform the learned swallowing exercises three times a day. In addition, these patients will document their swallowing practice on a daily basis.

Behavioral: Swallowing Exercise Group

Control

NO INTERVENTION

Control Arm: This arm will receive the standard of care which provides swallowing evaluation and treatment once symptoms of swallowing dysfunction are experienced by the patient.

Interventions

Swallowing Exercise Group BEHAVIORAL

Swallowing Exercises Perform each exercise 10 times. Do these 3 times a day. Vary the order of the exercises. Effortful Swallow: As you swallow squeeze hard with all your muscles. (Can do with water or without) Super Supraglottic Swallow: Inhale and hold your breath very tightly, bearing down. Keep holding your breath and bearing down as you swallow. Cough when you are finished. (Can do with water or without) Tongue Hold Maneuver: Gently hold your tongue in between your front teeth and swallow your saliva. Tongue Retraction: Pull the back of your tongue to the back of your mouth and hold. Mendelsohn Maneuver: Swallow your saliva and pay attention to your neck as you swallow. Try to feel that something (your Adam's apple of voice box) lifts and lowers as you swallow. Now, when you swallow and you feel something lift as you swallow don't let it drop. Hold it with your muscles for several seconds.

Also known as: Prophylactic Swallowing Exercises

Swallowing Exercise Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patient diagnosed with head and neck cancer who will be receiving radiation therapy either alone of with chemotherapy as their treatment modality.

You may not qualify if:

• Patients with a history of neurologic disease
• Patients with previous head and neck cancer or surgical or radiation treatment to the head and neck region
• Patients taking medication that might effect their swallowing function
• Patients with gastroenterologic dysfunction
• Patients who have previously undergone swallowing therapy
• Patients with cognitive impairments that limit their ability to follow and comply with multi-step commands

Sponsors & Collaborators

• Icahn School of Medicine at Mount Sinai: lead

Study Sites (1)

Icahn School of Medicine at Mount Sinai

New York, New York, 10029, United States

Location

Related Publications (27)

• Lee NY, de Arruda FF, Puri DR, Wolden SL, Narayana A, Mechalakos J, Venkatraman ES, Kraus D, Shaha A, Shah JP, Pfister DG, Zelefsky MJ. A comparison of intensity-modulated radiation therapy and concomitant boost radiotherapy in the setting of concurrent chemotherapy for locally advanced oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2006 Nov 15;66(4):966-74. doi: 10.1016/j.ijrobp.2006.06.040.

  PMID: 17145527 BACKGROUND

• El-Sayed S, Nelson N. Adjuvant and adjunctive chemotherapy in the management of squamous cell carcinoma of the head and neck region. A meta-analysis of prospective and randomized trials. J Clin Oncol. 1996 Mar;14(3):838-47. doi: 10.1200/JCO.1996.14.3.838.

  PMID: 8622032 BACKGROUND

• Pignon JP, Bourhis J, Domenge C, Designe L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet. 2000 Mar 18;355(9208):949-55.

  PMID: 10768432 BACKGROUND

• Mendenhall WM, Amdur RJ, Stringer SP, Villaret DB, Cassisi NJ. Radiation therapy for squamous cell carcinoma of the tonsillar region: a preferred alternative to surgery? J Clin Oncol. 2000 Jun;18(11):2219-25. doi: 10.1200/JCO.2000.18.11.2219.

  PMID: 10829041 BACKGROUND

• Kramer S, Gelber RD, Snow JB, Marcial VA, Lowry LD, Davis LW, Chandler R. Combined radiation therapy and surgery in the management of advanced head and neck cancer: final report of study 73-03 of the Radiation Therapy Oncology Group. Head Neck Surg. 1987 Sep-Oct;10(1):19-30. doi: 10.1002/hed.2890100105.

  PMID: 3449477 BACKGROUND

• Robbins KT. Barriers to winning the battle with head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2002 May 1;53(1):4-5. doi: 10.1016/s0360-3016(02)02713-x. No abstract available.

