OncoLog, Volume 61, Number 2, February 2016 Page: 6
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Swallowing Therapy
[Continued from page 5]training sessions are conducted by
speech pathologists, many of whom
have specialty certifications in swallow-
ing disorders from the American
Speech-Language-Hearing Association.
Each patient is given a specific set
of exercises for the pharynx and larynx
to maintain activity of the muscles that
receive a bystander dose of radiation.
The daily regimen includes six to eight
exercises and takes less than 15 minutes
to perform. Dr. Hutcheson said that
proactive swallowing therapy is espe-
cially important for patients who will
undergo radiation therapy to both sides
of the neck, as this group has a high
risk of radiation-associated dysphagia.
The exercise regimen is one of two
tasks given to patients during radiation
therapy; the other task is eating regu-
larly. "The vast majority of patients stop
eating solid food during the course of
head and neck radiation therapy be-
cause it tastes bad or hurts to swallow.
But we encourage patients to push
through and keep eating to maintain
as much normal muscle function as
possible," Dr. Hutcheson said.
During radiation therapy to the
head and neck, 50%-60% of patients
require feeding tubes; the resulting dis-
use of the musculature can contribute
to further deterioration of swallowing
function. However, feeding tubes can
be avoided in many patients through
individualized supportive care.
"We know that patients who keep
their swallowing system engaged during
the course of their radiation therapy
have a better chance of recovering
meaningful swallowing ability after
their therapy," Dr. Hutcheson said. "We
have a philosophy of 'use it or lose it."'
Patients in the preventive swallow-
ing therapy program return for sessions
with their speech pathologist at the
midpoint and at the completion of their
radiation therapy, with additional ther-
apy sessions if necessary. Patients are
advised to continue their home exercise
regimen for at least 6 months after the
completion of radiation therapy. "We
do not have great evidence to show
how long or how often the exercises
should continue after treatment," Dr.
Hutcheson said. "But I tell patients that"[W~e've had
success in treating
patients with very
severe or long-
standing dysphagia."
- Dr. Kate Hutcheson
if it were me, based on what I've seen,
I would keep up lifelong maintenance
therapy of probably one or two sessions
per week."
Intensive therapy for
persistent dysphagia
After surgery or radiation therapy
for head and neck cancer, most patients
who practice a home exercise regimen
recover a reasonable level of swallowing
ability. However, 15%-20% develop
persistent swallowing difficulties. Per-
sistent dysphagia is a challenging clini-
cal problem that is typically not
responsive to a home exercise regimen.
For patients with persistent dyspha-
gia-whether their cancer treatment
was done at MD Anderson or else-
where-Dr. Hutcheson and her col-
leagues developed a program they call
boot camp swallowing therapy. This is
an intensive program in which the pa-
tient works with a speech pathologist
daily for about 3 weeks.
During the daily sessions, speech
pathologists use progressive resistance
training coupled with functional swal-
lowing tasks to help patients increase
the intensity of their swallowing train-
ing. Patients' progress can be monitored
by various methods of biofeedback, in-
cluding surface electromyography and
manometry. Bolus-driven exercises help
patients remove "crutches," such as
flushing food down with water, from
their eating habits while eating increas-
ingly difficult foods.
Dr. Hutcheson said that because
many different swallowing therapies
are available, it can be challenging for
speech pathologists to find the best
ones for a particular patient. "We have
an algorithm to work through the ther-apeutic options and then select the
therapies we think will target the indi-
vidual patient's issue," she said.
The boot camp swallowing therapy
program has shown impressive results:
about 70% of patients see gains in their
functional status. "This intensive pro-
gram is unique to MD Anderson," Dr.
Hutcheson said. "And we've had suc-
cess in treating patients with very se-
vere or long-standing dysphagia."
Improving quality of life
Not satisfied with the success rate
of the current swallowing therapy pro-
grams, researchers at MD Anderson
continue to address swallowing issues
for which treatments are lacking. "We
still need therapies that will address
chronic aspiration," Dr. Hutcheson
said. "There is no proven treatment to
reverse chronic aspiration in head and
neck cancer survivors." She added that
the Section of Speech Pathology and
Audiology has a grant-funded program
to study expiratory muscle strength
training in head and neck cancer pa-
tients. Such training has shown promise
in reducing aspiration in patients with
neurodegenerative dysphagia such as
that seen in patients with Parkinson
disease, and Dr. Hutcheson is hopeful
that it will help her patients as well.
"Swallowing is a huge quality of life
issue. The key to improving swallowing
function is early and individualized
therapy," Dr. Hutcheson said. "A dys-
phagia-specialized speech pathologist-
whether seen at MD Anderson or
elsewhere-can help maximize a pa-
tient's outcome." U
FOR MORE INFORMATION
Dr. Kate Hutcheson......713-792-6513
To learn more about swallowing
therapy, visit MD Anderson's Head
and Neck Survivorship Clinic at
http://bit.ly/1MRmpnY or the
American Speech-Language-Hearing
Association's Board on Swallowing
and Swallowing Disorders at
www.swallowingdisorders.org.6 OncoLog February 2016
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University of Texas M.D. Anderson Cancer Center. OncoLog, Volume 61, Number 2, February 2016, periodical, February 2016; Houston, Texas. (https://texashistory.unt.edu/ark:/67531/metapth839415/m1/6/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.