Background

Head and neck cancer treatment destroys nerves and/or organs associated with swallowing. Previous studies have investigated the efficacy of exercises for muscles used in swallowing before treatment in reducing disuse atrophy and delaying the occurrence of muscle fibrosis. However, the rehabilitation effects of training and the optimal intervention strategy are unknown.

Objectives

To establish evidence for the efficacy of prophylactic swallowing interventions in reducing aspiration and restoring oral intake in patients with head and neck cancer with dysphagia.

Methods

We searched electronic databases (PubMed, Embase, Cochrane and MEDLINE) for studies published up to June 2021 reporting outcomes following prophylactic swallowing interventions in patients with head and neck cancer with dysphagia and the related influencing factors. The methodological quality of the literature was assessed using the Joanna Briggs Institute appraisal tools.

Results

The search identified 1468 articles, and 13 studies were eventually included. Four categories involving 12 different swallowing interventions were classified. Regarding the descriptive analysis of the rehabilitation effects across all studies, in terms of oropharyngeal safety, five studies showed that swallowing interventions reduced the risk of aspiration, penetration or residue. In terms of oral intake and tube feeding dependence, four studies demonstrated reduced time to return to oral intake in the intervention group compared with the control group. In terms of intervention adherence, three studies showed that speech-language pathologist- and nurse-supervised training was a potential promoter of adherence, and five studies showed that the negative factors affecting adherence included pain, fatigue, forgetting, smoking, decreased exercise motivation, side effects of radiotherapy and distance to the rehabilitation site.

Conclusions

Preventive swallowing interventions may be effective at reducing aspiration, improving swallowing function, and restoring oral intake. However, due to the lack of standardization and consistency of interventions and measurement results, which prevented the production of a best practice guide, future rigorous methodological trials will be needed to determine the most effective interventions for maximizing exercise adherence over the long term.

中文翻译：

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头颈癌预防性吞咽干预的回顾

背景

头颈癌治疗会破坏与吞咽相关的神经和/或器官。以前的研究调查了治疗前吞咽肌肉锻炼在减少废用性萎缩和延缓肌肉纤维化发生方面的功效。然而，训练的康复效果和最佳干预策略尚不清楚。

目标

建立证据证明预防性吞咽干预在减少吞咽困难的头颈癌患者误吸和恢复口腔摄入方面的有效性。

方法

我们在电子数据库（PubMed、Embase、Cochrane 和 MEDLINE）中搜索了截至 2021 年 6 月发表的研究报告，这些研究报告了头颈癌伴吞咽困难患者预防性吞咽干预后的结果及相关影响因素。使用乔安娜布里格斯研究所评估工具评估文献的方法学质量。

结果

搜索确定了 1468 篇文章，最终纳入了 13 项研究。对涉及 12 种不同吞咽干预的四个类别进行了分类。关于所有研究中康复效果的描述性分析，就口咽安全而言，五项研究表明吞咽干预降低了误吸、穿透或残留的风险。在口服摄入和管饲依赖方面，四项研究表明，与对照组相比，干预组恢复口服摄入的时间缩短。在干预依从性方面，三项研究表明语言病理学家和护士监督的培训是依从性的潜在促进者，五项研究表明影响依从性的负面因素包括疼痛、疲劳、遗忘、吸烟、

结论

预防性吞咽干预可能有效减少误吸、改善吞咽功能和恢复口腔摄入。然而，由于干预措施和测量结果缺乏标准化和一致性，这阻碍了最佳实践指南的产生，未来需要严格的方法学试验来确定最有效的干预措施，以最大限度地长期坚持锻炼。