Swallowing Outcomes In Head And Neck Cancer At One Year
For patients with head and neck cancer receiving radiation therapy, dysphagia can emerge early and persist as a chronic or late complication. Swallowing exercises and maintaining oral intake during treatment are often recommended to protect swallowing outcomes in head and neck cancer, yet long-term effects of adherence have been less clear. This secondary analysis of a randomized controlled trial evaluated whether adherence to prescribed swallowing exercises and feeding tube use during definitive radiation-based treatment influenced one-year swallowing outcomes.
The cohort included 64 participants with one-year follow up after radiation therapy. Adherence was defined as completing at least half of the prescribed swallowing exercise sessions during treatment. Feeding tube use during treatment was prospectively recorded. Swallowing outcomes at one year were assessed using patient-reported and clinician-rated measures, including the MD Anderson Dysphagia Inventory, the Performance Status Scale for Head and Neck, the Functional Oral Intake Scale, the Penetration Aspiration Scale, the Modified Barium Swallow Impairment Profile, and the Dynamic Imaging Grade of Swallowing Toxicity.
Exercise Adherence Linked To Better Patient-Reported Function
Only 26 of 64 participants, or 41%, met the adherence threshold for swallowing exercises. However, these adherent patients reported more favorable swallowing outcomes in head and neck cancer one year after treatment. Mean MD Anderson Dysphagia Inventory scores were more normal in the adherent group compared with the nonadherent group, with scores of 91 versus 80 respectively, and a statistically significant difference. Normalcy of diet scores on the Performance Status Scale for Head and Neck were also higher among adherent patients, indicating broader dietary intake and greater functional oral intake in daily life.
These findings support the clinical practice of prescribing and reinforcing structured swallow therapy during radiation, and suggest that engaging patients in at least half of planned exercise sessions may translate into meaningful benefits in perceived swallowing function and diet at one year.
Feeding Tube Use And Physiologic Swallowing Measures
Feeding tube use during treatment was documented in 8 of 64 participants, representing 12% of the cohort, and only one patient continued to use a feeding tube at one year. Feeding tube placement during treatment was associated with worse outcomes on several physiologic swallowing measures. Patients with feeding tubes had higher maximum Penetration Aspiration Scale scores and worse Dynamic Imaging Grade of Swallowing Toxicity safety and overall grades. They also showed higher pharyngeal composite scores on the Modified Barium Swallow Impairment Profile, indicating more pronounced pharyngeal swallow impairment.
Although feeding tube use likely reflects patients with more severe treatment toxicity or disease burden, these associations emphasize the importance of early swallow therapy, proactive dysphagia management, and careful decision making around feeding tube timing. Taken together, the study suggests that adherence to swallowing exercises and, where clinically safe, avoidance of feeding tube placement may help preserve longer-term swallowing outcomes in head and neck cancer.
Reference: Starmer H et al. One-year Swallowing Outcomes in a Head and Neck Cancer Cohort: The Impact of Adherence to Swallowing Exercises and Feeding Tube Use. Dysphagia. 2025;doi:10.1007/s00455-025-10918-z.
