Maintaining oral intake of food and participating in swallowing exercises during radiotherapy for oropharynx cancer (OPC) correlated with favorable functional outcomes in both the subacute and long-term phases, according to findings published in JAMA Otolaryngology— Head and Neck Surgery. Katherine A. Hutcheson, PhD, and colleagues conducted a secondary analysis of a prospective OPC registry of patients who underwent primary radiotherapy (RT)/chemoradiotherapy (CRT) or primary transoral robotic surgery plus RT/ CRT for OPC. Adherence to the speech pathology swallowing intervention during RT was coded as (1) eating at the end of RT—nothing by mouth (NPO); partial oral (PO) intake with feeding tube (FT) supplementation; or full PO—and (2) adherence to swallowing exercises, specifically non-adherent versus partially/fully adherent. At baseline, 3-6 months, andn18-24 months post-RT, Dr. Hutcheson and team obtained data on feeding tube and diet (Performance Status Scale for Head and Neck Cancer), patient-reported swallowing-related QOL (MD Anderson Dysphagia Inventory [MDADI]), and clinician-graded dysphagia severity (video fluoroscopic Dynamic Imaging Grade of Swallowing Toxicity [DIGEST]). Among 595 patients (mean age, 65; 89% male), 73% underwent CRT, 19% underwent primary RT, and 8% underwent primary transoral robotic surgery plus RT/CRT. At the end of RT, 55 patients were NPO (9%), 115 were partial PO (19%), 425 were full PO (71%), and 340 reported exercise adherence (57%). Following multivariate adjustment, subacute return to solid diet and FT were independently associated with oral intake (ORs, 2.0 and 0.1, respectively) and exercise (ORs, 2.9 and 0.3, respectively). Subacute MDADI (β=6.5), FT duration (days; β=−123.4), and less severe dysphagia per DIGEST (OR, 0.6) were independently associated with oral intake, while exercise was independently associated with less severe laryngeal penetration/aspiration per DIGEST-safety (OR, 0.7). DIGEST grade associations with oral intake were not maintained in the long-term, although exercise was associated with an increased likelihood of solid diet and better swallowing safety per DIGEST.
