Swallowing and Voice Outcomes following Treatment of Hypopharyngeal Cancer: The Need for Supervised Rehabilitation.

Abstract

Advances in and intensification of treatment in hypopharyngeal cancer have led to an increase in organ preservation and in overall survival. Treatment intensification comes at the cost of more pronounced acute and long-term side effects causing functional impairments in voice and swallowing. Swallowing and voice problems have a significant impact on communication, eating and nutrition, social well-being and quality of life. Swallowing problems may be so severe that patients suffer profuse aspiration or are left gastrostomy-tube dependent. Pre-treatment evaluation of swallowing and voice as well as a tailored rehabilitation programme including personalized exercise prescriptions and advices on nutrition and weight, allows for a decrease and preferably prevention of the late effects. Although the evidence is still at a suboptimal level, there is general consensus to integrate prevention, monitoring and management of swallowing and voice impairments as part of treatment protocols. Optimal timing is still controversial, but a trend is seen to start voice and swallowing exercises prior to or at the start of treatment. However, patients are often reluctant to perform and adhere to the exercise prescriptions due to the burdensome tumour-treatment-schedules. This leads to a need for supervision, either face to face or online, during these rehabilitation programmes.