Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Purpose: Radiation therapy (RT) is an effective treatment for head-and-neck cancer (HNC). However, dysphagia has been noted as a principal side effect, diminishing patient quality of life. Swallowing rehabilitation programs (SRPs) are a mainstay of dysphagia treatment, but patient adherence may be low, primarily due to pain.
Motor imagery (MI), the mental execution of a movement without any corresponding muscle activation, has shown promise in improving SRP adherence. This study aims to investigate the efficacy of MI combined into SRPs for HNC patients undergoing RT.
Methods: Participants with HNC receiving RT were divided into experimental and control groups. The experimental group engaged in daily physical swallowing exercises for the first three weeks of RT, followed by MI exercises for the remainder of treatment. Regardless of modality, patients were instructed to complete their exercises once daily, 5 times per week. Outcomes of pain, feeding tube dependency, swallowing quality of life, and weight were assessed at baseline before RTRT, end of RT, and at three- and six-months post-treatment. Data for the control group, which received institutional standard of care (speech therapy consultations and traditional physical swallowing exercises) was collected retrospectively at similar timepoints.
Six outcomes were analyzed: pain score, morphine milligram equivalents (MME) prescribed, feeding tube dependency, weight change and two quality of life indicators: incidence of coughing when drinking liquids and comfort eating with others.
Results: Twenty patients received MI therapy while 36 were in the control group. Both groups displayed a variety of HNC subtypes. In the MI group, one patient had thyroid carcinoma while the remainder of patients had squamous cell carcinoma (SCC). The most common subsite was supraglottic (25%). All patients in the control group had SCC with the most common subsite being oropharyngeal (53%). Average age across the whole cohort was 59.4 years (SD=11.6). Thirty-six patients had Stage III/IV cancer (60% of MI group, 66% of control group). Forty-three patients underwent chemotherapy in addition to RT (55% of MI group, 89% of control group). The MI group showed a mean pain score reduction of 0.67 points at the 6-month post-treatment time point as compared to control (p=0.23). Log-transformed analysis showed a 67% decrease in expected MME prescribed to the MI group (p=0.17). The estimated mean change in weight for the MI group was 36.85lbs higher than the control group at 6 months post-treatment (p=0.01). The MI group had 82% lower odds of needing a feeding tube (OR=0.18, p=0.17) and significantly lower feeding tube placements (p<0.0001). Additionally, they exhibited 25% lower estimated odds of coughing when drinking liquids (OR=0.75, p=0.57) and 32% lower odds of difficulty eating with others (OR=0.68, p=0.55).
Conclusions: MI therapy correlates with positive patient outcomes—decreased pain scores, increased weight, decreased MME prescriptions, lower feeding tube reliance, and better QoL indicators. However, many of these results were not statistically significant, likely due to the small sample size of the study. Multicenter initiatives with larger sample sizes are needed to further expound on the potential of MI as a treatment for RT-related dysphagia.