ABSTRACT
BACKGROUND: Acute oral mucositis is associated with pain and impaired swallowing. Little information is available on the effects of chronic mucositis on swallowing. METHODS: Sixty patients treated for cancer of the head and neck were examined during the first year after their cancer treatment. Oral mucosa was rated with the Oral Mucositis Assessment Scale. Stimulated whole-mouth saliva, oral pain rating, percent of oral intake, and 2 subscales of the Performance Status Scale for Head and Neck (PSS-HN) cancer were also collected. RESULTS: Mucositis scores and pain ratings decreased over time while functional measures of eating improved over time. Reduction in chronic mucositis was correlated with improved oral intake and diet. CONCLUSION: Lack of association with pain was attributed to the absence of ulcerations. Continued impairment of oral intake during the first year posttreatment may be related to oral mucosal changes and other factors.
Subject(s)
Eating , Head and Neck Neoplasms/therapy , Mucositis/physiopathology , Pain/physiopathology , Adult , Aftercare , Aged , Chemotherapy, Adjuvant/adverse effects , Cohort Studies , Combined Modality Therapy , Deglutition/physiology , Deglutition Disorders/etiology , Deglutition Disorders/physiopathology , Diet , Female , Follow-Up Studies , Head and Neck Neoplasms/diagnosis , Humans , Male , Middle Aged , Mouth Mucosa/pathology , Mucositis/etiology , Neck Dissection/adverse effects , Neck Dissection/methods , Neoplasm Staging , Pain/etiology , Pain Measurement , Radiotherapy, Adjuvant/adverse effects , Risk Assessment , Time Factors , Treatment Outcome , Young AdultABSTRACT
There is little evidence regarding the type(s) of information clinicians use to make the recommendation for oral or nonoral feeding in patients with oropharyngeal dysphagia. This study represents a first step toward identifying data used by clinicians to make this recommendation and how clinical experience may affect the recommendation. Thirteen variables were considered critical in making the oral vs. nonoral decision by the 23 clinicians working in dysphagia. These variables were then used by the clinicians to independently recommend oral vs. nonoral feeding or partial oral with nonoral feeding for the 20 anonymous patients whose modified barium swallows were sent on a videotape to each clinician. Clinicians also received data on the 13 variables for each patient. Results of clinician agreement on the recommendation of full oral and nonoral only were quite high, as measured by Kappa statistics. In an analysis of which of the 13 criteria clinicians used in making their recommendations, amount of aspiration was the criterion with the highest frequency. Recommendations for use of postures and maneuvers and the effect of clinician experience on these choices were also analyzed.
Subject(s)
Clinical Competence , Deglutition Disorders/physiopathology , Deglutition , Health Knowledge, Attitudes, Practice , Practice Guidelines as Topic , Access to Information , Decision Making , Deglutition Disorders/diagnosis , Humans , OropharynxABSTRACT
BACKGROUND: Radiation alone or concurrent chemoradiation can result in severe swallowing disorders. This manuscript defines the swallowing disorders occurring at pretreatment and 3 and 12 months after completion of radiation or chemoradiation. METHODS: Forty-eight patients (10 women and 38 men) participated in this study involving videofluorographic evaluation of oropharyngeal swallow at the 3 time points. RESULTS: At baseline, patients had some swallow disorders, probably related to presence of their tumor. At 3 months posttreatment, frequency of reduced tongue base retraction, slow or delayed laryngeal vestibule closure, and reduced laryngeal elevation increased from baseline. Some disorders continued at 12 months posttreatment. Functional swallow decreased over time in patients treated with chemoradiation, but not those treated with radiation alone. DISCUSSION: Chemoradiation results in fewer functional swallowers than radiation alone at 12 months posttreatment completion.
