This study prospectively evaluated relationships between oral morbidities and swallowing ability in head/neck cancer patients following chemoradiation therapy (CRT) and at 3 months following CRT. Thirty patients with confirmed head/neck cancer undergoing chemoradiation were assessed with a battery of swallowing measures and measures of oral morbidities related to chemoradiation (xerostomia, mucositis, pain, taste/smell, oral moisture). All measures were completed at baseline (within the first week of CRT), at 6 weeks (end of treatment), and at 3 months following chemoradiation. Descriptive and univariate statistics were used to depict change over time in swallowing and each oral morbidity. Correlation analyses evaluated relationships between swallowing function and oral morbidities at each time point. Most measures demonstrated significant negative change at 6 weeks with incomplete recovery at 3 months. At 6 weeks, mucositis ratings, xerostomia, and retronasal smell intensity demonstrated significant inverse relationships with swallowing function. In addition, oral moisture levels demonstrated significant positive relationships with swallowing function. At 3 months, mucositis ratings maintained a significant, inverse relationship with swallow function. Taste and both orthonasal and retronasal smell intensity ratings demonstrated inverse relationships with measures of swallow function. Swallow functions and oral morbidities deteriorate significantly following CRT with incomplete recovery at 3 months post treatment. Furthermore, different patterns of relationships between swallow function measures and oral morbidities were obtained at the 6-week versus the 3-month assessment point suggesting that different mechanisms may contribute to the development versus the maintenance of dysphagia over the trajectory of treatment in these patients.
Dysphagia Head and neck cancer Oral morbidities Chemoradiation therapy
This is a preview of subscription content, log in to check access.
This study was funded by a grant to Professor Crary from the Florida Department of Health—Bankhead-Coley Cancer Research Program (BB203). Dr. Yoshiaki Ihara’s participation on this project was supported by a Showa University Research Grant for Young Researchers.
Compliance with Ethical Standards
Conflicts of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the local institutional review board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants including in the study.
Lazarus CL, Logemann JA, Pauloski BR, et al. Swallowing disorders in head and neck cancer patients treated with radiotherapy and adjuvant chemotherapy. Laryngoscope. 1996;106(9):1157–66.CrossRefGoogle Scholar
Salas S, Baumstarck-Barrau K, Alfonsi M, et al. Impact of the prophylactic gastrostomy for unresectable squamous cell head and neck carcinomas treated with radio-chemotherapy on quality of life: prospective randomized trial. Radiother Oncol. 2009;93(3):503–9.CrossRefGoogle Scholar
Young D, Xiao CC, Murphy B, et al. Increase in head and neck cancer in younger patients due to human papillomavirus (HPV). Oral Oncol. 2015;51(8):727–30.CrossRefGoogle Scholar
American Cancer Society. Cancer fact & figure 2016. Atlanta: American Cancer Society; 2016. p. 1–10.Google Scholar
Ganzer H, Rothpletz-Puglia P, Byham-Gray L, Murphy BA, Touger-Decker R. The eating experience in long-term survivors of head and neck cancer: a mixed-methods study. Support Care Cancer. 2015;23(11):3257–68.CrossRefGoogle Scholar
Glastonbury CM, Parker EE, Hoang JK. The postradiation neck: evaluating response to treatment and recognizing complications. AJR Am J Roentgenol. 2010;195(2):W164–71.CrossRefGoogle Scholar
Carnaby GD, Crary MA. Development and validation of a cancer-specific swallowing assessment tool: MASA-C. Support Care Cancer. 2014;22(3):595–602.CrossRefGoogle Scholar
Hutcheson Katherine A, Lewin Jan S, et al. Late dysphagia after radiotherapy-based treatment of head and neck cancer. Cancer. 2012;118(23):5793–9.CrossRefGoogle Scholar
Van den Berg MG, Rütten H, Rasmussen-Conrad EL, et al. Nutritional status, food intake, and dysphagia in long-term survivors with head and neck cancer treated with chemoradiotherapy: a cross-sectional study. Head Neck. 2014;36(1):60–5.CrossRefGoogle Scholar
Rütten H, Pop LA, Janssens GO, et al. Long-term outcome and morbidity after treatment with accelerated radiotherapy and weekly cisplatin for locally advanced head-and-neck cancer: results of a multidisciplinary late morbidity clinic. Int J Radiat Oncol Biol Phys. 2011;81(4):923–9.CrossRefGoogle Scholar
Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86(8):1516–20.CrossRefGoogle Scholar
Crary MA, Carnaby GD, Sia I. Spontaneous swallow frequency compared with clinical screening in the identification of dysphagia in acute stroke. J Stroke Cerebrovasc Dis. 2014;23(8):2047–53.CrossRefGoogle Scholar
Takahashi K, Groher ME, Michi K. Methodology for detecting swallowing sounds. Dysphagia. 1994;9:54–62.PubMedGoogle Scholar
Bartoshuk LM, Duffy VB, Fasta K, et al. Labeled scales (e.g., category, Likert, VAS) and invalid across-group comparisons: what we have learned from genetic variation in taste. Food Qual Prefer. 2002;14(2):125–38.CrossRefGoogle Scholar
World Health Organization. WHO Handbook for reporting results of cancer treatment. Geneva: World Health Organization; 1979. p. 15–22.Google Scholar
Henson BS, Inglehart MR, Eisbruch A, Ship JA. Preserved salivary output and xerostomia-related quality of life in head and neck cancer patients receiving parotid-sparing radiotherapy. Oral Oncol. 2001;37(1):84–93.CrossRefGoogle Scholar
Eliasson L, Birkhed D, Strömberg N. Studies on human minor salivary gland secretions using the Periotron method. Arch Oral Biol. 1996;41(12):1179–82.CrossRefGoogle Scholar
Bartoshuk L. Clinical evaluation of the sense of taste. Ear Nose Throat J. 1989;68(4):331–7.PubMedGoogle Scholar
Gunness P, Kravchuk O, Nottingham SM, et al. Sensory analysis of individual strawberry fruit and comparison with instrumental analysis. Postharv Biol Technol. 2009;52(2):164–72.CrossRefGoogle Scholar
Russell A, Stevenson RJ, Rich AN. Chocolate smells pink and stripy: exploring olfactory-visual synesthesia. Cogn Neurosci. 2015;6(2–3):77–88.CrossRefGoogle Scholar
Kendall K, McKenzie M, Leonard R, Jones C. Structural mobility in deglutition after single modality treatment of head and neck carcinomas with radiotherapy. Head Neck. 1998;20:720–5.CrossRefGoogle Scholar
Álvarez-Camachoa M, Gonellab S, Campbellc S, et al. A systematic review of smell alterations after radiotherapy for head and neck cancer. Cancer Treat Rev. 2017;54:110–21.CrossRefGoogle Scholar
Landis Basile Nicolas, Frasnelli Johannes, Reden Jens, et al. Differences between orthonasal and retronasal olfactory functions in patients with loss of the sense of smell. Arch Otolaryngol Head Neck Surg. 2005;131(11):977–81.CrossRefGoogle Scholar
Hong JH, Omur-Ozbek P, Stanek BT, et al. Taste and odor abnormalities in cancer patients. J Support Oncol. 2009;7(2):58–65.PubMedGoogle Scholar
Isitt J, Murphy BA, Beaumont JL, et al. Oral mucositis (OM) related morbidity and resource utilization is a prospective study of head and neck cancer (HNC) patients. Proc Am Soc Clin Oncol. 2006;24:289.Google Scholar
Rosenthal DI, Eisbruch A. Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol. 2006;24:2636–43.CrossRefGoogle Scholar
Pauloski BR, Rademaker AW, Logemann JA, Lundy D, Bernstein M, McBreen C. Relation of mucous membrane alterations to oral intake during the first year after treatment for head and neck cancer. Head Neck. 2011;33(6):774–9.CrossRefGoogle Scholar
Rudney JD, Ji Z, Larson CJ. The prediction of saliva swallowing frequency in humans from estimates of salivary flow rate and the volume of saliva swallowed. Arch Oral Biol. 1995;40:507–12.CrossRefGoogle Scholar
Crary MA, Sura L, Carnaby GD. Validation and demonstration of an isolated acoustic recording technique to estimate spontaneous swallow frequency. Dysphagia. 2013;28(1):86–94.CrossRefGoogle Scholar
Crary MA, Carnaby GD, Sia I, et al. Spontaneous swallowing frequency has potential to identify dysphagia in acute stroke. Stroke. 2013;44:3452–7.CrossRefGoogle Scholar
Teguh DN, Levendag PC, Noever I, et al. Treatment techniques and site considerations regarding dysphagia-related quality of life in cancer of the oropharynx and nasopharynx. Int J Radiat Oncol Biol Phys. 2008;15:1119–27.CrossRefGoogle Scholar
Abetz LM, Savage NW. Burning mouth syndrome and psychological disorders. Aust Dent J. 2009;54:84–93.CrossRefGoogle Scholar
Epstein Joel B, Barasch Andrei. Taste disorders in cancer patients: pathogenesis, and approach to assessment and management. Oral Oncol. 2010;46:77–81.CrossRefGoogle Scholar
Rademaker Alfred W, Vonesh Edward F, Logemann Jeri A, et al. Eating ability in head and neck cancer patients after treatment with chemoradiation: a 12-months follow-up study accounting for dropout. Head Neck. 2003;25(12):1034–41.CrossRefGoogle Scholar
Shinn EH, Basen-Engquist K, Baum G, et al. Adherence to preventive exercises and self-reported swallowing outcomes in post-radiation head and neck cancer patients. Head Neck. 2013;35(12):1707–12.CrossRefGoogle Scholar