Deglutition Disorders, Head and Neck Neoplasms
Conditions
Keywords
oropharyngeal cancer, laryngeal cancer, swallow, chemoradiation, expiratory muscle strength training
Brief summary
This study is a randomized trial examining the impact of expiratory muscle strength training (EMST) on maintenance of safe and efficient oropharyngeal swallow function in persons with cancer of the head and neck (HNCA) undergoing treatment with radiation therapy or chemoradiotherapy (RT/CRT).
Detailed description
Thirty (30) persons with newly-diagnosed HNCA who will be treated with RT/CRT will be randomized to an 8-week program of either Active Expiratory Muscle Strength Training (EMST) + Standard Care or Sham EMST + Standard Care in order to examine the impact of EMST on swallowing function. The training program will consist of 5 sets of 5 breaths, 5 days per week for 8 weeks, coincident with RT/CRT. Patients randomized to the Active EMST group will use the EMST150 (product name) expiratory muscle strength trainer according to package instructions. Those randomized to the Sham EMST group will use an EMST150 device that has been modified to eliminate resistance to airflow. All subjects will be evaluated prior to initiation of cancer treatment (baseline assessment), 4 weeks into cancer treatment and again at the completion of cancer treatment (8 weeks after initiation of treatment). Assessment will include measurement of maximum expiratory pressure (MEP), a videofluoroscopic swallow study (VFSS) to objectively document swallow function, and administration of swallow-related quality of life (QOL) questionnaires.
Interventions
OTHEREMST
Expiratory muscle strength training (EMST) is an exercise program designed to strengthen the muscles of expiration by increasing expiratory load during breathing exercises using either resistive or pressure threshold devices. The EMST150 is a commercially-available device considered non-significant risk (NSR). The EMST150 device will be used for this study.
Sponsors
Froedtert Hospital
Medical College of Wisconsin
University of Wisconsin, Milwaukee
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
Subjects will not know whether the device that they are given has a functioning valve spring or whether the valve spring has been removed. Researchers assessing the outcomes will not know the arm to which the subject was randomized.
Intervention model description
Subjects will be randomized to an 8-week program of either Active Expiratory Muscle Strength Training (EMST) + Standard Care or Sham EMST + Standard Care in order to examine the impact of EMST on swallowing function.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* New diagnosis of cancer in the oral cavity, oropharynx, hypopharynx, or larynx; * Planned treatment with primary radiotherapy with or without chemotherapy; * Age 18 or older and able to provide consent; * Ability to use the EMST150 device (hold in mouth and maintain lip seal)
Exclusion criteria
* Primary surgery to the head and neck (neck dissection is permitted); * Unknown primary tumor; * Primary cancers of the nasopharynx, paranasal sinuses, salivary glands and skin. * Progressive neurologic condition affecting muscle strength (e.g. amyotrophic lateral sclerosis (ALS), Parkinson's disease) * Dysphagia not related to HNCA (e.g. unresolved swallowing difficulty post-stroke or post--traumatic brain injury (TBI)) * Prior history of head and neck radiotherapy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feeding-tube-free food intake (days) | 8 weeks | the number of days from the beginning of the study until change in feeding status from 100% oral intake to combined oral intake and tube intake and/or 100% tube feeding will be calculated |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Penetration-Aspiration Scale rating (number) | 8 weeks | From Videofluoroscopic Swallow Studies (VFSS), change in Penetration-Aspiration scale score will be determined from baseline to mid-treatment to post-treatment. Penetration-Aspiration Scale is an 8-point ordinal rating scale. |
| Timing of Aspiration (category) | 8 weeks | From Videofluoroscopic Swallow Studies (VFSS), timing of aspiration will be determined from baseline to mid-treatment to post-treatment. Timing is identified as a category, either before, during, or after. |
| Presence of pharyngeal residue (dichotomous) | 8 weeks | From Videofluoroscopic Swallow Studies (VFSS), the presence of residue in the pharynx (yes or no) will be determined from baseline to mid-treatment to post-treatment. |
| Extent of hyoid movement (mm) | 8 weeks | From Videofluoroscopic Swallow Studies (VFSS), the change in extent of hyoid movement in mm will be determined from baseline to mid-treatment to post-treatment. |
| Upper esophageal sphincter (UES) opening width (mm) | 8 weeks | From Videofluoroscopic Swallow Studies (VFSS), the change in width of UES opening width in mm will be determined from baseline to mid-treatment to post-treatment. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Eating Assessment Tool (EAT-10) (number) | 8 weeks | Change in score on the EAT-10 will be calculated from baseline to mid-treatment to post-treatment. EAT-10 is an ordinal rating scale with values that range from 0 to 40, with lower score reflecting better function. |
| M.D. Anderson Dysphagia Inventory (MDADI) (number) | 8 weeks | Change in scores on the M.D. Anderson Dysphagia Inventory (MDADI) will be calculated from baseline to mid-treatment to post-treatment. MDADI consists of four ordinal rating scales with scores ranging from 0 to 100 with higher score reflecting better function. |
Countries
United States
Contacts
Primary ContactBarbara Pauloski, Ph.D.
Backup ContactStephanie Stevens, M.S.
Outcome results
None listed