  PMID: 12007934 BACKGROUND

• Calais G, Alfonsi M, Bardet E, Sire C, Germain T, Bergerot P, Rhein B, Tortochaux J, Oudinot P, Bertrand P. Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stage oropharynx carcinoma. J Natl Cancer Inst. 1999 Dec 15;91(24):2081-6. doi: 10.1093/jnci/91.24.2081.

  PMID: 10601378 BACKGROUND

• Brizel DM, Albers ME, Fisher SR, Scher RL, Richtsmeier WJ, Hars V, George SL, Huang AT, Prosnitz LR. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med. 1998 Jun 18;338(25):1798-804. doi: 10.1056/NEJM199806183382503.

  PMID: 9632446 BACKGROUND

• Vokes EE, Stenson K, Rosen FR, Kies MS, Rademaker AW, Witt ME, Brockstein BE, List MA, Fung BB, Portugal L, Mittal BB, Pelzer H, Weichselbaum RR, Haraf DJ. Weekly carboplatin and paclitaxel followed by concomitant paclitaxel, fluorouracil, and hydroxyurea chemoradiotherapy: curative and organ-preserving therapy for advanced head and neck cancer. J Clin Oncol. 2003 Jan 15;21(2):320-6. doi: 10.1200/JCO.2003.06.006.

  PMID: 12525525 BACKGROUND

• Newman LA, Vieira F, Schwiezer V, Samant S, Murry T, Woodson G, Kumar P, Robbins KT. Eating and weight changes following chemoradiation therapy for advanced head and neck cancer. Arch Otolaryngol Head Neck Surg. 1998 May;124(5):589-92. doi: 10.1001/archotol.124.5.589.

  PMID: 9604988 BACKGROUND

• Adelstein DJ, Saxton JP, Lavertu P, Rybicki LA, Esclamado RM, Wood BG, Strome M, Carroll MA. Maximizing local control and organ preservation in stage IV squamous cell head and neck cancer With hyperfractionated radiation and concurrent chemotherapy. J Clin Oncol. 2002 Mar 1;20(5):1405-10. doi: 10.1200/JCO.2002.20.5.1405.

  PMID: 11870186 BACKGROUND

• Smith RV, Kotz T, Beitler JJ, Wadler S. Long-term swallowing problems after organ preservation therapy with concomitant radiation therapy and intravenous hydroxyurea: initial results. Arch Otolaryngol Head Neck Surg. 2000 Mar;126(3):384-9. doi: 10.1001/archotol.126.3.384.

  PMID: 10722013 BACKGROUND

• Hutcheson KA, Barringer DA, Rosenthal DI, May AH, Roberts DB, Lewin JS. Swallowing outcomes after radiotherapy for laryngeal carcinoma. Arch Otolaryngol Head Neck Surg. 2008 Feb;134(2):178-83. doi: 10.1001/archoto.2007.33.

  PMID: 18283161 BACKGROUND

• Bleier BS, Levine MS, Mick R, Rubesin SE, Sack SZ, McKinney K, Mirza N. Dysphagia after chemoradiation: analysis by modified barium swallow. Ann Otol Rhinol Laryngol. 2007 Nov;116(11):837-41. doi: 10.1177/000348940711601108.

  PMID: 18074669 BACKGROUND

• Murry T, Madasu R, Martin A, Robbins KT. Acute and chronic changes in swallowing and quality of life following intraarterial chemoradiation for organ preservation in patients with advanced head and neck cancer. Head Neck. 1998 Jan;20(1):31-7. doi: 10.1002/(sici)1097-0347(199801)20:13.0.co;2-4.

  PMID: 9464950 BACKGROUND

• Pauloski BR, Logemann JA. Impact of tongue base and posterior pharyngeal wall biomechanics on pharyngeal clearance in irradiated postsurgical oral and oropharyngeal cancer patients. Head Neck. 2000 Mar;22(2):120-31. doi: 10.1002/(sici)1097-0347(200003)22:23.0.co;2-u.

  PMID: 10679899 BACKGROUND

• Kotz T, Costello R, Li Y, Posner MR. Swallowing dysfunction after chemoradiation for advanced squamous cell carcinoma of the head and neck. Head Neck. 2004 Apr;26(4):365-72. doi: 10.1002/hed.10385.

