Respiratory-Swallow Training in Veterans With Oropharyngeal Cancer
| Status: | Completed |
|---|---|
| Conditions: | Cancer, Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 21 - Any |
| Updated: | 5/27/2013 |
| Start Date: | June 2011 |
| End Date: | September 2013 |
| Contact: | Julie A Blair, BS MA |
| Email: | julie.blair@va.gov |
| Phone: | (843) 876-7200 |
Cancers of the head and neck require surgical, radiation, and chemotherapy treatments that
are intended to cure the disease. These treatments have toxic effects on muscles and
structures that are necessary to swallow safely and efficiently. The resulting swallowing
problems (dysphagia) often remain chronic for Veterans and interfere with their ability to
eat and drink. The cost burden to the VA health system is high. There is an urgent need to
develop rehabilitative treatments that lessen these burdens. The proposed research is
designed to test a novel swallowing therapy that includes the coordination of breathing with
swallowing. Our study will train medically and surgically treated, chronically dysphagic
Veterans with histories of oropharyngeal cancer in a novel therapy that involves both
swallowing and respiratory systems. If the therapy is found to be effective, the long term
goal of the project is to extend the study to a multi-site, clinical trial and test the
longstanding effect of this treatment compared to other swallowing therapies on swallowing
function, QOL and cost.
Swallowing impairments (dysphagia) represent the highest functional morbidity in veteran
patients treated for oropharyngeal cancers with either surgical approaches followed by
radiation or with more recent organ-preservation protocols. The nature of the impairments is
often resistive to treatment and results in life-long health consequences and high cost
burden on the VA health system. Recent preliminary data have linked alterations in the
otherwise highly stable respiratory-swallowing phase pattern relationships to the swallowing
impairment and penetration/aspiration and in this patient group. The immediate goal of this
clinical trial is to test the effect of a novel respiratory-swallow intervention on
swallowing impairment and penetration/aspiration in a cohort of chronically dysphagic
veterans following treatment for oropharyngeal cancer. Patients presenting with a
"non-optimal" respiratory-swallow phase pattern during liquid swallows and measurable
swallowing impairment will learn an "optimal" physiologic pattern that facilitates both
airway protective and mechanical advantages during swallowing. The broad goal of this
research is to develop ideal respiratory-swallowing phase training methods and regimens that
alone or combined with traditional swallowing treatments improve swallowing function in the
acute phases of recovery and improve long term patient outcome. Our intention is to use
these preliminary data to motivate a larger clinical trial to compare the effect of
respiratory-swallow phase training with other evidenced based methods of swallowing
treatment and expand the approach to other patient groups that have indications of
respiratory-swallow phase impairments (e.g. pulmonary disease and stroke) contributing to
impaired swallowing function
Inclusion Criteria:
- at least 21 years of age
- agreed to participate in this study and signed an informed consent, either completed
by the participant or designated other
- have chronic impairments in oropharyngeal swallowing function following chemotherapy,
radiation, and/or surgical intervention for the treatment of first time diagnosis of
squamous cell carcinoma of the head and neck
- have completed medical treatments for his/her cancer and any traditional swallowing
therapy at least 6 months earlier
- pass a cognitive screening (COGNISTAT)
- have at least one area of impairment (initiation of pharyngeal swallow, anterior
hyolaryngeal excursion, extent and duration of PES opening, tongue base retraction,
pharyngeal residue) as indicated by the results of the pre-intervention MBSImP (total
sum MBSImP
- have PAS scores >/= 3 on 10% of swallows on pre-intervention MBSS
- have a non-optimal (E-I, I-E, or I-I) breathing pattern on 60% of trial swallows.
Exclusion Criteria:
- known allergy or dietary restriction for food or contrast materials used during the
exam
- evidence of persistent or recurrent disease on physical examination of the head and
neck
- evidence of esophageal stricture noted on MBS
- recurrent oropharyngeal cancer and/or are being treated for other cancer(s)
concurrently
- severe COPD (see Pulmonary Criteria below)
- nasogastric feeding tube
- recent change in swallowing status characterized by increase in perceived or observed
-swallowing problems by patient, family or testing SLP
- any co-occurring neurological impairment affecting muscle strength and/or cognition
- history of aspiration pneumonia over the past 12 months.
- fail cognitive screening
- absence of swallowing impairment
- evidence of esophageal stricture on MBS
- inability to tolerate at least one of the liquid barium consistencies
- consistent optimal respiratory-swallow phase patterning
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