Normalcy of Swallowing in Head and Neck Cancer Patients Undergoing Particle Therapy Supported by Combined Swallowing Training and Feeding Management: A Randomised Controlled Trial

IF 4 3区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Journal of oral rehabilitation Pub Date : 2025-02-27 DOI:10.1111/joor.13939

Yu Zhang, Yu Zhu, Lijuan Zhang, Yiqiao Wang, Wenjie Xu, Hongwei Wan

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Abstract

Objective

As a common complication following particle therapy for head and neck cancer (HNC), dysphagia poses significant risks and adverse outcomes for patients. This study aims to investigate the efficacy of an evidence-based combined regimen of feeding management and swallowing training on improving swallowing function, swallowing-related quality of life and nutritional status in patients with dysphagia.

Methods

We conducted a randomised parallel-controlled trial at the Shanghai Proton and Heavy Ion Center from March 2023 to October 2023. The study included patients aged 18 or older with HNCs undergoing particle therapy, with or without concurrent chemotherapy. Patients with dysphagia caused by conditions other than cancer were excluded. Patients were randomly assigned to intervention or control groups. The control group received routine radiotherapy care during and 3 months post-treatment, while the intervention group received an additional combined regimen of feeding management and swallowing training. The control group received standard radiotherapy care during treatment and for 3 months post-treatment. In addition, the intervention group was instructed to undergo preventive swallowing training at the start of treatment, with feeding management measures (adjusting food texture, bite size, eating speed, posture and utensils) implemented once swallowing discomfort occurred. Swallowing function was assessed using the Eating Assessment Tool-10 (EAT-10). Swallowing-related quality of life was measured with the M.D. Anderson Dysphagia Inventory (MDADI), which covers emotional, functional, physical and global dimensions. Nutritional status was evaluated based on Body Mass Index (BMI) and the Nutrition Risk Screening 2002 (NRS2002). Assessments were performed at baseline, immediately post-treatment (within 3 days after completion of treatment) and 3 months post-treatment.

Results

Ninety-six patients were enrolled in this study, with 48 in the intervention group and 48 in the control group. Group effect analysis revealed that the intervention group outperformed the control group in improving swallowing function (p = 0.002) and overall swallowing-related quality of life (p = 0.001). Time effects also indicated improvements in swallowing function and quality of life in the intervention group compared to baseline (p < 0.001), with no significant interaction effect (p > 0.05). Specifically, improvements were observed in the functional dimension (p < 0.001) and physical dimension (p < 0.001) of swallowing-related quality of life in the intervention group. The MDADI total scores showed a clinically significant difference (> 10 points) between groups. However, no significant between-group differences were found in BMI values (p = 0.474) or NRS2002 scores (p = 0.957).

Conclusion

Our study indicates that combining feeding management and swallowing training effectively enhances swallowing function and quality of life in HNC patients receiving particle therapy. However, insufficient evidence was found to support its impact on nutritional status or malnutrition risk.

Trial Registration

ClinicalTrials.gov identifier: ChiCTR2300067550

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在吞咽训练和喂养管理联合支持下接受颗粒治疗的头颈癌患者吞咽正常：一项随机对照试验。

目的：吞咽困难是头颈癌（HNC）颗粒治疗后常见的并发症，对患者具有显著的风险和不良结局。本研究旨在探讨循证喂养管理和吞咽训练联合方案对改善吞咽困难患者吞咽功能、吞咽相关生活质量和营养状况的疗效。方法：我们于2023年3月至2023年10月在上海质子重离子中心进行了一项随机平行对照试验。该研究包括18岁或以上的HNCs患者，接受颗粒治疗，伴或不伴化疗。排除非癌症引起的吞咽困难患者。患者被随机分为干预组和对照组。对照组在治疗期间及治疗后3个月给予常规放疗护理，干预组在此基础上给予喂养管理和吞咽训练联合治疗方案。对照组患者治疗期间及治疗后3个月接受标准放疗护理。此外，干预组在治疗开始时接受预防性吞咽训练，一旦出现吞咽不适，实施喂养管理措施（调整食物质地、咬口大小、进食速度、姿势和器具）。使用进食评估工具-10 （EAT-10）评估吞咽功能。通过md安德森吞咽困难量表（MDADI）测量与吞咽相关的生活质量，该量表涵盖情感、功能、身体和整体维度。根据身体质量指数（BMI）和2002年营养风险筛查（NRS2002）评估营养状况。评估分别在基线、治疗后立即（治疗完成后3天内）和治疗后3个月进行。结果：96例患者入组，干预组48例，对照组48例。组效分析显示，干预组在改善吞咽功能（p = 0.002）和整体吞咽相关生活质量（p = 0.001）方面优于对照组。与基线相比，时间效应也表明干预组的吞咽功能和生活质量有所改善（p < 0.05）。具体而言，两组之间在功能维度上观察到改善（p 10分）。BMI值（p = 0.474）和NRS2002评分（p = 0.957）组间差异无统计学意义。结论：本研究表明，进食管理与吞咽训练相结合可有效提高接受颗粒治疗的HNC患者的吞咽功能和生活质量。然而，没有足够的证据支持它对营养状况或营养不良风险的影响。试验注册：ClinicalTrials.gov标识符：ChiCTR2300067550。

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来源期刊

Journal of oral rehabilitation 医学-牙科与口腔外科

CiteScore

5.60

自引率

10.30%

发文量

116

审稿时长

4-8 weeks

期刊介绍： Journal of Oral Rehabilitation aims to be the most prestigious journal of dental research within all aspects of oral rehabilitation and applied oral physiology. It covers all diagnostic and clinical management aspects necessary to re-establish a subjective and objective harmonious oral function. Oral rehabilitation may become necessary as a result of developmental or acquired disturbances in the orofacial region, orofacial traumas, or a variety of dental and oral diseases (primarily dental caries and periodontal diseases) and orofacial pain conditions. As such, oral rehabilitation in the twenty-first century is a matter of skilful diagnosis and minimal, appropriate intervention, the nature of which is intimately linked to a profound knowledge of oral physiology, oral biology, and dental and oral pathology. The scientific content of the journal therefore strives to reflect the best of evidence-based clinical dentistry. Modern clinical management should be based on solid scientific evidence gathered about diagnostic procedures and the properties and efficacy of the chosen intervention (e.g. material science, biological, toxicological, pharmacological or psychological aspects). The content of the journal also reflects documentation of the possible side-effects of rehabilitation, and includes prognostic perspectives of the treatment modalities chosen.