CoDAS
https://codas.org.br/journal/codas/article/doi/10.1590/2317-1782/20232021246en
CoDAS
Revisão Sistemática

Preventive measures for the progression of dysphagia in patients with cancer of head and neck subjected to radiotherapy: a systematic review with meta-analysis

Medidas de prevenção da progressão da disfagia em pacientes com câncer de cabeça e pescoço submetidos a radioterapia: uma revisão sistemática com meta-análise

Amanda Guterres Beuren; Émille Dalbem Paim; Nathália da Silva Flores; Vera Beatris Martins; Fabricio Edler Macagnan

Downloads: 3
Views: 228

Abstract

Purpose

To identify the effects of prophylactic, non-pharmacological measures on the progression of dysphagia in patients with head and neck cancer undergoing radiotherapy.

Research strategies

The search was performed in Medline (via PubMed), Scopus, and Embase databases, as well as in the gray literature.

Selection criteria

Randomized clinical trials were included, with adult patients (≥ 18 years old) and diagnosed with head and neck cancer, treated with radiotherapy (with or without surgery and chemotherapy), and submitted to non-pharmacological protocols for the prevention of dysphagia.

Data analysis

The risk of bias was assessed using the PEDRO scale and the overall quality of evidence was assessed using the GRADE instrument.

Results

Four studies were considered eligible, and of these, two were included in the meta-analysis. The result favored the intervention group, with a mean difference of 1.27 [95% CI: 0.74 to 1.80]. There was low heterogeneity and the mean score for risk of bias was 7.5 out of 11 points. The lack of detail in the care with selection, performance, detection, attrition, and reporting biases contributed to the judgment of the quality of the evidence, considered low.

Conclusion

Prophylactic measures to contain dysphagia can promote important benefits on the oral intake of patients with head and neck cancer when compared to those who did not undergo such a therapeutic measure during radiotherapy.

Keywords

Prophylaxis; Preventive Measures; Dysphagia; Head and Neck Neoplasms; Radiotherapy

Resumo

Objetivo

Identificar os efeitos de medidas profiláticas, não farmacológicas, sobre a progressão da disfagia em pacientes com câncer de cabeça e pescoço submetidos a radioterapia.

Estratégia de pesquisa

A busca foi realizada nas bases de dados Medline (via PubMed), Scopus e Embase, assim como na literatura cinzenta.

Critérios de seleção

Foram incluídos ensaios clínicos randomizados, com pacientes adultos (≥ 18 anos) e diagnóstico de câncer de cabeça e pescoço, tratados com radioterapia (associada ou não à cirurgia e quimioterapia) submetidos a protocolos não farmacológicos de prevenção da disfagia.

Análise dos dados

O risco de viés foi avaliado por meio da escala PEDRO e a qualidade global da evidência foi avaliada de acordo com o instrumento GRADE.

Resultados

Foram considerados elegíveis 4 estudos, e desses, dois foram incluídos na metanálise. O resultado favoreceu o grupo intervenção, com diferença média de 1,27 [IC 95%: 0,74 à 1,80]. Houve baixa heterogeneidade e a pontuação média para risco de viés foi de 7,5 de um total de 11 pontos. A falta de detalhamento nos cuidados com os vieses de seleção, performance, detecção, atrito e de relato contribuíram para o julgamento da qualidade da evidência, considerada baixa.

Conclusão

Medidas profiláticas de contenção da disfagia podem promover importantes benefícios sobre a ingesta oral dos pacientes com câncer de cabeça e pescoço, quando comparados aqueles que não realizaram tal medida terapêutica ao longo da radioterapia.

