Int J Radiat Oncol Biol Phys. 2021 Nov 1;111(3S):e408-e409. doi: 10.1016/j.ijrobp.2021.07.1176.
ABSTRACT
PURPOSE/OBJECTIVE(S): The investigators' 2013 use it or lose it study suggested functional benefit of two pharyngeal activities during head and neck radiotherapy (RT) - maintenance of oral intake (EAT) and swallowing exercise. EAT and EXERCISE independently associated with better odds of resuming a regular diet in long term survivorship and shorter duration of gastrostomy (FT) d ependence. The prior work is limited by the retrospective nature of the dataset and historically far higher FT utilization. Our aim was to validate the previous work in a contemporary cohort of oropharyngeal cancer (OPC) survivors treated with RT using prospectively acquired validated outcome measures.
MATERIALS/METHODS: Endpoints included subacute diet after RT per the performance status scale for head and neck cancer (PSS-HN; solid food diet coded as ≥60 and no FT) and length of FT-dependence in days. Primary independent variables included oral intake (PO) at the end of RT (nothing per oral/NPO; partial PO; full PO) and swallow exercise adherence. Multiple linear regression and logistic regression models were analyzed adjusting for tumor location, baseline diet, chemotherapy and N and T stage.
RESULTS: Analysis included 595 patients treated with primary radiotherapy (RT; 19% 111) /chemoradiation (CRT; 73% 434) or primary TORS + CRT (8% 50) for OPC (base of tongue/glo ssopharyngeal sulcus [46% 276]; tonsil [44% 263]; other [9% 56]). At the end of RT 9% of patients were NPO (55), 19% partial PO (115), 71% full PO (425). Statistically significant (P < 0.05) covariates for EAT and/or EXERCISE included tumor location, chemotherapy, N and T stage. Fifty-seven percent of patients (340) reported adherence to swallow exercises. Overall, 66% (394) of patients returned to a solid diet by 3-6 months. In adjusted models, EAT and EXERCISE during RT were independently, significantly (P < 0.01) associated with sub-acute diet recovery and FT duration. Patients who maintained full PO during RT were 2.5 times more likely to eat a solid diet by 3-6 months (OR 2.5, 95% CI: 1.3, 5) when compared to those who were NPO during treatment. Patients who exercised were 2.9 times more likely to return to a solid diet (OR 2.9, 95% CI: 1.8, 4.4) relative to those who did not. Thirty-eight percent of patients received a FT (231) and the median duration of tube dependence was 89 days (IQR: 28-142). EAT was independently associated with FT duration (P < 0.001, Coefficient, -123.6, 95% CI: -148.7, -98.4), while EXERCISE was not (P = .73).
CONCLUSION: These prospective registry data validate prior work that indicate independent benefit of EAT and swallowing EXERCISE adherence during RT on subacute functional outcomes. Patients who maintained full PO and/or exercise were more likely to eat solid foods by 3-6 months after treatment, while patients who EAT during treatment expectedly have the shortest feeding tube dependence.
PMID:34701381 | DOI:10.1016/j.ijrobp.2021.07.1176
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