A Swallow Preservation Protocol Improves Function for Veterans Receiving Chemoradiation for Head and Neck Cancer

Objectives: Determine the efficacy of a swallowing preservation protocol on maintaining swallow function in patients undergoing chemoradiation (CRT) for head and neck squamous cell carcinoma (HNSCC). Methods: Retrospective case-control study of patients treated with CRT for HNSCC between July 2011 and December 2013 at a Veterans Affairs medical center. The study group comprised patients participating in a swallowing preservation protocol, including swallowing exercises and biweekly follow-up, during CRT. The control group received no swallowing intervention during CRT. A previously described functional outcomes of swallowing scale (FOSS; 0 = no symptoms and 5 = nonoral feeding for all nutrition) was used to quantify dysphagia prior to, at the completion of, and 2 months following the completion of CRT. Results: Forty-eight (all male; mean age, 67 years) and 85 patients (all male; mean age, 61 years) were included in the swallowing preservation and control groups, respectively. In the swallowing preservation group, mean pre- and posttreatment FOSS scores were 2.2 and 1.9, respectively, while the corresponding scores in the control group were 0.92 and 1.0. This approached statistical significance (Fisher’s exact test, P = .2). Conclusions: Patients enrolled in a swallow preservation protocol had overall poorer swallowing function at the initiation of CRT, but compared to the control group, a higher fraction of patients in the swallowing preservation protocol maintained or improved their swallow at posttreatment follow-up. This confirms the importance of early evaluation and intervention for dysphagia prior to and during CRT.