Starmer Heather M
Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Curr Opin Otolaryngol Head Neck Surg. 2014 Jun;22(3):195-200. doi: 10.1097/MOO.0000000000000044.
Swallowing difficulties are among the most problematic outcomes associated with head and neck cancer (HNCA) and the strategies employed to treat it. With a rising incidence of human papilloma virus-associated HNCA, a larger number of patients are expected to survive their cancer, and therefore will be more susceptible to long-term treatment toxicities. Optimization of long-term swallowing outcomes is an important objective for those working with patients with HNCA.
The role of the swallowing therapist in the management of patients with HNCA cannot be overstated. This begins with pretreatment evaluation of swallowing. At the time of initial assessment, education should be provided regarding treatment toxicities and the importance of prophylactic swallowing exercises and oral intake. Recent evidence suggests that maintaining an oral diet and engaging in swallowing exercise during radiation have a positive impact on diet level, swallowing physiology, patient-perceived swallowing-related quality of life, and reduced feeding tube use. Although treatment strategies such as radiation de-intensification and transoral surgical treatments show promise for reducing toxicities, evidence regarding their impact is still being amassed.
Maintaining an oral diet and performing prophylactic swallowing exercises are currently the most evidence-based strategies for dysphagia prevention in HNCA.
吞咽困难是头颈癌（HNCA）及其治疗相关的最棘手的后果之一。随着人乳头瘤病毒相关头颈癌发病率的上升，预计会有更多患者从癌症中存活下来，因此他们更容易受到长期治疗毒性的影响。优化长期吞咽结果是头颈癌患者治疗工作的一个重要目标。
吞咽治疗师在头颈癌患者管理中的作用再怎么强调也不为过。这始于吞咽的预处理评估。在初次评估时，应就治疗毒性以及预防性吞咽练习和经口摄入的重要性进行教育。最近的证据表明，在放疗期间保持经口饮食并进行吞咽练习对饮食水平、吞咽生理、患者感知的吞咽相关生活质量以及减少饲管使用有积极影响。尽管诸如放疗减强度和经口手术治疗等治疗策略有望降低毒性，但关于其影响的证据仍在积累中。
目前，保持经口饮食和进行预防性吞咽练习是头颈癌吞咽困难预防最具循证依据的策略。
