JAMA Otol Logo Orlando 2013 AHNS Meeting Location
American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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Presentation: S008
Topic: Clinical - Outcomes Research
Type: Oral Presentation
Date: Wednesday, April 10, 2013
Session: 01:30 PM - 02:30 PM Reconstruction / Oropharynx / HPV
Authors: Katherine A Hutcheson, PhD, Mihir K Bhayani, MD, Beth M Beadle, MD, PhD, Kathryn A Gold, MD, Eileen H Shinn, PhD, Stephen Y Lai, MD, PhD, Jan S Lewin, PhD
Institution(s): The University of Texas MD Anderson Cancer Center, The University of Chicago Pritzker School of Medicine

BACKGROUND: Data support proactive swallowing therapy during radiotherapy (RT) or chemoradiotherapy (CRT). The benefits of both swallowing exercise and maintenance of oral intake throughout treatment are reported, but independent effects are unclear.

METHODS: We conducted a retrospective study of patients treated with definitive RT or CRT for oropharyngeal cancer (2003-2008). Exclusion criteria were palliative RT, postoperative RT, dose <66Gy, or incomplete response at the primary site. Primary outcomes were length of gastrostomy-dependence and diet level ≥12-months after RT/CRT. Primary independent variables included per oral (PO) status at the end of RT/CRT (nothing per oral [NPO], partial PO, complete PO) and swallowing exercise adherence per medical records. Multiple linear regression and ordered logistic regression models were analyzed.

RESULTS: Four hundred fifty-eight patients were included. At the conclusion of RT/CRT, 119 (26%) were NPO, 151 (33%) were partially PO, and 185 (40%) were completely PO. Fifty-seven percent (259/458) reported adherence to swallowing exercises. Maintenance of PO intake during RT/CRT and swallowing exercise adherence were independently associated (p<0.05) with higher diet levels ≥12-months after RT/CRT and shorter length of gastrostomy dependence in models adjusted for tumor stage and concurrent chemotherapy. The proportion of patients returning to a regular diet ≥12-months after RT was: 67% of those who were NPO during RT and did not perform exercises, 83% who either performed swallowing exercises or maintained some PO throughout RT, and 91% who were both adherent and maintained complete PO during RT/CRT (p=0.001). Among 285 patients who received a PEG, median PEG dependence was 219 days among those who were NPO and did not perform exercises, 141-153 days among those who either maintained some PO throughout RT/CRT or performed swallowing exercises, and 101 days among those who both maintained some PO and performed swallowing exercises (p=0.043).

CONCLUSIONS: Data indicate an independent association between swallowing exercise adherence and maintenance of PO intake throughout RT/CRT with long-term swallowing outcomes. Patients who either eat or exercise fare better than those who do neither. Patients who both eat and exercise have the highest return to a regular diet and least gastrostomy dependence.

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