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Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises

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Abstract

Concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer (HNC) is associated with substantial early and late side effects, most notably regarding swallowing function, but also regarding voice quality and quality of life (QoL). Despite increased awareness/knowledge on acute dysphagia in HNC survivors, long-term (i.e., beyond 5 years) prospectively collected data on objective and subjective treatment-induced functional outcomes (and their impact on QoL) still are scarce. The objective of this study was the assessment of long-term CCRT-induced results on swallowing function and voice quality in advanced HNC patients. The study was conducted as a randomized controlled trial on preventive swallowing rehabilitation (2006–2008) in a tertiary comprehensive HNC center with twenty-two disease-free and evaluable HNC patients as participants. Multidimensional assessment of functional sequels was performed with videofluoroscopy, mouth opening measurements, Functional Oral Intake Scale, acoustic voice parameters, and (study specific, SWAL-QoL, and VHI) questionnaires. Outcome measures at 6 years post-treatment were compared with results at baseline and at 2 years post-treatment. At a mean follow-up of 6.1 years most initial tumor-, and treatment-related problems remained similarly low to those observed after 2 years follow-up, except increased xerostomia (68 %) and increased (mild) pain (32 %). Acoustic voice analysis showed less voicedness, increased fundamental frequency, and more vocal effort for the tumors located below the hyoid bone (n = 12), without recovery to baseline values. Patients’ subjective vocal function (VHI score) was good. Functional swallowing and voice problems at 6 years post-treatment are minimal in this patient cohort, originating from preventive and continued post-treatment rehabilitation programs.

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Acknowledgments

Harm van Tinteren, certified statistician at the Netherlands Cancer Institute is greatly acknowledged for his support and advice in the statistical analysis. This study was made possible by grants provided by “Stichting de Hoop” and the Verwelius Foundation.

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Authors and Affiliations

  1. Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Sophie A. C. Kraaijenga, Lisette van der Molen, Irene Jacobi, Frans J. M. Hilgers & Michiel W. M. van den Brekel

  2. Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Olga Hamming-Vrieze

  3. Institute of Phonetic Sciences, University of Amsterdam, Spuistraat 210, 1012 VT, Amsterdam, The Netherlands

    Frans J. M. Hilgers & Michiel W. M. van den Brekel

  4. Department of Oral and Maxillofacial Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Michiel W. M. van den Brekel

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  1. Sophie A. C. Kraaijenga
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  2. Lisette van der Molen
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  3. Irene Jacobi
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  4. Olga Hamming-Vrieze
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  5. Frans J. M. Hilgers
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  6. Michiel W. M. van den Brekel
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Corresponding author

Correspondence to Michiel W. M. van den Brekel.

Additional information

This paper was selected for an ORAL PRESENTATION at the IFHNOS World Congress & AHNS Annual Meeting in New York City (July 2014).

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Kraaijenga, S.A.C., van der Molen, L., Jacobi, I. et al. Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises. Eur Arch Otorhinolaryngol 272, 3521–3531 (2015). https://doi.org/10.1007/s00405-014-3379-6

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