Supportive Care in Cancer

, Volume 27, Issue 10, pp 3681–3700 | Cite as

Deglutition disorders as a consequence of head and neck cancer therapies: a systematic review and meta-analysis

  • Isabela Porto de ToledoEmail author
  • Leticia Lopes Quirino Pantoja
  • Karen Fontes Luchesi
  • Daniele Xavier Assad
  • Graziela De Luca Canto
  • Eliete Neves Silva Guerra
Review Article



In this study, we aimed to estimate the frequency of deglutition disorders in patients pre- and post-treatment for head and neck cancer (HNC).


Search strategies were developed for the following databases: LILACS, PubMed, SpeechBITE, LIVIVO, Web of Science, and Scopus. Additionally, the gray literature was searched using Google Scholar, OpenGrey, and ProQuest. Only studies that conducted an evaluation of deglutition before and after cancer treatment and had sufficient quantitative data were included. We conducted a proportion of random effects meta-analysis using R statistical software.


Seventeen studies were included. Aspiration showed a high frequency in the period less than 3 months post-treatment, with 28.6% (total sample = 229). Penetration of fluids above the vocal folds and reduced laryngeal elevation were more frequent in the period less than 6 months post-treatment.


The frequency of deglutition disorders and its complications, such as aspiration, appears to be higher in the immediate to 6-month post-treatment period in patients with HNC. The parameter pharyngeal residue continued to increase through the period analyzed.


Deglutition disorders Head and neck cancer Chemotherapy Radiation therapy 



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Isabela Porto de Toledo is supported by CNPq (Brazilian National Council for Scientific and Technological Development). Letícia Lopes Quirino Pantoja was supported by CAPES (Coordination for the Improvement of Higher Education Personnel), Ministry of Education, Brazil.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

520_2019_4920_MOESM1_ESM.docx (22 kb)
ESM 1 (DOCX 21 kb)
520_2019_4920_MOESM2_ESM.docx (191 kb)
ESM 2 (DOCX 191 kb)
520_2019_4920_MOESM3_ESM.docx (46 kb)
ESM 3 (DOCX 45 kb)
520_2019_4920_MOESM4_ESM.docx (21 kb)
ESM 4 (DOCX 20 kb)


