AN EVALUATION OF SWALLOWING FUNCTION AFTER CANCER TREATMENT IN HEAD AND NECK CANCER PATIENTS

Year 2020, Volume: 31 Issue: 2, 196 - 201, 28.08.2020

Ömer Faruk Yaşaroğlu , Selen Serel Arslan , Hasan Erkan Kılınç , Numan Demir , Aynur Ayşe Karaduman

https://doi.org/10.21653/tjpr.538316

Abstract

Purpose: Evaluation of swallowing and feeding types are essential in patients with head and neck cancer (HNC). This study aimed to evaluate the swallowing function of patients treated for HNC. Methods: One hundred fifty-seven patients with HNC who were referred for swallowing disorder were included. Descriptive information including age, gender, weight, height, diagnosis, and feeding type was recorded. Videofluoroscopic swallowing study (VFSS) was performed to assess swallowing function. Penetration and aspiration severity was determined using the Penetration and Aspiration Scale (PAS). Results: The mean age was 54.16±12.90 years, of which 66.9% was male. The 23.6% of patients were treated for oropharyngeal cancer, 17.2% for nasopharyngeal cancer, and 59.2% for hypopharyngeal cancer. The 26.75% of patients underwent surgery, and 25.5% received chemoradiotherapy, and 45.9% underwent surgery combined with chemoradiotherapy. The mean PAS score for liquid was 4.96±2.93, and the mean PAS score for pudding was 3.76±3.05 according to the VFSS. While only liquid aspiration was 70.1%, aspiration in liquid and pudding was 37.2%. A significant difference was found between referral and recommended feeding types (p=0.003). No difference was detected in terms of PAS score for liquids, PAS score for pudding, and recommended feeding type according to received treatment types (p>0.05). Conclusion: More than half of the patients had airway aspiration, and their referral feeding type was not appropriate. Therefore, swallowing function should be evaluated in patients with HNC, and appropriate feeding type should be determined in an early period.

Keywords

Chemotherapy, Dysphagia, Head and Neck Cancer

BAŞ VE BOYUN KANSERLİ HASTALARDA KANSER TEDAVİSİ SONRASI YUTMA FONKSİYONUNUN DEĞERLENDİRİLMESİ

Abstract

Amaç: Baş ve boyun kanserlerinde yutmanın ve beslenme şeklinin belirlenmesi önemlidir. Bu çalışmanın amacı, baş ve boyun kanseri (BBK) tedavisi almış hastaların yutma fonksiyonlarının değerlendirilmesi idi. Yöntem: Çalışmaya yutma bozukluğu şikâyeti ile başvuran 157 BBK'lı hasta dahil edildi. Hastaların yaş, cinsiyet, boy, vücut ağırlığı, tanı ve beslenme şekli gibi tanımlayıcı bilgileri kaydedildi. Yutma fonksiyonunun değerlendirilmesi için videofloroskopik yutma çalışması (VFYÇ) yapıldı. Penetrasyon ve aspirasyon şiddetini belirlemede Penetrasyon ve Aspirasyon Skalası (PAS) kullanıldı. Sonuçlar: Yaş ortalaması 54,16±12,90 yıl olan hastaların % 66,9'u erkekti. Hastaların % 23,6'sı orofarengeal kanser, % 17,2'si nazofarengeal kanser ve % 59,2'si hipofarengeal bölge kanseri için tedavi edilmişti. Hastaların % 26,7'si cerrahi tedavi, % 25,5'i kemoradyoterapi ve % 45,9'u cerrahi ve kemoradyoterapi tedavisini birlikte almıştı. Hastaların VFYÇ'ye göre ortalama PAS sıvı skoru 4,96±2,93 ve kıvamlı skoru 3,76±3,05 idi. Sadece sıvı aspirasyonu % 70,1 iken, kıvamlı gıdalarda aspirasyon % 37,2 idi. Başvuru beslenme şekli ile önerilen beslenme şekli arasında istatistiksel olarak anlamlı fark bulundu (p=0,003). Uygulanan tedavi tipine göre sıvı PAS skoru, kıvamlı PAS skoru ve önerilen beslenme şekli açısından anlamlı fark bulunamadı (p>0,05). Tartışma: BBK'lı hastaların yarısından fazlasında havayolu aspirasyonu olduğu ve mevcut beslenme şekillerinin uygun olmadığı tespit edildi. Bu nedenle, BBK'lı hastalarda yutma fonksiyonu değerlendirilmeli ve erken dönemde doğru beslenme şekli belirlenmelidir.