Palavras-chave

Profilaxia; Medidas Preventivas; Disfagia; Neoplasias de Cabeça e Pescoço; Radioterapia

Referências

  1. Hutcheson KA, Lewin JS, Barringer DA, Lisec A, Gunn GB, Moore MW, et al. Late dysphagia after radiotherapy-based treatment of head and neck cancer. Cancer. 2012;118(23):5793-9. http://dx.doi.org/10.1002/cncr.27631 PMid:23640737.
  2. García-Peris P, Parón L, Velasco C, de la Cuerda C, Camblor M, Bretón I, et al. Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: impact on quality of life. Clin Nutr. 2007;26(6):710-7. http://dx.doi.org/10.1016/j.clnu.2007.08.006 PMid:17954003.
  3. Yifru TA, Kisa S, Dinegde NG, Atnafu NT. Dysphagia and its impact on the quality of life of head and neck cancer patients: institution-based cross-sectional study. BMC Res Notes. 2021;14(1):11. http://dx.doi.org/10.1186/s13104-020-05440-4 PMid:33413623.
  4. Zebralla V, Wichmann G, Pirlich M, Hammermüller C, Berger T, Zimmermann K, et al. Dysphagia, voice problems, and pain in head and neck cancer patients. Eur Arch Otorhinolaryngol. 2021;278(10):3985-94. http://dx.doi.org/10.1007/s00405-020-06584-6 PMid:33452920.
  5. Jurdana M, Cemazar M, Pegan K, Mars T. Effect of ionizing radiation on human skeletal muscle precursor cells. Radiol Oncol. 2013;47(4):376-81. http://dx.doi.org/10.2478/raon-2013-0058 PMid:24294183.
  6. Clark BC. In vivo alterations in skeletal muscle form and function after disuse atrophy. Med Sci Sports Exerc. 2009;41(10):1869-75. http://dx.doi.org/10.1249/MSS.0b013e3181a645a6 PMid:19727027.
  7. Pezdirec M, Strojan P, Boltezar IH. Swallowing disorders after treatment for head and neck cancer. Radiol Oncol. 2019;53(2):225-30. http://dx.doi.org/10.2478/raon-2019-0028 PMid:31194691.
  8. Langmore S, Krisciunas GP, Miloro KV, Evans SR, Cheng DM. Does PEG use cause dysphagia in head and neck cancer patients? Dysphagia. 2012;27(2):251-9. http://dx.doi.org/10.1007/s00455-011-9360-2 PMid:21850606.
  9. Bojaxhiu B, Shrestha BK, Luterbacher P, Elicin O, Shelan M, MacPherson AJS, et al. Unplanned hospitalizations in patients with locoregionally advanced head and neck cancer treated with (chemo)radiotherapy with and without prophylactic percutaneous endoscopic gastrostomy. Radiat Oncol. 2020;15(1):281. http://dx.doi.org/10.1186/s13014-020-01727-9 PMid:33317602.
  10. Hutcheson KA, Bhayani MK, Beadle BM, Gold KA, Shinn EH, Lai SY, et al. Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it. JAMA Otolaryngol Head Neck Surg. 2013;139(11):1127-34. http://dx.doi.org/10.1001/jamaoto.2013.4715 PMid:24051544.
  11. Carnaby-Mann G, Crary MA, Schmalfuss I, Amdur R. “Pharyngocise”: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2012;83(1):210-9. http://dx.doi.org/10.1016/j.ijrobp.2011.06.1954 PMid:22014959.
  12. Kristensen MB, Isenring E, Brown B. Nutrition and swallowing therapy strategies for patients with head and neck cancer. Nutrition. 2020;69:110548. http://dx.doi.org/10.1016/j.nut.2019.06.028 PMid:31563019.
  13. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomized trials. BMJ. 2011;343(2):d5928. http://dx.doi.org/10.1136/bmj.d5928 PMid:22008217.
  14. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. http://dx.doi.org/10.1371/journal.pmed.1000100 PMid:19621070.
  15. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5(1):13. http://dx.doi.org/10.1186/1471-2288-5-13 PMid:15840177.
