Efetividade da reabilitação fonoaudiológica na comunicação oral e na deglutição em pacientes irradiados devido ao câncer de cabeça e pescoço / The efficacy of voice and swallowing therapy in the voice and swallowing in patients submitted to radiotherapy due to head and neck cancer

RESUMO

OBJETIVO: O objetivo deste estudo foi avaliar os resultados da reabilitação fonoaudiológica, antes, durante e após a radioterapia, na voz e na deglutição de pacientes tratados para câncer de cabeça e pescoço. PACIENTES E MÉTODOS: Foi um estudo prospectivo, onde foram analisados 25 pacientes que foram submetidos à radioterapia exclusiva ou associada à quimioterapia. ... RESULTADOS: Para as variáveis perceptivas, no grupo SF o subgrupo PVE apresentou tendência de permanecer igual ou apresentar melhora em relação ao grau da disfonia, rouquidão e articulação. O subgrupo PVP apresentou, pelo menos em 1 momento de análise, piora de alguma variável. No grupo CF, ambos os subgrupos demonstraram resultados semelhantes ao do grupo SF, embora se observe piora em quase todas as variáveis. Quanto às medidas acústicas no grupo SF, o subgrupo PVE, apresentou as medidas alteradas no primeiro momento com melhora no decorrer do tratamento. O grupo CF manteve as medidas alteradas (shimmer (%), APQ e VTI) nos três momentos de análise. Em relação ao VHI, os pacientes do grupo CF referiram pior desvantagem vocal quando comparados ao grupo SF. Em relação à deglutição, para as fases preparatória e oral, os pacientes do grupo CF pioraram menos do que os pacientes do grupo SF. Quanto à fase faríngea, não foi observado diferença entre os grupos. Quanto à qualidade de vida relaciona à deglutição, os pacientes do grupo CF apresentaram melhores resultados. CONCLUSÕES: Os resultados obtidos neste estudo indicam que a terapia vocal antes, durante e logo após a radioterapia, não contribui para melhores resultados vocais. Em relação à deglutição a intervenção fonoaudiológica pode ser útil na redução da incidência das alterações no decorrer do tratamento radioterápico...

ABSTRACT

OBJECTIVE: The objective of this study was to evaluate the results of voice and swallowing therapy before, during and after radiation therapy, in voice and swallowing in patients treated for head and neck cancer. PATIENTS AND METHODS: It was a prospective study of the series of cases, in which 25 patients, who have been submitted to radiation therapy alone, or in concomitant with chemotherapy, were analyzed. The patients were distributing into two groups according to admission in the hospital without therapy (W/OT) and with therapy (WT), and underwent vocal function and swallowing evaluations at three distinct moments 1. pre-radiation therapy, 2. immediately post-therapy and 3. one month after the end of therapy. To evaluate the results of voice therapy, the patients were classified according to the vocal folds exposure to radiation (EVF = exposed vocal fold and PVF = protected vocal cord). In order to analyze the results of the voice therapy, the following evaluations were performed 1. perceptual-auditory analysis, voice-objective acoustic analysis, and 3. voice-handicap index (VHI). The following tools were carried out to evaluate the results of the swallowing therapy 1. videofluoroscopic evaluation of swallowing and 2. quality-of-life related to swallowing (SWAL-QOL) questionnaire. RESULTS: Regarding the perceptive variables the EVF subgroup of the group W/OT presented a trend to remain the same or to improve in relation to the level of dysphonia, hoarseness and articulation. The PVF subgroup presented, at least at one moment of the analysis, a worse result in some variable. In the group WT, both subgroups showed results similar to the group W/OT, although almost all variables showed worse results. As to the acoustic measurement in the group W/OT, the EVF subgroup presented measurement changes at the first moment, improving during the treatment. The group WT presented altered measurement (shimmer (%), APQ and VTI) at the three moments of the analysis. In relation to VHI, the patients in the group WT referred to a worse voice disadvantage when compared to the group W/OT. Regarding the swallowing, the patients in the group WT were not as affected as those in the group W/OT in the preparatory and oral phases. On the other hand, no differences were observed between the groups in the pharyngeal phase. The patients in the group WT presented better results regarding the quality-of-life related to swallowing. CONCLUSION: The results obtained in this study indicate that voice therapy proposal in the present study, before, during and immediately after radiation therapy, did not contribute to improve voice results. In relation to swallowing, the swallowing therapy intervention can be useful to reduce the incidence of the changes throughout the radiation therapy treatment (AU)