Keywords

Kemoterapi, Disfaji, Baş ve Boyun Kanserleri

References

• 1. Malagelada, J.R., Bazzoli, F., Boeckxstaens, G., De Looze, D., Fried, M., Kahrilas, P., et al., World gastroenterology organisation global guidelines: dysphagia—global guidelines and cascades update September 2014. Journal of clinical gastroenterology, 2015. 49(5): p. 370-378.
• 2. Manikantan, K., Khode, S., Sayed, S. I., Roe, J., Nutting C. M., Rhys-Evans, P., et al., Dysphagia in head and neck cancer. Cancer treatment reviews, 2009. 35(8): p. 724-732.
• 3. Rosenthal, D.I., J.S. Lewin, and A. Eisbruch, Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. Journal of clinical oncology, 2006. 24(17): p. 2636-2643.
• 4. Xu, B., Boero, I. J, Hwang, L., Le, Q. T, Moiseenko, V., Sanghvi, P. R., et al., Aspiration pneumonia after concurrent chemoradiotherapy for head and neck cancer. Cancer, 2015. 121(8): p. 1303-1311.
• 5. Langendijk, J. A., Doornaert, P., Verdonck-de Leeuw, I. M., Leemans, C. R., Aaronson, N. K., & Slotman, B. J. et al., Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. Journal of clinical oncology, 2008. 26(22): p. 3770-3776.
• 6. Brookes, G.B., Nutritional status-a prognostic indicator in head and neck cancer. Otolaryngology—Head and Neck Surgery, 1985. 93(1): p. 69-74.
• 7. Chen, A. M., Li, B. Q., Lau, D. H., Farwell, D. G., Luu, Q., Stuart, K., et al., Evaluating the role of prophylactic gastrostomy tube placement prior to definitive chemoradiotherapy for head and neck cancer. International Journal of Radiation Oncology• Biology• Physics, 2010. 78(4): p. 1026-1032.
• 8. Mekhail, T. M., Adelstein, D. J., Rybicki, L. A., Larto, M. A., Saxton, J. P., & Lavertu, P. Enteral nutrition during the treatment of head and neck carcinoma. Cancer, 2001. 91(9): p. 1785-1790.
• 9. Rosenbek, J. C., Robbins, J. A., Roecker, E. B., Coyle, J. L., & Wood, J. L. A penetration-aspiration scale. Dysphagia, 1996. 11(2): p. 93-98.
• 10. Graner, D. E., Foote, R. L., Kasperbauer, J. L., Stoeckel, R. E., Okuno, S. H., Olsen, K. D., et al., Swallow Function in Patients Before and After Intra‐Arterial Chemoradiation. The Laryngoscope, 2003. 113(3): p. 573-579.
• 11. Newman, L. A., Thomas Robbins, K., Logemann, J. A., Rademaker, A. W., Lazarus, C. L., Hamner, A. et al., Swallowing and speech ability after treatment for head and neck cancer with targeted intraarterial versus intravenous chemoradiation. Head & neck, 2002. 24(1): p. 68-77.
• 12. Nguyen, N. P., Frank, C., Moltz, C. C., Vos, P., Smith, H. J., Bhamidipati, P. V., et al., Aspiration rate following chemoradiation for head and neck cancer: an underreported occurrence. Radiotherapy and oncology, 2006. 80(3): p. 302-306.
• 13. Aviv, J.E., Prospective, randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia. The Laryngoscope, 2000. 110(4): p. 563-574.
• 14. Logemann JA. Evaluation and treatment of swallowing disorders Austin/Texas: Pro-ed; 1998.
• 15. Karkos, P.D., Papouliakos, S., Karkos, C.D.,Theochari, E.G. Current evaluation of the dysphagic patient. Hippokratia, 2009. 13 (3), 141-146.
• 16. Pauloski, B.R. Rehabilitation of dysphagia following head and neck cancer. Physical Medicine and Rehabilitation Clinics of North America, 2008. 19 (4), 889-928.