Because head and neck cancer treatment can destroy tissues associated with swallowing, swallowing exercises are an integral part of post-cancer rehabilitation. But what about prophylactic exercises before treatment? Could these help prevent disuse atrophy and delay muscle fibrosis?
A recent study* has sought to compile existing evidence for the efficacy of prophylactic swallowing interventions in reducing aspiration and maintaining oral intake in patients with head and neck cancer with dysphagia.
This took the form of an electronic database search (PubMed, Embase, Cochrane and MEDLINE), for studies published up to June 2021. Thirteen studies were selected. Four categories involving 12 different swallowing interventions were classified. Regarding the descriptive analysis of the rehabilitation effects across all studies, in terms of oropharyngeal safety, five studies showed that swallowing interventions reduced the risk of aspiration, penetration or residue. In terms of oral intake and tube feeding dependence, four studies demonstrated reduced time to return to oral intake in the intervention group compared with the control group. In terms of intervention adherence, three studies showed that speech-language pathologist and nurse-supervised training was a potential promoter of adherence, and five studies showed that the negative factors affecting adherence included pain, fatigue, forgetting, smoking, decreased exercise motivation, side effects of radiotherapy and distance to the rehabilitation site.
Preventive swallowing interventions may be effective at reducing aspiration, improving swallowing function and restoring oral intake, in other words. However, due to lack of standardization and consistency of interventions and measurement results, which have inhibited the production of a best-practice guide, more methodological trials will be needed to determine the most effective interventions for maximizing prophylactic exercise adherence over the long term.
* Yang W, Nie W, Zhou X, Guo W, Mou J, Yong J, Wu T, Liu X. Review of prophylactic swallowing interventions for head and neck cancer. Int J Nurs Stud. 2021 Nov;123:104074. doi: 10.1016/j.ijnurstu.2021.104074
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