, Volume 33, Issue 2, pp 227–233 | Cite as

Feasibility of a Mobile Application to Enhance Swallowing Therapy for Patients Undergoing Radiation-Based Treatment for Head and Neck Cancer

  • Heather M. Starmer
  • Rina Abrams
  • Kimberly Webster
  • Jennifer Kizner
  • Beth Beadle
  • F. Christopher Holsinger
  • Harry Quon
  • Jeremy Richmon
Original Article


Dysphagia following treatment for head and neck cancer is one of the most significant morbidities impacting quality of life. Despite the value of prophylactic exercises to mitigate the impact of radiation on long-term swallowing function, adherence to treatment is limited. The purpose of this investigation was to explore the feasibility of a mobile health application to support patient adherence to swallowing therapy during radiation-based treatment. 36 patients undergoing radiation therapy were provided with the Vibrent™ mobile application as an adjunct to standard swallowing therapy. The application included exercise videos, written instructions, reminders, exercise logging, and educational content. 80% of participants used the app during treatment and logged an average of 102 exercise sessions over the course of treatment. 25% of participants logged at least two exercise sessions per day over the 7-week treatment period, and 53% recorded at least one session per day. Exit interviews regarding the patient experience with the Vibrent™ mobile application were largely positive, but also provided actionable strategies to improve future versions of the application. The Vibrent™ mobile application appears to be a tool that can be feasibly integrated into existing patient care practices and may assist patients in adhering to treatment recommendations and facilitate communication between patients and providers between encounters.


Mobile application Dysphagia Deglutition Deglutition disorders Swallowing Head and neck cancer 


Compliance with Ethical Standards

Conflicts of interest

The authors have no conflicts of interest to disclose.


