Effects of Swallowing Exercises on Patients Undergoing Radiation Treatment for Head and Neck Cancer

PRIMARY OBJECTIVE:

I. To assess the difference between early and late onset swallowing exercises on swallowing
quality of life in patients undergoing chemo/radiation therapy for head and neck cancer.

SECONDARY OBJECTIVE:

I. To assess the difference between early and late onset swallowing exercises on swallowing
function in patients undergoing radiation therapy for head and neck cancer.

TERTIARY OBJECTIVE:

I. To assess the difference between early and late onset swallowing exercises on: individual
domains of swallowing quality of life; Penetration Aspiration Scale (PAS) as assessed via
FEES; diet level (Dysphagia Outcome and Severity Scale (DOSS) as assessed via FEES; feeding
tube duration (days); Eating Assessment Tool (EAT); lingual strength as assessed via lingual
manometry; and percent weight loss and percent weight recovery.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

Arm I (Early exercise group): Patients perform swallowing exercises comprising lingual press,
head lift, breath hold, Masako swallow, high pitch e, effortful swallow, and neck stretch and
massage for 2 weeks prior to beginning radiotherapy and again immediately after completion of
radiotherapy.

Arm II (Late exercise group): Patients begin performing swallowing exercises as in arm I 1
month after completion of radiotherapy.

In both arms, swallowing exercises are performed twice daily, 6 days a week, for 12 months
following completion of radiotherapy.

Inclusion

- Written informed consent must be obtained from all participants prior to beginning
therapy (participants should have the ability to understand be willing to sign a
written informed consent document)

- Individuals with oropharyngeal, hypopharyngeal, or laryngeal cancer of Stages I-IV
undergoing radiation and chemo therapies at Wake Forest Baptist Medical Center

- Participants will have surgically received no more than selective neck dissection and
tumor biopsy (participants who have undergone primary tumor resection or radical neck
dissection will not be eligible)

- Participants must have completed a minimum of third grade education in order to answer
questions of the quality of life survey

- Participants must be willing to participate in the swallowing exercise program

Exclusion

- Medical history of cerebrovascular accident, Parkinson's disease, any type of
dementia, myasthenia gravis, or amyotrophic lateral sclerosis

- Previous radiation treatment for head/neck cancer

- Swallowing problem of etiology other than current lesion

- Pregnant women are not anticipated in the patient population, but would be excluded
from participation in the study