Clinicians working in head and neck cancer will be familiar with the increased interest in prophylactic swallowing exercises to reduce the devastating impact of dysphagia experienced by patients undergoing radiation or chemo-radiation therapy. This study from Denmark is one of only a handful of RCTs designed to test the effectiveness of providing patients with exercises prior to the start of their treatment. The purpose is to maintain the function of the swallowing musculature and possibly delay or reduce long-term fibrotic changes, keeping patients eating by mouth for a longer period. The study did not show any significant benefit in the intervention group compared with the usual care control group on all of the multidimensional swallowing outcome measures at any of the multiple time points up until 11 months post radiotherapy. The primary outcome measure was the Swallowing Performance Status Scale (SPSS), but secondary measures included the EORTC, MBS, clinical measures (weight, mouth opening, tube feeding, DAHANCA dysphagia scale) and patient compliance. Findings were similar in both groups at the different time points with a similar change over time. Only 51% of patients were available at the final follow-up (dropout rate reported to be similar in both arms) with only 53% of patients reporting adherence to the exercise protocol at week five of radiotherapy and 33% at 11 months post. The authors provide a good discussion about their findings in relation to other studies as well as problems encountered in their own study. They also provide a very useful table in the supplementary information describing the current evidence for the effect of swallowing exercises on different endpoints. This paper has all the elements (methodological quality, challenges of conducting an RCT with this population, is there enough evidence yet to be “pushing” prophylactic exercises in clinical practice, lessons for future studies) for an interesting journal club discussion! 

Prophylactic swallowing in head and neck cancer radiotherapy.
Mortensen HR, Jensen K, Aksglaede K, et al.
Published online 19 Feb 2015 DOI 10.1007/s00455-015-9600-y
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Roganie Govender

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

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