  1. 1.
    Kraaijenga SAC, van der Molen L, Van Den Brekel MWM, Hilgers FJM (2014) Current assessment and treatment strategies of dysphagia in head and neck cancer patients: a systematic review of the 2012/13 literature. Curr Opin Support Palliat Care 8:152–163CrossRefGoogle Scholar
  2. 2.
    Huang SH, O'Sullivan B (2013) Oral cancer: current role of radiotherapy and chemotherapy. Med Oral Patol Oral Cir Bucal 18:233–240CrossRefGoogle Scholar
  3. 3.
    Cohen EE, LaMonte SJ, Erb NL, Beckman KL, Sadeghi N, Hutcheson KA, Stubblefield MD, Abbott DM, Fisher PS, Stein KD, Lyman GH, Pratt-Chapman ML (2016) American Cancer Society Head and Neck Cancer Survivorship Care Guideline. CA Cancer J Clin 66:203–239CrossRefGoogle Scholar
  4. 4.
    Murphy BA, Gilbert J (2009) Dysphagia in head and neck cancer patients treated with radiation: assessment, sequelae, and rehabilitation. Semin Radiat Oncol 19:35–42CrossRefGoogle Scholar
  5. 5.
    Kraaijenga SA, Oskam IM, Van Son RJ et al (2016) Assessment of voice, speech, and related quality of life in advanced head and neck cancer patients 10-years+ after chemoradiotherapy. Oral Oncol 55:24–30CrossRefGoogle Scholar
  6. 6.
    Lazarus CL (2009) Effects of chemoradiotherapy on voice and swallowing. Curr Opin Otolaryngol Head Neck Surg 17:172–178CrossRefGoogle Scholar
  7. 7.
    Park SS, Choi SH, Hong JA, Hong YH, Jeong NG, Lee SY, Sung MW, Hah JH (2016) Validity and reliability of the Korean version of the Speech Handicap Index in patients with oral cavity cancer. Int J Oral Maxillofac Surg 45:433–439CrossRefGoogle Scholar
  8. 8.
    García-Peris P, Parón L, Velasco C, de la Cuerda C, Camblor M, Bretón I, Herencia H, Verdaguer J, Navarro C, Clave P (2007) Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: impact on quality of life. Clin Nutr 26:710–717CrossRefGoogle Scholar
  9. 9.
    Shune SE, Karnell LH, Karnell MP, Van Daele DJ, Funk GF (2012) Association between severity of dysphagia and survival in patients with head and neck cancer. Head Neck 34:776–784CrossRefGoogle Scholar
  10. 10.
    Frowen JJ, Perry AR (2006) Swallowing outcomes after radiotherapy for head and neck cancer: a systematic review. Head Neck 28:932–944CrossRefGoogle Scholar
  11. 11.
    Wall LR, Ward EC, Cartmill B, Hill AJ (2013) Physiological changes to the swallowing mechanism following (chemo)radiotherapy for head and neck cancer: a systematic review. Dysphagia 28:481–493CrossRefGoogle Scholar
  12. 12.
    Erkal EY, Canoğlu D, Kaya A et al (2014) Assessment of early and late dysphagia using videofluoroscopy and quality of life questionnaires in patients with head and neck cancer treated with radiation therapy. Radiat Oncol 9:137CrossRefGoogle Scholar
  13. 13.
    Patterson JM, McColl E, Carding PN, Hildreth AJ, Kelly C, Wilson JA (2014) Swallowing in the first year after chemoradiotherapy for head and neck cancer: clinician- and patient-reported outcomes. Head Neck 36:352–358CrossRefGoogle Scholar
  14. 14.
    Rogus-Pulia NM, Pierce MC, Mittal BB, Zecker SG, Logemann JA (2014) Changes in swallowing physiology and patient perception of swallowing function following chemoradiation for head and neck cancer. Dysphagia 29:223–233CrossRefGoogle Scholar
  15. 15.
    Serel S, Demir N, Karaduman AA, Cengiz M, Yakut Y (2013) Head and neck cancer: changes in artrokinematic parameters of neck and swallowing function after radiotherapy. UHOD 27:97–103Google Scholar
  16. 16.
    Son YR, Choi KH, Kim TG (2015) Dysphagia in tongue cancer patients. Ann Rehabil Med 39:210–217CrossRefGoogle Scholar
  17. 17.
    Van der Molen L, Heemsbergen WD, de Jong R et al (2013) Dysphagia and trismus after concomitant chemo-intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose-effect relationships for swallowing and mastication structures. Radiother Oncol 106:364–369CrossRefGoogle Scholar
  18. 18.
    Moher D, Liberati A, Tetzlaff J et al (2009) Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. Ann Intern Med 151:264–269CrossRefGoogle Scholar
  19. 19.
    Porto de Toledo I, Pantoja LLQ, Luchesi K, Assad DX, De Luca Canto G, Guerra ENS (2017) Deglutition disorders as a consequence of cancer therapies: a systematic review and meta-analysis. PROSPERO CRD42017067837. Available from: Accessed 17 November 2017
  20. 20.
    Greenhalgh T, Peacock R (2005) Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources. BMJ 331:1064–1065CrossRefGoogle Scholar
  21. 21.
    Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A (2016) Rayyan—a web and mobile app for systematic reviews. Syst Rev 5:210CrossRefGoogle Scholar
  22. 22.
    Joanna Briggs Institute (2014) Joanna Briggs institute reviewers’ manual: 2014 edition. The systematic review of prevalence and incidence data. The University of Adelaide: The Joanna Briggs Institute p 37Google Scholar
  23. 23.
    Deeks JJ, Bossuyt PM, Gatsonis C, eds (2009) Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 1.0. The Cochrane CollaborationGoogle Scholar
  24. 24.
    Higgins JPT, Green S (eds) (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Available from:
  25. 25.
    Agarwal J, Palwe V, Dutta D, Gupta T, Laskar SG, Budrukkar A, Murthy V, Chaturvedi P, Pai P, Chaukar D, D’Cruz AK, Kulkarni S, Kulkarni A, Baccher G, Shrivastava SK (2011) Objective assessment of swallowing function after definitive concurrent (chemo)radiotherapy in patients with head and neck cancer. Dysphagia 26:399–406CrossRefGoogle Scholar
