Manual Therapy in Treating Fibrosis-Related Late Effect Dysphagia in Head and Neck Cancer Survivors

PRIMARY OBJECTIVES:

I. To determine the feasibility and safety of manual therapy for treatment of
fibrosis-related dysphagia in head and neck cancer survivors.

SECONDARY OBJECTIVES:

I. To examine preliminary efficacy, dose-response (number of treatment sessions to normalized
cervical range of motion), and durability of manual therapy for improving cervical range of
motion in head and neck cancer survivors with fibrosis-related late dysphagia.

II. To examine functional outcomes after manual therapy in head and neck cancer survivors
with fibrosis-related late effects and their association with change in dysphagia grade,
cervical extension, and other cofactors.

OUTLINE:

Participants receive 10 manual therapy sessions performed by a speech pathologist during
weeks 1-6. After completion of 6 weeks of therapy, participants perform manual therapy at
home daily for 6 weeks.

Inclusion Criteria:

- Late Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) grade >= 2 dysphagia on
Modified Barium Swallow (MBS) >= 2 years after curative-intent radiotherapy for head
and neck cancer

- Grade >= 2 Common Terminology Criteria for Adverse Events (CTCAE) fibrosis

- Willing and able to return for 10 sessions over 6 weeks of therapy

Exclusion Criteria:

- Active recurrent or second primary head and neck, central nervous system, or thoracic
cancer at time of enrollment

- Active osteoradionecrosis or other non-healing wounds (e.g., fistula, ulcer, soft
tissue necrosis) at time of enrollment

- History of subtotal or total glossectomy or total laryngectomy

- Functionally limiting cardiac, pulmonary, or neuromuscular disease

- Current tracheostomy