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Dysphagia (Difficulty Swallowing) No More?

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Radiation to my fifth cervical vertebra (bottom of my neck) caused my swallowing muscles to slowly weaken aka a side effect called dysphasia. Though the study linked and excerpted below focuses on oral cancers, I have a blood cancer called multiple myeloma.

The focus of this post is the radiation-induced side effect called dysphasia, not the cancer itself.

In all of my previously written blog posts focusing on dysphagia, I never questioned the cause of the side effect. It never occurred to me that the dose of radiation received by the cancer patient could be reduced therefore minimizing this difficult adverse event. Duh…

Time after time research confirms that cancer patients live longer and experience fewer side effects with lower doses of chemotherapy and radiation.

Experience has taught me that conventional oncology focuses ONLY on treatment and length of life at the expense of quality of life-

I thought that I had stabilized my dysphagia by developing a daily routine of neck exercises. Unfortunately, over the past 6-8 months or so I’ve begun experiencing some of the symptoms of aspiration discussed below.

I’ve actually felt a bit of food or drink almost being sucked into my lungs. I’ve gagged once or twice on something I’ve been eating. The bottom line is that I have to exercise my neck muscles more and eat more carefully.

Do you have difficulty swallowing? Did you receive radiation to your neck? What type of cancer do you have? Scroll down the page, post a question or a comment and I will reply to you ASAP.

Hang in there,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Dysphagia-optimised intensity-modulated radiotherapy versus standard intensity-modulated radiotherapy in patients with head and neck cancer (DARS): a phase 3, multicentre, randomised, controlled trial

“Most newly diagnosed oropharyngeal and hypopharyngeal cancers are treated with chemoradiotherapy with curative intent but at the consequence of adverse effects on quality of life…

Interpretation- Our findings suggest that DO-IMRT (dysphagia-optimised intensity-modulated radiotherapy) improves patient-reported swallowing function compared with standard IMRT.

Cancers of the pharynx are common…For most newly diagnosed patients, radiotherapy or chemoradiotherapy is the treatment of choice. These treatments are curative for the majority of patients but have adverse effects on quality of life.

The most common long-term side-effects of radiotherapy to the pharynx are dry mouth, dysphagia, and soft tissue fibrosis…

Evidence before this study- We searched PubMed… No randomised studies were identified. Two small series of patients treated with dysphagia-optimised radiotherapy were found. The literature showed that poor swallowing outcomes affect most patients with head and neck cancer in the long-term after radiotherapy.

Observational data suggest that the radiation dose delivered to the muscles of the pharynx during radiotherapy for head and neck cancer was related to swallowing function after treatment, with lower doses being associated with better swallowing outcomes…

Added value of this study- To our knowledge, this is the first phase 3 trial to compare dysphagia-optimised IMRT (DO-IMRT) with standard IMRT in patients with head and neck cancer. DO-IMRT reduces the radiation dose to the pharyngeal constrictor muscles. Our results show patient-reported superior swallowing function after 12 months in participants treated with DO-IMRT compared with those treated with standard IMRT…
The clinical consequences of swallowing dysfunction after radiotherapy can be mild, with restriction of diet or modification of swallowing function, or might be severe, particularly if swallowing is so badly affected that aspiration of food into the lungs is a risk, resulting in the requirement for a permanent gastrostomy tube and long-term supportive care…
In a review, aspiration rates of 30–62% were reported in studies using objective instrumental measures of swallowing, in addition to patient-reported outcome measures, in patients with symptomatic and asymptomatic head and neck cancer who had received chemoradiotherapy.
These negative functional and social impacts are accompanied by a negative effect on mortality, with aspiration contributing to 19% of non-cancer deaths…

Dysphagia, Aspiration and Stricture

“What is it?

Dysphagia refers to difficulty swallowing. While dysphagia can have many causes, often it results from scar tissue formation contributing to a narrowing in the throat or esophagus. Such a narrowing is called a ‘stricture’. Patients who experience dysphagia may also experience ‘aspiration’ which is a condition where food, fluid or saliva unintentionally leaks into the windpipe…

How is the condition treated?

For patients treated with radiation or a combination of chemotherapy and radiation therapy, studies have shown that continuing to use the muscles and to stimulate the tissues of the throat during treatment results in improved swallowing function…”



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