  26. 26.
    Cartmill B, Cornwell P, Ward E, Davidson W, Porceddu S (2012) A prospective investigation of swallowing, nutrition, and patient-rated functional impact following altered fractionation radiotherapy with concomitant boost for oropharyngeal cancer. Dysphagia 27:32–45CrossRefGoogle Scholar
  27. 27.
    Eisbruch A, Lyden T, Bradford CR, Dawson LA, Haxer MJ, Miller AE, Teknos TN, Chepeha DB, Hogikyan ND, Terrell JE, Wolf GT (2002) Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 53:23–28CrossRefGoogle Scholar
  28. 28.
    Graner DE, Foote RL, Kasperbauer JL, Stoeckel RE, Okuno SH, Olsen KD, Sabri AN, Maragos NE, Cha SS, Sargent DJ, Strome SE (2003) Swallow function in patients before and after intra-arterial chemoradiation. Laryngoscope 113:573–579CrossRefGoogle Scholar
  29. 29.
    Kotz T, Costello R, Li Y, Posner MR (2004) Swallowing dysfunction after chemoradiation for advanced squamous cell carcinoma of the head and neck. Head Neck 26:365–372CrossRefGoogle Scholar
  30. 30.
    Ku PK, Yuen EH, Cheung DM, Chan BY, Ahuja A, Leung SF, Tong MC, van Hasselt A (2007) Early swallowing problems in a cohort of patients with nasopharyngeal carcinoma: symptomatology and videofluoroscopic findings. Laryngoscope 117:142–146CrossRefGoogle Scholar
  31. 31.
    Lazarus CL, Logemann JA, Pauloski BR, Rademaker AW, Larson CR, Mittal BB, Pierce M (2000) Swallowing and tongue function following treatment for oral and oropharyngeal cancer. J Speech Lang Hear Res 43:1011–1023CrossRefGoogle Scholar
  32. 32.
    Logemann JA, Rademaker AW, Pauloski BR, Lazarus CL, Mittal BB, Brockstein B, MacCracken E, Haraf DJ, Vokes EE, Newman LA, Liu D (2006) Site of disease and treatment protocol as correlates of swallowing function in patients with head and neck cancer treated with chemoradiation. Head Neck 28:64–73CrossRefGoogle Scholar
  33. 33.
    Logemann JA, Pauloski BR, Rademaker AW et al (2008) Swallowing disorders in the first year after radiation and chemoradiation. Head Neck 30:148–158CrossRefGoogle Scholar
  34. 34.
    O'Connell DA, Rieger J, Harris JR et al (2008) Swallowing function in patients with base of tongue cancers treated with primary surgery and reconstructed with a modified radial forearm free flap. Arch Otolaryngol Head Neck Surg 134:857–864CrossRefGoogle Scholar
  35. 35.
    Xinou E, Chryssogonidis I, Kalogera-Fountzila A, Panagiotopoulou-Mpoukla D, Printza A (2018) Longitudinal evaluation of swallowing with videofluoroscopy in patients with locally advanced head and neck cancer after chemoradiation. [published ahead of print March 23, 2018]. Dysphagia.
  36. 36.
    Kronenberger MB, Meyers AD (1994) Dysphagia following head and neck cancer surgery. Dysphagia 9:236–244CrossRefGoogle Scholar
  37. 37.
    Haidich AB (2010) Meta-analysis in medical research. Hippokratia 14:29–37Google Scholar
  38. 38.
    Rinkel RN, Verdonck-de Leeuw IM, Doornaert P, Buter J, de Bree R, Langendijk JA, Aaronson NK, Leemans CR (2016) Prevalence of swallowing and speech problems in daily life after chemoradiation for head and neck cancer based on cut-off scores of the patient-reported outcome measures SWAL-QOL and SHI. Eur Arch Otorhinolaryngol 273:1849–1855CrossRefGoogle Scholar
  39. 39.
    Bhattacharyya N (2014) The prevalence of dysphagia among adults in the United States. Otolaryngol Head Neck Surg 151:765–769CrossRefGoogle Scholar
  40. 40.
    Hiss SG, Postma GN (2003) Fiberoptic endoscopic evaluation of swallowing. Laryngoscope 113:1386–1393CrossRefGoogle Scholar
  41. 41.
    Murray J, Langmore SE, Ginsberg S, Dostie A (1996) The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration. Dysphagia 11:99–103CrossRefGoogle Scholar
  42. 42.
    Neubauer PD, Hersey DP, Leder SB (2016) Pharyngeal residue severity rating scales based on fiberoptic endoscopic evaluation of swallowing: a systematic review. Dysphagia 31:352–359CrossRefGoogle Scholar
  43. 43.
    Hutcheson KA, Lewin JS, Barringer DA, Lisec A, Gunn GB, Moore MWS, Holsinger FC (2012) Late dysphagia after radiotherapy-based treatment of head and neck cancer. Cancer 118:5793–5799CrossRefGoogle Scholar
  44. 44.
    Huang TL, Chien CY, Tsai WL et al (2016) Long-term late toxicities and quality of life for survivors of nasopharyngeal carcinoma treated with intensity-modulated radiotherapy versus non-intensity-modulated radiotherapy. Head Neck 38:1026–1032CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Isabela Porto de Toledo
    • 1
    • 2
    Email author
  • Leticia Lopes Quirino Pantoja
    • 1
  • Karen Fontes Luchesi
    • 3
  • Daniele Xavier Assad
    • 1
    • 4
  • Graziela De Luca Canto
    • 2
    • 5
  • Eliete Neves Silva Guerra
    • 1
  1. 1.Laboratory of Oral Histopathology, Health Sciences FacultyUniversity of BrasíliaBrasíliaBrazil
  2. 2.Brazilian Centre for Evidence-Based Research, Department of DentistryFederal University of Santa CatarinaFlorianopolisBrazil
  3. 3.Department of Speech-Language TherapyFederal University of Santa CatarinaFlorianopolisBrazil
  4. 4.Hospital Sírio-LibanêsBrasíliaBrazil
  5. 5.Department of DentistryFederal University of Santa CatarinaFlorianopolisBrazil

Personalised recommendations