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Treatment toxicities and their impact on oral intake following non-surgical management for head and neck cancer: a 3-year longitudinal study

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Abstract

Purpose

Patients who receive (chemo)radiotherapy [(C)RT] for head and neck cancer (HNC) experience multiple treatment effects. However, the presence and recovery of treatment toxicities and how these impact on oral intake over time post-treatment are not fully understood. The primary aim of this study was to examine patient perceptions of the toxicities present and which are barriers to oral intake, up to 3 years post (C)RT. The secondary aim was to identify mealtime strategies used to optimise oral intake.

Methods

A prospective cohort of 96 patients after completion of (C)RT for HNC reported the presence of toxicities, if they were barriers to oral intake, and use of any mealtime strategies at the end of treatment (EoT), and at 3, 6, 12, 24, and 36 months post-treatment.

Results

All toxicities and reported barriers changed over time (p < 0.05) except trismus. Odynophagia, reduced appetite, and fatigue improved (p < 0.05) by 3 months. Significantly less patients reported xerostomia and dysgeusia as barriers to oral intake at 3 months despite no improvement in their presence. No change in the presence of any toxicity or its impact on oral intake occurred from 12 to 36 months, with exception of dentition problems which significantly increased at 36 months. Alternating food/fluids was the most frequently used mealtime swallowing strategy at all time points beyond the EoT.

Conclusions

The dysphagia and associated toxicities HNC patients experience are chronic in nature. Rehabilitation should include mealtime strategies and support with adjusting to the changing presence and impact of toxicities on oral intake.

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Acknowledgements

The authors wish to thank the Speech Pathology Department, research team, and multidisciplinary team at Prince of Wales Hospital for their contributions and continued support to this project.

Funding

This project has been fully supported and funded by the Head and Neck Cancer Research Fund at Prince of Wales Hospital.

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Authors and Affiliations

  1. Speech Pathology Department, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, Sydney, NSW, 2031, Australia

    Molly K. Barnhart, Rachelle A. Robinson, Virginia A. Simms & Sophie J. Chandler

  2. School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia

    Molly K. Barnhart & Elizabeth C. Ward

  3. Centre for Functioning and Health Research, Queensland Health, Buranda, Brisbane, QLD, 4102, Australia

    Elizabeth C. Ward & Bena Cartmill

  4. Speech Pathology, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia

    Bena Cartmill

  5. Comprehensive Cancer Centre, POWH, Sydney, NSW, 2031, Australia

    Robert I. Smee

  6. The Clinical Teaching School, University New South Wales, Kensington, NSW, Australia

    Robert I. Smee

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  1. Molly K. Barnhart
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Correspondence to Molly K. Barnhart.

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Ethics approval was obtained (HREC No: 10/131).

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Barnhart, M.K., Robinson, R.A., Simms, V.A. et al. Treatment toxicities and their impact on oral intake following non-surgical management for head and neck cancer: a 3-year longitudinal study. Support Care Cancer 26, 2341–2351 (2018). https://doi.org/10.1007/s00520-018-4076-6

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