Rehabilitation Interventions in Head and Neck Cancer: A Scoping Review
American Journal of Physical Medicine & Rehabilitation
Cheng, J. T., Ramos Emos, M., et al. (2024).
American Journal of Physical Medicine & Rehabilitation, 103(3S Suppl 1), S62-S71.
This scoping review investigates the effects of rehabilitative interventions for individuals with head and neck cancer (HNC). This summary highlights conclusions within the scope of speech-language pathology.
None declared
January 1, 1990 to January 11, 2023
Interventional studies with experimental and control groups
83
<div>Exercise-based swallowing interventions showed promise for the treatment of dysphagia in adults with HNC. Specific findings included:</div>
<ul>
<li><span style="color: #333333;"><strong>Preventive swallow interventions</strong> (i.e., exercises performed before or during radiation treatment) showed mixed results, ranging from no effects to significant improvements (3 studies). </span></li>
<li><span style="color: #333333;"><strong>Restorative swallow interventions</strong> (i.e., interventions performed following cancer treatment) showed mixed results, ranging from no effects to significant improvements (7 studies). </span></li>
<li><span style="color: #333333;"><strong>Restorative swallowing interventions with adjunctive nerve or sensory stimulation</strong> demonstrated mixed results, ranging from worsened to improved outcomes (6 studies). </span></li>
</ul>
<div><span style="color: #333333;">Limitations of these studies include heterogeneity between studies, small sample sizes, poor treatment adherence, and high dropout rates. Additional, high-quality intervention studies are needed.</span></div>
<div>Jaw interventions (e.g., TheraBite, range of motion exercises) demonstrated mixed effects on trismus in adults with HNC. Specific findings included:</div>
<ul>
<li><strong>Preventative jaw interventions </strong>generally did not increase oral opening (4 out of 5 studies).</li>
<li><strong>Restorative jaw interventions</strong> demonstrated mixed outcomes for both primary (e.g., maximal interincisal opening, pain) and secondary outcomes (e.g., pain with function; 6 studies).</li>
</ul>
<div>Limitations of these studies include heterogeneity between studies, small sample sizes, poor treatment adherence, and high dropout rates. Additional high-quality intervention studies are needed.</div>
<div>Restorative voice therapy showed promise for adults with laryngeal cancer, however, studies generally reported mixed findings (10 studies). In one study, interventions with direct and indirect components resulted in improved self-reports of hoarseness, loudness, and communication dysfunction when compared to vocal hygiene advice at 6 months post-radiotherapy. <br><br>Limitations of this review include heterogeneity between studies, small sample sizes, poor treatment adherence, and high dropout rates. Additional high-quality intervention studies are needed.</div>
<div>Multimodal interventions (i.e., swallowing and trismus interventions delivered together) demonstrated greater short-term benefits for trismus in adults with HNC when compared to either intervention in isolation. Specific findings include the following:</div>
<ul>
<li><span style="color: #333333;"><strong>Preventive multimodal interventions</strong> showed mixed outcomes for swallowing and trismus. These interventions also had mixed effects for secondary outcomes such as quality of life, depression, and pain, varying from no effects to significant improvements (5 studies). </span></li>
<li><span style="color: #333333;"><strong>Restorative multimodal interventions </strong>demonstrated improved swallow function and slowed trismus development (1 study). </span></li>
</ul>
<div><span style="color: #333333;">Limitations of these studies include heterogeneity between studies, small sample sizes, poor treatment adherence, and high dropout rates. Additional high-quality intervention studies are needed.</span></div>
