Effectiveness Not Established

Swallowing Training in Head and Neck Cancer

for Depression

Swallowing training involves various rehabilitation exercises and techniques to facilitate swallowing in patients with dysphagia. Swallowing training in patients with head and neck cancer was examined for its effect on depression in patients with dysphagia.

Research Evidence Summaries

Zhang, L., Huang, Z., Wu, H., Chen, W., & Huang, Z. (2014). Effect of swallowing training on dysphagia and depression in postoperative tongue cancer patients. European Journal of Oncology Nursing, 18, 626–629. 

Study Purpose

To evaluate the effect of swallowing training on dysphagia and depression in postoperative patients with tongue cancer

Intervention Characteristics/Basic Study Process

A multidisciplinary team of trained experts performed a water swallowing test with consenting eligible patients(10 30-minute sessions of general swallowing training). The study intervention was implemented by nursing. Initial evaluation included a timed-test evaluating number of swallows required to drink 30 cc. Classification criteria ranging from level 1 (smooth swallowing of all water in one swallow) to level 5 (unable to swallow all water and with much bucking) were used to evaluate swallowing. The study included patients with level 2-5 swallowing. The Zung Self-Rating Depression Scale (SDS) was used to evaluate depression severity. Patients completed the 20-item questionnaire (10 positive and 10 negative items) before and after swallowing training.
 
The swallowing training intervention was designed based on literature review and expertise of the research team. Direct and indirect therapies were included. Addressed compensatory strategies were diet modification, environmental arrangement positioning, and feeding and compensatory swallowing strategies, such as the Mendelsohn Maneuver.

Sample Characteristics

  • N = 58  
  • MEAN AGE: 40-81 years
  • MEDIAN AGE: 56.6 years
  • MALES: 43 (75%), FEMALES: 15 (25%)
  • KEY DISEASE CHARACTERISTICS: 9 patients had stage 1 cancer, 23 had stage II, 21 had stage III, and 5 had stage IV.
  • OTHER KEY SAMPLE CHARACTERISTICS: 12 had floor-of-tongue cancers, 27 had side-of-tongue cancers, 6 had near-the-throat cancers, and 13 had top-of-tongue cancers. Eleven patients underwent segmental mandibular resection, and the remaining underwent resection of the mandibular rim only. Extent of tongue resection varied from 10%-75%.

Setting

  • SITE: Single site    
  • SETTING TYPE: Not specified    
  • LOCATION: Guangzhou, China

Phase of Care and Clinical Applications

  • PHASE OF CARE: Transition phase after active treatment
  • APPLICATIONS: Palliative care 

Study Design

  • Prospective study

Measurement Instruments/Methods

  • Zung Self-Rating Depression Scale (SDS)
  • Water-swallowing test (WST)

Results

The WST and SDS scores were significantly lower in the less than 50% tongue resection and rehabilitation group, and also in the early tumor stage group as opposed to the advanced stage group. There was no significant differences in WST and SDS based on age, flap defect rehabilitation, neck dissection, or range of mandibulectomy. WST levels and SDS scores before swallowing training were significantly greater than after training (WST: p = 0.027, SDS: p = 0.034). In all cases, lower WST scores were associated with lower SDS scores.

Conclusions

Improved swallowing may reduce severity of depression. Improving functional outcomes, such as eating, is a significant quality-of-life issue.

Limitations

  • Small sample (less than 100)
  • Baseline sample/group differences of import
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment) 
  • Risk of bias (no appropriate attentional control condition)  
  • Risk of bias (sample characteristics)
  • Possible selection bias (58/128 patients were assessed, but there was no criteria for inclusion or exclusion in the study)
  • Gender bias (75% men)
  • Selective outcomes reporting
  • Key sample group differences that could influence results
  • Findings not generalizable

Nursing Implications

This is an important issue for nurses in developing and implementing interventions to improve quality of life and survivorship. Swallowing retraining can potentially be effective for both swallowing and depression associated with the disease process.

Print