Compliance, Pain Experience, and Outcomes from Dysphagia Exercises in Individuals with Oropharyngeal Cancer with Latent Dysphagia

Abstract

Background: Several studies in the past ten years support the use of dysphagia exercises before and during RT as a means of reducing swallowing difficulty in people with head and neck cancer (HNC) prompting widespread change in the standard of clinical care that now emphasizes such intervention. However, latent dysphagia (i.e., dysphagia that occurs three months or more after completion of oncologic treatment) is still common. Three studies have focused on exercises to treat latent dysphagia, each with mixed results but sharing two common problems: poor compliance and heterogeneous participant groups. The purpose of this study was to address both of these issues while describing the outcomes and individual experience of completing a four-week exercise program targeted at improving latent dysphagia. Methods: Twelve individuals who received radiation therapy (RT) for base of tongue (BOT) tumors and who were experiencing latent dysphagia completed an exercise protocol, consisting of four oral and swallowing exercises completed five times per day, seven days per week, for four weeks. Lingual strength, lingual endurance, swallowing related quality of life (QOL) via the MD Anderson Dysphagia Inventory (MDADI), oral pain, and sense of effort pre- and post-exercise completion were analyzed. Compliance to the exercise protocol was also described and quantified. Results: Participants completed 78.9% of prescribed exercise sessions, on average, with moderate-strong compliance reported by 75% of participants. Lingual strength and lingual endurance were not statistically significantly different from pre- to post-exercise completion, but lingual endurance did have a medium effect size. A statistically significant change and a large effect size were demonstrated between pre- and post- MDADI emotional subscale scores. Three of the remaining MDADI scores (composite, global subscale, physical subscale) did not have a statistically significant change but the composite score had a large effect size and the global and physical scores had medium effect sizes. The functional subscale of the MDADI did not have statistically significant change and had a small effect size. Participants reported essentially no pain or change in sense of effort associated with completing the exercises at any of the data collection intervals before, during or after the exercise protocol. Conclusions: Four weeks of oral and swallowing exercises by adults with BOT cancer who had latent dysphagia after RT did not significantly improve tongue strength or endurance but did improve dysphagia related QOL in the emotional domain. Medium to large effect sizes despite non-statistically significant differences for three of the other dysphagia QOL scores and lingual endurance suggest that further investigation of the exercise regimen is prudent.