Objectives: Chemoradiation and surgical management are two mainstays of treatment for oropharyngeal cancer, both of which are associated with development of dysphagia, which can adversely affect a patient’s quality of life. Early rehabilitation is often associated with improved functional outcomes and quality of life. The purpose of this study is to evaluate the impact of swallowing intervention timing on functional swallowing outcomes after treatment of oropharyngeal cancer.
Study Design: Retrospective cohort study at a single academic tertiary care center between 2007 – 2018
Methods: Patients who underwent swallow therapy after surgical or medical management of oropharyngeal cancer were identified on retrospective chart review and stratified into three cohorts based on tumor management: (1) patients who underwent transoral robotic surgery with adjuvant chemoradiation (TORS), (2) patients who underwent free tissue transfer and flap reconstruction with adjuvant chemoradiation (Flap), and (3) patients who underwent primary chemoradiation of the primary tumor alone (CRT). Patients were excluded from the study if they only underwent evaluation by the speech pathologists but no treatment. Surgical and pathologic data were abstracted from medical records. Functional oral intake scores (FOIS) and timing of swallowing intervention after cancer treatment were abstracted from speech therapy records. Timing of swallowing intervention was defined as “early” if less than, or “late” if greater, than 26 weeks after primary resection date or completion of chemoradiation. The primary outcome of the study was differences in FOIS after swallowing therapy.
Results: A total of 32 patients (TORS: n=10, Flap: n=12, CRT: n=10) were included in the analysis. There were significant differences in pre-therapy FOIS (p=0.010) between cohorts, with TORS patients having greater FOIS than flap and CRT patients prior to swallowing therapy. Pre- and post-treatment improvement in FOIS was noted in TORS (4.4 vs 5.8, p=0.010), flap (2.3 vs 4.2, p=0.006), and CRT patients (2.7 vs 4.1, p=0.023). When adjusting for timing of swallowing therapy, post-treatment FOIS improvements were noted in CRT patients regardless of therapy timing (p=0.023 early vs p=0.040 late) but were no longer significant for TORS (3.7 vs 5, p=0.057) or flap patients (2.3 vs 3.5, p=0.059) who received late swallowing therapy. In all treatment groups, late initiation of swallowing therapy treatment was associated with a reduced treatment effect compared to early initiation of swallowing therapy.
Conclusions: Primary chemoradiation and extensive surgical resection of oropharyngeal cancers are associated with poorer functional swallowing outcomes. Early initiation of swallowing therapy is associated with increased improvement in FOIS scores, improving patients’ quality of life by allowing them to eat orally. This highlights the need for early referral and engagement in swallow rehabilitation after treatment of oropharyngeal cancers.