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Comparative Study
. 2013 Nov;139(11):1127-34.
doi: 10.1001/jamaoto.2013.4715.

Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it

Katherine A Hutcheson  1 , Mihir K Bhayani, Beth M Beadle, Kathryn A Gold, Eileen H Shinn, Stephen Y Lai, Jan Lewin
Affiliations
Comparative Study

Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it

Katherine A Hutcheson et al. JAMA Otolaryngol Head Neck Surg. 2013 Nov.

Abstract

Importance: Data support proactive swallowing therapy during radiotherapy (RT) or chemoradiotherapy (CRT) for pharyngeal cancers. The benefits of adherence to a regimen of swallowing exercises and maintaining oral intake throughout treatment are reported, but independent effects are unclear.

Objective: To evaluate the independent effects of maintaining oral intake throughout radiotherapy and adherence to preventive swallowing exercise.

Design: Retrospective observational study.

Setting: The University of Texas MD Anderson Cancer Center, Houston.

Patients: The study included 497 patients treated with definitive RT or CRT for pharyngeal cancer (458 oropharynx, 39 hypopharynx) between 2002 and 2008.

Main outcomes and measures: Swallowing-related end points were final diet after RT or CRT and duration of gastrostomy dependence. Primary independent variables included oral intake status at the end of RT or CRT (no oral intake, partial oral intake, or full oral intake) and adherence to a swallowing exercise regimen. Multiple linear regression and ordered logistic regression models were analyzed.

Results: At the conclusion of RT or CRT, 131 patients (26%) had no oral intake and 74% maintained oral intake (167 partial [34%], 199 full [40%]). Fifty-eight percent (286 of 497) reported adherence to swallowing exercises. Maintenance of oral intake during RT or CRT and swallowing exercise adherence were independently associated with better long-term diet after RT or CRT (P = .045 and P < .001, respectively) and shorter duration of gastrostomy dependence (P < .001 and P = .007, respectively) in models adjusted for tumor and treatment burden.

Conclusions and relevance: The data indicate independent, positive associations of maintenance of oral intake throughout RT or CRT and swallowing exercise adherence with long-term swallowing outcomes. Patients who either eat or exercise fare better than those who do neither. Patients who both eat and exercise have the highest rate of return to a regular diet and shortest duration of gastrostomy dependence.

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Figures

Figure 1
Figure 1
Long-term Diet by Swallowing Groups Greater proportions of patients who performed swallowing exercise and/or maintained PO intake throughout treatment ate a regular diet after RT or CRT (p=0.012). Abbreviations: NPO, nothing per oral, PO, per oral
Figure 2
Figure 2
Gastrostomy Duration by Swallowing Groups Among the 313 patients who received a g-tube, exercise adherence and maintenance of some PO intake at the end of treatment was associated with significantly shorter duration of gastrostomy (p=0.03) Abbreviations: NPO, nothing per oral, PO, per oral
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References

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