This randomised controlled trial aimed to establish the impact of prophylactic swallowing exercises in patients undergoing chemoradiation therapy for head and neck cancer. The primary outcome was the functional oral intake scale (FOIS), although secondary measures for feeding tube use, functional swallow and QOL were also collected. Sixty patients were randomised into one of two groups. The exercise group received a pre-defined set of swallowing exercises as well as a TheraBite device for mandibular range of motion exercises. This group was instructed in a protocol that took 20-30 minutes to perform twice daily. In addition, this group was seen weekly during radiation treatment. The control group was provided with a TheraBite and instructed in its use, but received no other exercises and were not seen again during radiation treatment unless specifically referred.

The study found a 10% improvement in oral intake scores for the exercise group at three months post-treatment although this was not statistically significant. There were significant improvements to secondary outcomes between three and six months after treatment in the exercise group, but this difference did not persist at 12 and 24 months. There was a steady decline in adherence to the exercise protocol from week 1 to week 7 of treatment with only 28% of patients completing 40 % or more of their daily exercises.

As with other studies that have examined the potential benefit of prophylactic swallowing exercises in the head and neck cancer population, results do not overwhelmingly support this practice. However, this study, like others, does demonstrate some positive findings. It also highlights factors such as poor patient adherence and inconsistent protocols that may undermine results.

Prophylactic swallow therapy for patients with head and neck cancer undergoing chemoradiotherapy: a randomized trial.
Messing BP, Ward EC, Lazarus CL, et al.
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Roganie Govender

University College London, Head & Neck Academic Centre, UK.

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