Page 223 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

ENGLISH SUMMARY
The objective of this thesis was to further explore functional impairment in patients treated for head and neck cancer (HNC), find relevant risk factors for functional loss and aid in the improvement of rehabilitation to improve quality of life of HNC survivors.
Chapter 1 provides a general introduction on the epidemiology of HNC, it’s treatment, the associated (functional) toxicities, and rehabilitation strategies. Despite the efforts put into minimalizing the toxicity of treatment in combination with the optimization of individualized training programs, the impaired functions of the head and neck area are still important issues in the lives of HNC survivors, suggesting considerable room for optimization.
In Chapter 2, surgery and radiotherapy (RT) for early-stage stage (T1-2N0-2bM0) oropharyngeal carcinoma are compared with respect to patient-reported swallowing function, to enable informed decisions on treatment choice and inform patients prior to treatment on the likely outcome of their intended treatment. For this purpose, data from an existing large UK- wide multicentre prospective cohort study (HN5000) was used. Patients offered RT (n = 150) had less favorable baseline characteristics than those offered surgery (n = 150). At 12-month follow-up, RT participants reported more swallowing problems (35% vs. 23%, risk ratio 1.3; 95% confidence interval 0.8–2.3, p = .277) in models adjusted for baseline characteristics. In those allocated to surgery who received adjuvant therapy (n = 78, 52%), the proportion with swallowing problems was similar to those allocated to RT alone. We concluded that participants offered surgery alone had similar mortality but less impaired swallowing, although the latter was statistically not significant. However, over half of participants offered surgery alone also received adjuvant radiotherapy, negating the slight advantage of surgery alone. Therefore, more effort should be put into defining the indications for postoperative RT and selecting the patients for surgery who most likely will not need adjuvant therapy.
Several methods are available to evaluate swallowing function, including objective as well as subjective methods. Objective swallowing outcomes measure the physical swallowing function while subjective outcomes measure swallowing perception. A test for swallowing capacity, measuring the ingestion of all consistencies, was not yet available. Therefore, the Swallowing Proficiency for Eating And Drinking (SPEAD) test was developed, which entails the timed ingestion of thin liquid, thick liquid and solid, presented in Chapter 3. The feasibility, reliability and validity of the SPEAD-test were evaluated in 38 patients with dysphagia after treatment for head and neck cancer (HNC) and 40 healthy participants. Test-retest, intra-rater and interrater reliability of ingestion duration was good to excellent. All hypotheses with regard to magnitude and direction of correlations with objective (e.g., videofluoroscopy and functional oral intake scale) and subjective (e.g., swallowing related quality of life questionnaire) swallowing outcomes were confirmed, supporting construct validity of the test. Results of this development and initial validation study suggest that the SPEAD-test reliably measures the transport capacity of the upper digestive tract (in grams per second) and that this test can be useful to objectively evaluate and monitor the swallowing capacity in HNC patients, in both research as well as daily clinical practice.
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English Summary
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