Assessment of Swallowing and Neck Dysfunction Post Radiotherapy/Chemo-Radiotherapy in Head and Neck Cancer Patients

Head and Neck Cancer (HNC) is a broad term that includes carcinomas arising from head and neck region and the most common type is squamous cell carcinoma [1]. HNC patients experience treatment-related complications that may interfere with health related quality of life (HRQOL [2]. Cancers of head and neck include malignant tumors of the buccal cavity, larynx, pharynx, thyroid, salivary glands, and nose/nasal passages [3]. Neck disability, impaired neck function, and eating or speaking contribute to decrements in HRQOL [4]. At the time of diagnosis, up to 2/3 of HNC Patients (HNCPs) present with dysphagia. Approximately, one third of dysphagic patients develop aspiration pneumonia requiring treatment, with mortality rates ranging between 20% and 65% [5]. Most troublesome and debilitating side effects of radiotherapy are lethargy, weakness, dry mouth, mouth ulcers and pain, taste changes, and sore throat. The single most debilitating side effect was oropharyngeal mucositis that was characterized by patients as sore throat, and mouth ulcers and pain; both negatively affecting the patient’s ability to eat and drink, causing many patients to experience significant weight loss [6]. A study has shown that many of the treatment related performance and quality of life (QOL) that had declined, resolved in months [7]. The association between neck pain, Neck Disability Index (NDI) and cervical Range of Motion (ROM) showed that NDI is a valid, reliable and internally consistent clinical tool to measure self-reported disability as it relates to patients with neck pain [8]. It objectifies the patient’s subjective experience. The NDI provides us with a starting point to springboard further research possibilities. When compared to other questionnaires, the NDI correlates well with other measures and has similar sensitivity to change and responsiveness, good convergent validity and correlates with pre and post treatment scores [8]. The Gugging Swallowing Screen (GUSS) is presented as a potentially better alternative to other dysphagia screens due to its safer progression of oral intake, more thorough evaluation of swallowing, and ability to enable earlier nutrition [9].