Dysphagia Treatment for Patients With Head and Neck Cancer Undergoing Radiation Therapy: A Meta-analysis Review

Purpose Patients undergoing radiation therapy with or without chemotherapy (C/RT) for head and neck cancer (HNC) often develop dysphagia. Interventions from speech-language pathologists aim to maintain or improve swallow physiology and function. However, it is unclear which interventions provide the greatest benefit. We performed a systematic review to assess the benefit of exercise therapy on swallow physiology, function, and related quality of life (QOL). Methods and Materials We searched 7 electronic databases up to July 12, 2017, for all primary studies of any language or design that included the following: a behavioral swallowing intervention for patients with HNC treated with curative C/RT, a comparison group, and outcomes related to swallow physiology, function, and/or QOL. Two blinded raters judged the abstracts and full articles, with discrepancies resolved by a third rater. Critical appraisal was completed using the Cochrane Risk of Bias. Descriptive analyses were conducted for all outcomes and meta-analyses for outcomes that were identical in type and time relative to C/RT. Results Of 1937 unique abstracts retrieved, 20 studies qualified. Of these, 12 were randomized controlled trials. Across the studies, dysphagia treatments varied by exercise type and start time (ie, before or during C/RT, n = 14; immediately after C/RT, n = 1; >3 months after C/RT, n = 5). After treatment, the outcomes measured varied by domain, tools, and follow-up schedule (ie, immediately after, n = 6; within 3 months after, n = 9, >3 months after, n = 12). All articles had risks of bias and most often lacked report of sample size calculations (n = 18), controlled clinician–participant interaction time across groups (n = 13), and treatment details to allow duplication (n = 9). The meta-analysis revealed physiological or functional, but not QOL, benefits after interventions with early and late start times. Conclusions Given that benefit was identified with both early and late interventions, future high-quality trials are needed to clarify the most effective time, type, and intensity of behavioral dysphagia interventions for these HNC patients.