  16. Baudelet M, van den Steen L, Tomassen P, Bonte K, Deron P, Huvenne W, et al. Very late xerostomia, dysphagia, and neck fibrosis after head and neck radiotherapy. Head Neck. 2019;41(10):3594-603. http://dx.doi.org/10.1002/hed.25880 PMid:31329343.
  17. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro Scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713-21. http://dx.doi.org/10.1093/ptj/83.8.713 PMid:12882612.
  18. Messing BP, Ward EC, Lazarus CL, Kim M, Zhou X, Silinonte J, et al. Prophylactic swallow therapy for patients with head and neck cancer undergoing chemoradiotherapy: a randomized trial. Dysphagia. 2017;32(4):487-500. http://dx.doi.org/10.1007/s00455-017-9790-6 PMid:28444488.
  19. Mortensen HR, Jensen K, Aksglæde K, Lambertsen K, Eriksen E, Grau C. Prophylactic Swallowing Exercises in Head and Neck Cancer Radiotherapy. Dysphagia. 2015;30(3):304-14. http://dx.doi.org/10.1007/s00455-015-9600-y PMid:25690840.
  20. Kotz T, Federman AD, Kao J, Milman L, Packer S, Lopez-Prieto C, et al. Prophylactic swallowing exercises in patients with head and neck cancer undergoing chemoradiation: a randomized trial. Arch Otolaryngol Head Neck Surg. 2012;138(4):376-82. http://dx.doi.org/10.1001/archoto.2012.187 PMid:22508621.
  21. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-6. http://dx.doi.org/10.1136/bmj.39489.470347.AD PMid:18436948.
  22. Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, et al. GRADE guidelines 6. Rating the quality of evidence-imprecision. J Clin Epidemiol. 2011;64(12):1283-93. http://dx.doi.org/10.1016/j.jclinepi.2011.01.012 PMid:21839614.
  23. Anjanappa M, Corden M, Green A, Roberts D, Hoskin P, McWilliam A, et al. Sarcopenia in cancer: risking more than muscle loss. Tech Innov Patient Support Radiat Oncol. 2020;16:50-7. http://dx.doi.org/10.1016/j.tipsro.2020.10.001 PMid:33385074.
  24. Abel E, Silander E, Nyman J, Bove M, Johansson L, Björk-Eriksson T, et al. Impact on quality of life of IMRT versus 3-D conformal radiation therapy in head and neck cancer patients: a case control study. Adv Radiat Oncol. 2017;2(3):346-53. http://dx.doi.org/10.1016/j.adro.2017.05.002 PMid:29114602.
  25. King SN, Dunlap NE, Tennant PA, Pitts T. Pathophysiology of radiation-induced dysphagia in head and neck cancer. Dysphagia. 2016;31(3):339-51. http://dx.doi.org/10.1007/s00455-016-9710-1 PMid:27098922.
  26. Iacovelli NA, Galaverni M, Cavallo A, Naimo S, Facchinetti N, Iotti C, et al. Prevention and treatment of radiation-induced acute dermatitis in head and neck cancer patients: a systematic review. Future Oncol. 2018;14(3):291-305. http://dx.doi.org/10.2217/fon-2017-0359 PMid:29153015.
  27. Bossi P, Ghiani M, Argenone A, Depenni R. Is pain part of a systemic syndrome in head and neck cancer? Support Care Cancer. 2020;28(2):451-9. http://dx.doi.org/10.1007/s00520-019-05147-8 PMid:31713692.
  28. Lakshmaiah KC, Sirsath NT, Subramanyam JR, Govind BK, Lokanatha D, Shenoy AM. Aspiration in head and neck cancer patients: a single centre experience of clinical profile, bacterial isolates and antibiotic sensitivity pattern. Indian J Otolaryngol Head Neck Surg. 2013;65(1, Suppl. 1):144-9. http://dx.doi.org/10.1007/s12070-013-0645-7 PMid:24427632.
  29. Xu B, Boero IJ, Hwang L, Le QT, Moiseenko V, Sanghvi PR, et al. Aspiration pneumonia after concurrent chemoradiotherapy for head and neck cancer. Cancer. 2015;121(8):1303-11. http://dx.doi.org/10.1002/cncr.29207 PMid:25537836.
