Exercises Ease Cancer-Related Swallowing Woes Short Term

Swallowing exercises during radiation and chemotherapy for head and neck cancer help preserve function early on, a small clinical trial showed.

Among 26 patients with head and neck cancer, functional scores turned out better at 3 and 6 months after the prophylactic intervention than after usual care (P=0.03 and P=0.009), Tamar Kotz, MS, CCC-SLP, of Mount Sinai Medical Center in New York City, and colleagues found.

But both groups improved to a similar degree over the longer-term at 9 and 12 months, the researchers reported in the April issue of Archives of Otolaryngology - Head & Neck Surgery.

Still, the short-term benefit is likely to be meaningful for patients, Kotz noted in an interview with MedPage Today.

"It means the difference between, for some, having to be fed through feeding tubes in their stomach rather than being able to eat by mouth," she explained. For others, it meant being able to "just tolerate sipping small amounts of water or [being able to] go to a restaurant and order something off the menu and eat it."

The small trial wasn't powered to show a difference in clinical endpoints like tube feeding.

But scores on the Eating in Public and Normalcy of Diet portions of a head and neck cancer performance status scale came out significantly better at 3 and 6 months post radiation with the prophylactic exercises (all P<0.05).

Many centers have already started using the exercises for their patients because it intuitively makes sense, Kotz noted.

With the promising trial data, "we are hoping that patients will be referred to a speech pathologist at the time of diagnosis so that these exercises can begin as early as possible rather than waiting for the swallowing dysfunction from treatment becoming so severe," she told MedPage Today.

The study used a combination of five exercises:

Effortful swallow, squeezing hard with all muscles
Super supraglotic swallow, holding breath tightly and bearing down as swallowing, then cough to finish
Tongue-hold maneuver, gently holding tongue in between front teeth while swallowing saliva
Tongue retraction, pulling the back of the tongue to the back of the mouth and holding it there
Mendelsohn maneuver, swallowing saliva while paying attention to the neck and trying not to let Adam's apple drop for several seconds

Patients randomized to the intervention at the tertiary care academic medical center were to perform 10 repetitions of each exercise three times a day, varying the order.

However, the exercise regimen was rigorous, and 69% of patients assigned to that arm of the study had stopped doing them by week five of radiation.