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Original Investigation |

Eat and Exercise During Radiotherapy or Chemoradiotherapy for Pharyngeal Cancers:  Use It or Lose It

Katherine A. Hutcheson, PhD1; Mihir K. Bhayani, MD2; Beth M. Beadle, MD, PhD3; Kathryn A. Gold, MD4; Eileen H. Shinn, PhD5; Stephen Y. Lai, MD, PhD1; Jan Lewin, PhD1
[+] Author Affiliations
1Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston
2Northshore University HealthSystems, Chicago, Illinois
3Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston
4Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
5Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
JAMA Otolaryngol Head Neck Surg. 2013;139(11):1127-1134. doi:10.1001/jamaoto.2013.4715.
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Published online

Importance  Data support proactive swallowing therapy during radiotherapy (RT) or chemoradiotherapy (CRT) for pharyngeal cancers. The benefits of adherence to a regimen of swallowing exercises and maintaining oral intake throughout treatment are reported, but independent effects are unclear.

Objective  To evaluate the independent effects of maintaining oral intake throughout radiotherapy and adherence to preventive swallowing exercise.

Design  Retrospective observational study.

Setting  The University of Texas MD Anderson Cancer Center, Houston.

Patients  The study included 497 patients treated with definitive RT or CRT for pharyngeal cancer (458 oropharynx, 39 hypopharynx) between 2002 and 2008.

Main Outcomes and Measures  Swallowing-related end points were final diet after RT or CRT and duration of gastrostomy dependence. Primary independent variables included oral intake status at the end of RT or CRT (no oral intake, partial oral intake, or full oral intake) and adherence to a swallowing exercise regimen. Multiple linear regression and ordered logistic regression models were analyzed.

Results  At the conclusion of RT or CRT, 131 patients (26%) had no oral intake and 74% maintained oral intake (167 partial [34%], 199 full [40%]). Fifty-eight percent (286 of 497) reported adherence to swallowing exercises. Maintenance of oral intake during RT or CRT and swallowing exercise adherence were independently associated with better long-term diet after RT or CRT (P = .045 and P < .001, respectively) and shorter duration of gastrostomy dependence (P < .001 and P = .007, respectively) in models adjusted for tumor and treatment burden.

Conclusions and Relevance  The data indicate independent, positive associations of maintenance of oral intake throughout RT or CRT and swallowing exercise adherence 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 rate of return to a regular diet and shortest duration of gastrostomy dependence.

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Figure 1.
Long-term Diet by Swallowing Groups

Greater proportions of patients who performed swallowing exercises and/or maintained PO throughout treatment ate a regular diet at the conclusion of radiotherapy or chemoradiotherapy (P = .01). NPO indicates no oral intake; PO, oral intake. Symbols represent means, and error bars represent standard errors. Significant differences between individual subgroups are shown by P values within the figure.

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Figure 2.
Duration of Gastrostomy Dependence by Swallowing Groups

Among the 313 patients who received a gastrostomy tube, exercise adherence and maintenance of some PO at the end of treatment was associated with significantly shorter duration of gastrostomy dependence (P = .03). NPO indicates no oral intake; PO, oral intake.

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