  30. Hashida N, Shamoto H, Maeda K, Wakabayashi H, Suzuki M, Fujii T. Rehabilitation and nutritional support for sarcopenic dysphagia and tongue atrophy after glossectomy: A case report. Nutrition. 2017;35:128-31. http://dx.doi.org/10.1016/j.nut.2016.11.003 PMid:28241980.
  31. Starmer HM. Dysphagia in head and neck cancer: prevention and treatment. Curr Opin Otolaryngol Head Neck Surg. 2014;22(3):195-200. http://dx.doi.org/10.1097/MOO.0000000000000044 PMid:24614062.
  32. De Felice F, Tombolini V, Vincentiis M, Magliulo G, Greco A, Valentini V, et al. Multidisciplinary team in head and neck cancer: a management model. Med Oncol. 2019;36(1):2. http://dx.doi.org/10.1007/s12032-018-1227-z PMid:30426243.
  33. Clarke P, Radford K, Coffey M, Stewart M. Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S176-80. http://dx.doi.org/10.1017/S0022215116000608 PMid:27841134.
  34. Messing BP, Ward EC, Lazarus C, Ryniak K, Kim M, Silinonte J, et al. Establishing a multidisciplinary head and neck clinical pathway: an implementation evaluation and audit of dysphagia-related services and outcomes. Dysphagia. 2019;34(1):89-104. http://dx.doi.org/10.1007/s00455-018-9917-4 PMid:29922848.
  35. Taberna M, Gil Moncayo F, Jane-Salas E, Antonio M, Arribas L, Vilajosana E, et al. The Multidisciplinary Team (MDT) approach and quality of care. Front Oncol. 2020;10:85. http://dx.doi.org/10.3389/fonc.2020.00085 PMid:32266126.
  36. Lazarus CL, Husaini H, Falciglia D, DeLacure M, Branski RC, Kraus D, et al. Effects of exercise on swallowing and tongue strength in patients with oral and oropharyngeal cancer treated with primary radiotherapy with or without chemotherapy. Int J Oral Maxillofac Implants. 2014;43(5):523-30. http://dx.doi.org/10.1016/j.ijom.2013.10.023 PMid:24332586.
  37. Gautam AP, Fernandes DJ, Vidyasagar MS, Maiya AG, Vadhiraja BM. Low level laser therapy for concurrent chemoradiotherapy induced oral mucositis in head and neck cancer patients - a triple blinded randomized controlled trial. Radiother Oncol. 2012;104(3):349-54. http://dx.doi.org/10.1016/j.radonc.2012.06.011 PMid:22884841.
  38. Paim ED, Berbert MCB, Zanella VG, Martins VB, Macagnan FE. Effects of transcutaneous electrical nerve stimulation on the salivary flow of patients with hyposalivation induced by radiotherapy in the head and neck region: a randomised clinical trial. J Oral Rehabil. 2019;46(12):1142-50. http://dx.doi.org/10.1111/joor.12851 PMid:31251407.
  39. Peng G, Masood K, Gantz O, Sinha U. Neuromuscular electrical stimulation improves radiation-induced fibrosis through Tgf-B1/MyoD homeostasis in head and neck cancer. J Surg Oncol. 2016;114(1):27-31. http://dx.doi.org/10.1002/jso.24265 PMid:27144672.
  40. Law T, Lee KY, Wong RW, Leung Y, Ku PK, Wong EW, et al. Effects of electrical stimulation on vocal functions in patients with nasopharyngeal carcinoma. Laryngoscope. 2017;127(5):1119-24. http://dx.doi.org/10.1002/lary.26243 PMid:27859286.
  41. Murad MH, Mustafa RA, Schünemann HJ, Sultan S, Santesso N. Rating the certainty in evidence in the absence of a single estimate of effect. Evid Based Med. 2017;22(3):85-7. http://dx.doi.org/10.1136/ebmed-2017-110668 PMid:28320705.
  42. Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, et al. GRADE guidelines 6. Rating the quality of evidence--imprecision. J Clin Epidemiol. 2011;64(12):1283-93. http://dx.doi.org/10.1016/j.jclinepi.2011.01.012 PMid:21839614.
     
646f828ba95395046c6fab42 codas Articles

CoDAS

Share this page
Page Sections