Self-management intervention improves patient adherence to swallowing exercises during radiation for head and neck cancer

Abstract

Background: While preventive swallowing exercises reduce the risk of radiation-associated dysphagia in patients with head and neck cancer, strategies are needed to improve patient adherence.

Methods: Before radiation, all participants were taught preventive swallowing exercises and randomized to either an adherence intervention or enhanced usual care. During radiation, all participants met twice with a speech pathologist for swallowing assessment and reinforcement of exercises. Intervention participants met weekly with a counselor in-person or by phone. At 6-week post-radiation follow-up, all participants completed a follow-up assessment of self-reported adherence, which was then corroborated with medical record documentation.

Results: Newly diagnosed pharyngeal and laryngeal cancer patients without distant metastases were randomized (n = 265; 135 to intervention, and 130 to usual care). Intervention participants were more likely to adhere to exercises during radiation compared to the control group (p < 0.0001).

Conclusion: The weekly in-person adherence intervention program significantly increased patient's adherence to preventive swallowing exercises during radiation.

Keywords: adherence; coping; psychosocial; radiation; self‐management.

Figure 1.. Planned Mediation and moderation analyses

Planned mediation and moderation analyses. Mediation models were run as unconditional and conditional models. For the conditional models, baseline age, sex, race, education level, marital status, income, chemotherapy status, diseases site, and tumor stage were controlled. Four separate moderation models (one for each moderator) were run by using multiple ordinary least squares regression model including independent variable, moderator, and their interaction (product) term.

Figure 2.. CONSORT