  PMID: 15054740 BACKGROUND

• Eisbruch A, Lyden T, Bradford CR, Dawson LA, Haxer MJ, Miller AE, Teknos TN, Chepeha DB, Hogikyan ND, Terrell JE, Wolf GT. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2002 May 1;53(1):23-8. doi: 10.1016/s0360-3016(02)02712-8.

  PMID: 12007937 BACKGROUND

• Lazarus CL, Logemann JA, Pauloski BR, Colangelo LA, Kahrilas PJ, Mittal BB, Pierce M. Swallowing disorders in head and neck cancer patients treated with radiotherapy and adjuvant chemotherapy. Laryngoscope. 1996 Sep;106(9 Pt 1):1157-66. doi: 10.1097/00005537-199609000-00021.

  PMID: 8822723 BACKGROUND

• Lazarus CL, Logemann JA, Pauloski BR, Rademaker AW, Larson CR, Mittal BB, Pierce M. Swallowing and tongue function following treatment for oral and oropharyngeal cancer. J Speech Lang Hear Res. 2000 Aug;43(4):1011-23. doi: 10.1044/jslhr.4304.1011.

  PMID: 11386468 BACKGROUND

• Kotz T, Abraham S, Beitler JJ, Wadler S, Smith RV. Pharyngeal transport dysfunction consequent to an organ-sparing protocol. Arch Otolaryngol Head Neck Surg. 1999 Apr;125(4):410-3. doi: 10.1001/archotol.125.4.410.

  PMID: 10208678 BACKGROUND

• Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA. Super-supraglottic swallow in irradiated head and neck cancer patients. Head Neck. 1997 Sep;19(6):535-40. doi: 10.1002/(sici)1097-0347(199709)19:63.0.co;2-4.

  PMID: 9278762 BACKGROUND

• Lazarus C, Logemann JA, Song CW, Rademaker AW, Kahrilas PJ. Effects of voluntary maneuvers on tongue base function for swallowing. Folia Phoniatr Logop. 2002 Jul-Aug;54(4):171-6. doi: 10.1159/000063192.

  PMID: 12169803 BACKGROUND

• Lazarus C, Logemann JA, Gibbons P. Effects of maneuvers on swallowing function in a dysphagic oral cancer patient. Head Neck. 1993 Sep-Oct;15(5):419-24. doi: 10.1002/hed.2880150509.

  PMID: 8407314 BACKGROUND

• Kulbersh BD, Rosenthal EL, McGrew BM, Duncan RD, McColloch NL, Carroll WR, Magnuson JS. Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. Laryngoscope. 2006 Jun;116(6):883-6. doi: 10.1097/01.mlg.0000217278.96901.fc.

  PMID: 16735913 BACKGROUND

• Carroll WR, Locher JL, Canon CL, Bohannon IA, McColloch NL, Magnuson JS. Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope. 2008 Jan;118(1):39-43. doi: 10.1097/MLG.0b013e31815659b0.

  PMID: 17989581 BACKGROUND

• Kotz T, Federman AD, Kao J, Milman L, Packer S, Lopez-Prieto C, Forsythe K, Genden EM. Prophylactic swallowing exercises in patients with head and neck cancer undergoing chemoradiation: a randomized trial. Arch Otolaryngol Head Neck Surg. 2012 Apr;138(4):376-82. doi: 10.1001/archoto.2012.187.

  PMID: 22508621 RESULT

MeSH Terms

Conditions

Deglutition Disorders; Head and Neck Neoplasms

Condition Hierarchy (Ancestors)

Esophageal Diseases; Gastrointestinal Diseases; Digestive System Diseases; Pharyngeal Diseases; Otorhinolaryngologic Diseases; Neoplasms by Site; Neoplasms

Study Officials

• Tamar Kotz, MS, CCC, SLP

  Icahn School of Medicine at Mount Sinai

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 28, 2011
• First Posted: May 6, 2011
• Study Start: June 1, 2007
• Primary Completion: January 1, 2011
• Study Completion: January 1, 2011
• Last Updated: December 4, 2015

Record last verified: 2015-12

Locations

US (1)