  1. 1.
    Chaturvedi AK, Engels EA, Anderson WF, et al. Incidence trends for human papilloma virus-related and -unrelated oral squamous cell carcinomas in the United States. J Clin Oncol. 2008;26:612–9.CrossRefPubMedGoogle Scholar
  2. 2.
    King SN, Dunlap NE, Tennant PA, Pitts T. Pathophysiology of radiation-induced dysphagia in head and neck cancer. Dysphagia. 2016;31(3):339–51.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Starmer HM, Tippett D, Webster K, et al. Swallowing outcomes in patients with oropharyngeal cancer undergoing organ-preservation treatment. Head Neck. 2014;36(10):1392–7.PubMedGoogle Scholar
  4. 4.
    Lazarus C, Logeman J, Pauloski B, et al. Swallowing disorders in head and neck cancer patients treated with radiotherapy and adjuvant chemotherapy. Laryngoscope. 1996;106(9Pt1):1157–66.CrossRefPubMedGoogle Scholar
  5. 5.
    Newman LA, Vieira F, Schwierzer V, et al. Eating and weight changes following chemoradiation therapy for advanced head and neck cancer. Arch Otolaryngol Head Neck Surg. 1998;124(5):589–92.CrossRefPubMedGoogle Scholar
  6. 6.
    Hunter KU, Lee OE, Lyden TH, et al. Aspiration pneumonia after chemo-intensity-modulated radiation therapy of oropharyngeal carcinoma and its clinical and dysphagia-related predictors. Head Neck. 2014;36:120–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Carroll WR, Locher JL, Canon CL, et al. Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope. 2008;118:39–43.CrossRefPubMedGoogle Scholar
  8. 8.
    Kotz T, Federman AD, Kao J, et al. Prophylactic swallowing exercises in patients with head and neck cancer undergoing chemoradiation: a randomized trial. Arch Otolaryngol Head Neck Surg. 2012;138:376–82.CrossRefPubMedGoogle Scholar
  9. 9.
    van der Molen L, van Rossum MA, Burkhead LM, et al. A randomized preventative rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: feasibility, compliance, and short-term effects. Dysphagia. 2011;26:115–70.Google Scholar
  10. 10.
    Carnaby-Mann G, Crary MA, Schmalfus I, Amdur R. “Pharyngocise”: randomized control trial of preventative exercises to maintain muscle structure and swallowing function during head and neck chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2012;83:210–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Langmore S, Krisciunas GP, Miloro KV, et al. Does PEG cause dysphagia in head and neck cancer patients? Dysphagia. 2012;27(2):251–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Hutcheson KA, Bhayani MK, Beadle BM, et al. Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers. Use it or lose it. JAMA. Otolaryngol Head Neck Surg. 2013;139(11):1127–34.CrossRefGoogle Scholar
  13. 13.
    Ward MC, Bjateja P, Nwizu T, et al. Impact of feeding tube choice on severe late dysphagia after definitive chemoradiotherapy for human papilloma virus-negative head and neck cancer. Head Neck. 2016;38(Suppl 1):E1054–60.CrossRefPubMedGoogle Scholar
  14. 14.
    Shinn EH, Basen-Engquist K, Baum G, et al. Adherence to preventative exercises and self-reported swallowing outcomes in post-radiation head and neck cancer patients. Head Neck. 2013;35(12):1707–12.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Mortensen HR, Jensen K, Aksglaede K, et al. Prophylactic swallowing exercises in head and neck cancer radiotherapy. Dysphagia. 2015;30(3):304–14.CrossRefPubMedGoogle Scholar
  16. 16.
    Cnossen IC, van Uden-Kraan CF, Witte BL, et al. Prophylactic exercises among head and neck cancer patients during and after swallowing sparing intensity modulated radiation: adherence and exercise performance levels of a 12-week guided home-based program. Eur Arch Otorhinolaryngol. 2017;274:1129–38.CrossRefPubMedGoogle Scholar
  17. 17.
    Wall LR, Ward EC, Cartmill B, Hill AJ, Porceddu SV. Adherence to a prophylactic swallowing therapy program during (chemo) radiotherapy: impact of service delivery model and patient factors. Dysphagia. 2017;32(2):279–92.CrossRefPubMedGoogle Scholar
  18. 18.
    Guarino H, Acosta M, Marsch LA, Xie H, Aponte-Melendez Y. A mixed-methods evaluation of the feasibility, acceptability, and preliminary efficacy of a mobile intervention for methadone maintenance clients. Psychol Addict Behav. 2016;30(1):1–11.CrossRefPubMedGoogle Scholar
  19. 19.
    Hui CY, Walton R, McKinstry B, et al. The use of mobile applications to support self-management for people with asthma: a systematic review of controlled studies to identify features associated with clinical effectiveness and adherence. J Am Med Inform Assoc. 2016;24:619–32.Google Scholar
  20. 20.
    Litman L, Rosen Z, Spierer D, et al. Mobile exercise apps and increased leisure time exercise activity: a moderated mediation analysis of the role of self-efficacy and barriers. J Med Internet Res. 2015;17(8):e195.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Badaway SM, Barrera L, Sinno MG, Kaviany S, O’Dwyer LC, Kuhns LM. Text messaging and mobile phone apps as interventions to improve adherence in adolescents with chronic health conditions: a systematic review. JMIR mHealth uHealth. 2017;5(5):e66.CrossRefGoogle Scholar
  22. 22.
    Lambert TE, Harvey LA, Avdalis C, Chen LW, Jeyalingam S, et al. An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomized trial. J Physiother. 2017;63:161–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Anderson M. Technology device ownership. Pew research center. Washington, DC. 2015. Accessed 8 oct 2017.
  24. 24.
    DiFillippo KN, Huang WH, Andrade JE, Chapman-Novakofski KM. The use of mobile apps to improve nutrition outcomes: a systematic literature review. J Telemed Telecare. 2015;21(5):243–53.CrossRefGoogle Scholar
  25. 25.
    Rossi MCE, Nicolucci A, Pellegrini F, et al. Interactive diary for diabetes: a useful and easy-to-use new telemedicine system to support the decision making process in type 1 diabetes. Diabetes Tech Ther. 2009;11:19–24.CrossRefGoogle Scholar
  26. 26.
    Kuijpers W, Groen WG, Aaronson NK, van Harten WH. A systematic review of web-based interventions for patient empowerment and physical activity in chronic diseases: relevance for cancer survivors. J Med Internet Res. 2015;15(2):e37.CrossRefGoogle Scholar
  27. 27.
    Govender R, Smith CH, Taylor SA, Barratt H, Gardner B. Swallowing interventions for the treatment of dysphagia after head and neck cancer: a systematic review of behavioural strategies used to promote patient adherence to swallowing exercises. BMC Cancer. 2017;17:43–58.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Dahlstrom KR, Bell D, Hanby D, et al. Socioeconomic characteristics of patients with oropharyngeal carcinoma according to tumor HPV status, patient smoking history, and sexual behavior. Oral Oncol. 2015;51(9):832–8.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Young D, Xiao CC, Murphy B, Moore M, Fakhry C, Day TA. Increase in head and neck cancer in younger patients due to human papillomavirus (HPV). Oral Oncol. 2015;51(8):727–30.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Otolaryngology – Head and Neck SurgeryStanford UniversityPalo AltoUSA
  2. 2.Department of Otolaryngology – Head and Neck SurgeryJohns Hopkins UniversityBaltimoreUSA
  3. 3.Stanford HealthcarePalo AltoUSA
  4. 4.Department of Radiation OncologyStanford UniversityPalo AltoUSA
  5. 5.Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins UniversityBaltimoreUSA
  6. 6.Department of Otolaryngology – Head and Neck SurgeryMass Eye and Ear InfirmaryBostonUSA
  7. 7.Stanford Cancer CenterPalo AltoUSA

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