Chronic swallowing ability in nasopharyngeal cancer survivors after radiotherapy with or without chemotherapy

Abstract

In light of the lack of multidimensional data of long-term swallowing functions in nasopharyngeal cancer (NPC) survivors, the current study investigated NPC survivors’ long-term swallowing dysfunctions after radiotherapy or chemoradiation by a multidimensional protocol and explored their relationships with demographic and treatment-related variables. Twenty-seven participants were recruited and assessed through oromotor assessment, fiberoptic endoscopic evaluation of swallowing and quality-of-life questionnaires. Nearly half of the participants had oromotor deficits (47.6%) and penetration in at least one of the swallowing trials (45.8%). All participants had pharyngeal residue in valleculae and most participants have residue in pyriform sinuses (81.8%) in at least one of the swallowing trials. Limitations in the activity and participation domains were prevalent though large variation in functioning was noted. Comparison between groups indicated that participants treated with concurrent chemotherapy have significantly less degree of penetration or aspiration and less residue in valleculae on oral trials for extra thick liquid than those treated with radiotherapy alone. Correlation analysis indicated that degree of penetration in thin liquid, mildly thick liquid and amount of residue residing on valleculae in extra thick liquid increase with the number of years since completion of radiotherapy. Functioning in the activity and participation domains also decreased with time since completion of radiotherapy. Regression analysis indicated that number of years since completion of radiotherapy was a significant predictor for pharyngeal residue. The deteriorating trend identified provided evidence to the need of continuous monitoring in swallowing functions in nasopharyngeal cancer survivors. Further research to identify risk factors for long-term swallowing problems and ways to minimize long-term swallowing problems are neededfor early identification and maximising swallowing functions for nasopharyngeal cancer survivors.