Improving compliance with swallowing exercise to decrease radiotherapy-related dysphagia in patients with head and neck cancer

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Abstract

Objective

Dysphagia, one of the most common complications in head and neck cancer (HNC) treated with radiotherapy, can severely affect patients’ quality of life. Currently, because no “gold standard” treatment exists, swallowing exercise remains the main rehabilitation strategy for dysphagia. However, patients’ compliance with long-term swallowing exercise is only 40%, thus, greatly compromising outcomes. This article aims to analyze thefactors influencing swallowing exercise compliance in patients with HNC and explains strategies developed to date for improved rehabilitation outcomes.

Methods

Research studies published between 2005 and 2022 were retrieved from seven databases: PubMed, Cochrane Library, Embase, CINAHL, CNKI, Wan Fang Database, and VIP Database, and 21 articles were shortlisted and systematically reviewed.

Results

The swallowing exercise compliance in patients with HNC undergoing radiotherapy was affected by multiple factors, including socio-demographic factors, illness-associated factors, treatment-associated factors, and psychosocial factors. Regarding the interventions, current strategies mainly address psychosocial issues via developing various education programs.

Conclusions

Different factors influencing swallowing exercise compliance are important and should be observed. Measures including developing multidisciplinary teams, applying innovative equipment, refining the intervention procedure, and applying systematic theory frameworks should be performed to achieve better outcomes of compliance interventions.

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Most cited references 61

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Susan Michie, Michelle Richardson, Marie Johnston … (2014)

CONSORT guidelines call for precise reporting of behavior change interventions: we need rigorous methods of characterizing active content of interventions with precision and specificity. The objective of this study is to develop an extensive, consensually agreed hierarchically structured taxonomy of techniques [behavior change techniques (BCTs)] used in behavior change interventions. In a Delphi-type exercise, 14 experts rated labels and definitions of 124 BCTs from six published classification systems. Another 18 experts grouped BCTs according to similarity of active ingredients in an open-sort task. Inter-rater agreement amongst six researchers coding 85 intervention descriptions by BCTs was assessed. This resulted in 93 BCTs clustered into 16 groups. Of the 26 BCTs occurring at least five times, 23 had adjusted kappas of 0.60 or above. "BCT taxonomy v1," an extensive taxonomy of 93 consensually agreed, distinct BCTs, offers a step change as a method for specifying interventions, but we anticipate further development and evaluation based on international, interdisciplinary consensus.

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The molecular landscape of head and neck cancer

C. René Leemans, Peter J. F. Snijders, Ruud H Brakenhoff (2018)

Head and neck squamous cell carcinomas (HNSCCs) arise in the mucosal linings of the upper aerodigestive tract and are unexpectedly heterogeneous in nature. Classical risk factors are smoking and excessive alcohol consumption, and in recent years, the role of human papillomavirus (HPV) has emerged, particularly in oropharyngeal tumours. HPV-induced oropharyngeal tumours are considered a separate disease entity, which recently has manifested in an adapted prognostic staging system while the results of de-intensified treatment trials are awaited. Carcinogenesis caused by HPV in the mucosal linings of the upper aerodigestive tract remains an enigma, but with some recent observations, a model can be proposed. In 2015, The Cancer Genome Atlas (TCGA) consortium published a comprehensive molecular catalogue on HNSCC. Frequent mutations of novel druggable oncogenes were not demonstrated, but the existence of a subgroup of genetically distinct HPV-negative head and neck tumours with favourable prognoses was confirmed. Tumours can be further subclassified based on genomic profiling. However, the amount of molecular data is currently overwhelming and requires detailed biological interpretation. It also became apparent that HNSCC is a disease characterized by frequent mutations that create neoantigens, indicating that immunotherapies might be effective. In 2016, the first results of immunotherapy trials with immune checkpoint inhibitors were published, and these may be considered as a paradigm shift in head and neck oncology.

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Author and article information

Contributors

Changying Chen

Tao Wang

Journal

Journal ID (nlm-ta): Asia Pac J Oncol Nurs

Journal ID (iso-abbrev): Asia Pac J Oncol Nurs

Title: Asia-Pacific Journal of Oncology Nursing

Publisher: Elsevier

ISSN (Print): 2347-5625

ISSN (Electronic): 2349-6673

Publication date PMC-release: 19 November 2022

Publication date Collection: January 2023

Publication date (Electronic): 19 November 2022

Volume: 10

Issue: 1

Electronic Location Identifier: 100169

Affiliations

[a ]College of Nursing and Health, Zhengzhou University, Zhengzhou, China

[b ]Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, WA, Australia

[c ]Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

[d ]Telethon Kids Institute, Perth, WA, Australia

[e ]Medical School, University of Western Australia, Perth, WA, Australia

[f ]People’ s Hospital of Hebi, Hebi, China

[g ]Academy of Medical Sciences of Zhengzhou University, Zhengzhou, China

Author notes

[∗ ]Corresponding author. changying@ 123456zzu.edu.cn wangtaomary@ 123456zzu.edu.cn

[1]

These authors contributed equally to this work.

Article

Publisher Item ID: S2347-5625(22)00227-X Publisher ID: 100169

DOI: 10.1016/j.apjon.2022.100169

PMC ID: 9792737

SO-VID: 756f597b-8fb8-4f03-91bc-22101f7c64ca

License:

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

History

Date received : 12 October 2022

Date accepted : 16 November 2022

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Improving compliance with swallowing exercise to decrease radiotherapy-related dysphagia in patients with head and neck cancer

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Abstract

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Most cited references 61

Developing and evaluating complex interventions: the new Medical Research Council guidance

The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.

The molecular landscape of head and neck cancer

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