Aspiration Risk Assessment Recommended for Patients with Head and Neck Cancer
According to an article recently published in the Archives of Otolargynology – Head and Neck Surgery, patients with head and neck cancer who are undergoing chemotherapy and radiation therapy have high rates of impaired ability to swallow, causing them to suck food or liquid particles through their vocal cords (aspiration).
Head and neck cancers originate in the oral cavity (lip, mouth, and tongue), salivary glands, paranasal sinuses, and nasal cavity, pharynx (upper back part of the throat), larynx (voice box), and lymph nodes in the upper part of the neck. Worldwide, head and neck cancer is diagnosed in approximately 640,000 people annually and is responsible for approximately 350,000 deaths each year.
Chemotherapy and radiation therapy are common treatment approaches for patients with head and neck cancer. These treatments are, however, associated with side effects, some of which impair ability to swallow. When swallowing is impaired, there is a risk of aspiration, often thought of as food or liquids going “down the wrong tube.” Aspiration can cause coughing, choking, and airway obstruction. Aspirated particles may also get sucked into the lungs, where they can cause serious infection. Testing a patient’s ability to swallow correctly may allow for therapy to teach effective swallowing techniques or monitoring during feeding or drinking times.
Researchers from Chicago recently conducted a clinical study in an attempt to determine the frequency of swallowing problems among patients with head and neck cancer who were treated with radiation therapy and chemotherapy. The study included 118 patients who underwent therapy between 1998 and 2002.
- 69% of patients demonstrated aspiration within the first year following therapy with chemotherapy and radiation therapy.
- 75% of these patients reported no symptoms of coughing or choking.
- Patients with cancer of the larynx and hypopharynx were most likely to aspirate.
The researchers concluded: “All patients with advanced [head and neck cancer] should undergoinstrumental swallow assessment, even in the absence of symptoms,to detect subclinical aspiration and to institute therapeutic maneuvers and swallow precautions as well as to determine thesafety of oral feeding.” Patients with head and neck cancer may wish to speak with their healthcare provider about a swallow assessment to determine their risk of aspiration.
Reference: Langerman A, MacCracken E, Kasza K, et al. Aspiration in chemoradiated patients with head and neck cancer. Archives of Otolaryngology – Head and Neck Surgery. 2007;133:1289-1295.