. 2021 Feb;278(2):577-616.

doi: 10.1007/s00405-020-06507-5. Epub 2020 Dec 19.

European white paper: oropharyngeal dysphagia in head and neck cancer

Laura W J Baijens^{1

2}, Margaret Walshe³, Leena-Maija Aaltonen⁴, Christoph Arens⁵, Reinie Cordier^{6

7}, Patrick Cras⁸, Lise Crevier-Buchman⁹, Chris Curtis¹⁰, Wojciech Golusinski¹¹, Roganie Govender¹², Jesper Grau Eriksen¹³, Kevin Hansen¹⁴, Kate Heathcote¹⁵, Markus M Hess^{16

17}, Sefik Hosal¹⁸, Jens Peter Klussmann¹⁴, C René Leemans^{19

20}, Denise MacCarthy²¹, Beatrice Manduchi³, Jean-Paul Marie²², Reza Nouraei²³, Claire Parkes²⁴, Christina Pflug¹⁷, Walmari Pilz^{25

26}, Julie Regan³, Nathalie Rommel²⁷, Antonio Schindler²⁸, Annemie M W J Schols²⁹, Renee Speyer^{6

7

30

31}, Giovanni Succo^{32

33}, Irene Wessel³⁴, Anna C H Willemsen^{35

29

36}, Taner Yilmaz³⁷, Pere Clavé^{38

39}

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. laura.baijens@mumc.nl.
² GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands. laura.baijens@mumc.nl.
³ Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland.
⁴ Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
⁵ Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany.
⁶ Department of Special Needs Education, University of Oslo, Oslo, Norway.
⁷ School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia.
⁸ Department of Neurology, Born Bunge Institute, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.
⁹ Voice, Speech, Swallowing Lab, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UVSQ and Research lab CNRS-UMR7018, Hôpital Foch, Suresnes, France.
¹⁰ Swallows Head and Neck Cancer Charity, Blackpool, UK.
¹¹ Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland.
¹² Head and Neck Cancer Centre, University College London Hospital, London, UK.
¹³ Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
¹⁴ Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany.
¹⁵ Robert White Centre for Airway, Voice and Swallow, Poole Hospital NHS Foundation Trust, Dorset, UK.
¹⁶ Deutsche Stimmklinik, Hamburg, Germany.
¹⁷ Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁸ Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Atılım University, Medicana International Ankara, Ankara, Turkey.
¹⁹ Department of Otolaryngology, Head and Neck Surgery, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands.
²⁰ Cancer Center Amsterdam, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands.
²¹ Division of Restorative Dentistry and Periodontology, Faculty of Health Sciences, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland.
²² Department of Otorhinolaryngology, Head and Neck Surgery, Rouen University Hospital, Rouen, France.
²³ Department of Ear Nose and Throat Surgery, The Robert White Centre for Airway Voice and Swallowing, Poole Hospital NHS Foundation Trust, University of Southampton, Southampton, UK.
²⁴ Department of Speech and Language Therapy, St. James's Hospital, Dublin, Ireland.
²⁵ Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
²⁶ MHeNs School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
²⁷ Department Neurosciences, Experimental Otorhinolaryngology, Deglutology, University of Leuven, Leuven, Belgium.
²⁸ Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy.
²⁹ Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
³⁰ Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
³¹ Faculty of Health, School of Health and Social Development, Victoria, Australia.
³² Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy.
³³ Department of Oncology, University of Turin, Orbassano, TO, Italy.
³⁴ Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
³⁵ GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
³⁶ Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
³⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
³⁸ Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.
³⁹ Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.

PMID: 33341909
PMCID: PMC7826315
DOI: 10.1007/s00405-020-06507-5

European white paper: oropharyngeal dysphagia in head and neck cancer

Laura W J Baijens et al. Eur Arch Otorhinolaryngol. 2021 Feb.

. 2021 Feb;278(2):577-616.

doi: 10.1007/s00405-020-06507-5. Epub 2020 Dec 19.

Authors

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. laura.baijens@mumc.nl.
² GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands. laura.baijens@mumc.nl.
³ Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland.
⁴ Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
⁵ Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany.
⁶ Department of Special Needs Education, University of Oslo, Oslo, Norway.
⁷ School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia.
⁸ Department of Neurology, Born Bunge Institute, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.
⁹ Voice, Speech, Swallowing Lab, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UVSQ and Research lab CNRS-UMR7018, Hôpital Foch, Suresnes, France.
¹⁰ Swallows Head and Neck Cancer Charity, Blackpool, UK.
¹¹ Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland.
¹² Head and Neck Cancer Centre, University College London Hospital, London, UK.
¹³ Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
¹⁴ Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany.
¹⁵ Robert White Centre for Airway, Voice and Swallow, Poole Hospital NHS Foundation Trust, Dorset, UK.
¹⁶ Deutsche Stimmklinik, Hamburg, Germany.
¹⁷ Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁸ Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Atılım University, Medicana International Ankara, Ankara, Turkey.
¹⁹ Department of Otolaryngology, Head and Neck Surgery, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands.
²⁰ Cancer Center Amsterdam, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands.
²¹ Division of Restorative Dentistry and Periodontology, Faculty of Health Sciences, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland.
²² Department of Otorhinolaryngology, Head and Neck Surgery, Rouen University Hospital, Rouen, France.
²³ Department of Ear Nose and Throat Surgery, The Robert White Centre for Airway Voice and Swallowing, Poole Hospital NHS Foundation Trust, University of Southampton, Southampton, UK.
²⁴ Department of Speech and Language Therapy, St. James's Hospital, Dublin, Ireland.
²⁵ Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
²⁶ MHeNs School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
²⁷ Department Neurosciences, Experimental Otorhinolaryngology, Deglutology, University of Leuven, Leuven, Belgium.
²⁸ Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy.
²⁹ Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
³⁰ Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
³¹ Faculty of Health, School of Health and Social Development, Victoria, Australia.
³² Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy.
³³ Department of Oncology, University of Turin, Orbassano, TO, Italy.
³⁴ Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
³⁵ GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
³⁶ Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
³⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
³⁸ Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.
³⁹ Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.

PMID: 33341909
PMCID: PMC7826315
DOI: 10.1007/s00405-020-06507-5

Abstract

Purpose: To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe.

Methods: Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion.

Results: Twenty-four sections on HNC-specific OD topics.

Conclusion: This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.

Keywords: Deglutition; Dysphagia; Head and neck cancer; Swallowing; White paper.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

Figures

**Fig. 1**
Shear thinning and amylase resistance of a xanthan gum-based (XGB) and a starch-based (SB) thickening agent. Note the shear thinning between 50 s⁻¹ and 300 s⁻¹ is quite comparable between XGB and SB agents; however, the reduction of viscosity caused by 30 s incubation with salivary amylase is much higher for the SB thickening agent

**Fig. 2**
The ESSD proposes to go further than just the use of a descriptive classification of viscosity levels and therefore recommends that manufacturers of thickening agents also include the viscosity values in Système Internationale d’Unités (SI) units (mPa s) into the labels of thickening agents as presented by this example

See this image and copyright information in PMC

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European white paper: oropharyngeal dysphagia in head and neck cancer

Affiliations

European white paper: oropharyngeal dysphagia in head and neck cancer

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