ORCID Profile
0000-0001-6843-5076
Current Organisations
Peter MacCallum Cancer Centre
,
University of Melbourne
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Publisher: Informa UK Limited
Date: 31-08-2021
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.PRRO.2012.11.009
Abstract: This study used prospective swallowing data to establish the following: (1) whether doses to the pharyngeal constrictor muscles (PCMs) were significantly associated with swallowing outcomes and (2) a mean dose constraint to aim for in intensity modulated radiation therapy planning. The PCMs were contoured and radiation dose data obtained for 55 patients with head and neck cancer. Associations between radiation dose and percentage of pharyngeal residue, penetration-aspiration and activity limitation measured at 6 months posttreatment were analyzed. Pretreatment swallowing function, tumor site, T classification, and chemotherapy were accounted for in multivariate analyses. On multivariate analysis, the percentage of pharyngeal residue was statistically significantly associated with the mean dose to the superior PCM (95% confidence interval [CI], 0.15-1.66 P = .02). Penetration-aspiration was associated with the mean dose to the superior, middle, and inferior PCMs (95% CI, 1.02-1.27 P = .003 95% CI, 1.02-1.23 P = .003 95% CI, 1.04-1.21 P = .003, respectively) and the mean dose to the total PCM (95% CI, 1.05-1.31 P = .001). Activity limitation was also associated with the mean dose to the superior, middle, and inferior PCMs (95% CI, 1.01-1.20 P = .02 95% CI, 1.00-1.15 P =.04 95% CI, 1.01-1.15 P = .02, respectively) and the mean dose to the total PCM (95% CI, 1.02-1.23 P = .01). On univariate analysis, all 3 swallowing measures were statistically significantly worse for patients who received a biologically equivalent mean dose of >60 Gy to the PCMs. This remained significant on multivariate analysis for both penetration-aspiration and activity limitation (95% CI, 2.05-58.2, P = .004 and 95% CI, 1.14-27.7, P = .03, respectively). The radiation dose to the PCMs is significantly associated with swallowing dysfunction. Limiting the mean PCM dose to less than 60 Gy results in better swallowing outcomes.
Publisher: Wiley
Date: 18-08-2009
DOI: 10.1002/HED.21218
Abstract: This prospective study evaluated the impact of patient demographics, tumor characteristics, and radiotherapy treatment on swallowing before and after radiotherapy or chemoradiotherapy. Eighty-one patients with head and neck cancer were examined using videofluoroscopy swallowing studies (VFSS) before treatment and again at 3 and 6 months after treatment. Swallowing was best at baseline, significantly worse 3 months posttreatment, and improved by 6 months posttreatment. Worse swallowing was associated with: living in rural areas ex-heavy alcohol consumption hypopharyngeal tumor site large (particularly T4) tumors nonconformal radiotherapy bilateral radiation to the pharynx and longer radiotherapy fields. Through the use of multiple regression analysis, previous swallowing was determined to be the most common predictor of swallowing outcomes, followed by T classification, alcohol history, and radiotherapy technique. The pretreatment and treatment factors that influenced swallowing in this cohort should be considered when planning treatment, in discussing potential side effects with patients, and when developing and testing future treatment techniques.
Publisher: Wiley
Date: 2006
DOI: 10.1002/HED.20438
Abstract: A systematic review of the current data on swallowing function after radiotherapy or chemoradiotherapy is presented. Electronic databases were searched for 1966-2005. Papers were categorized according to level of evidence, methodological quality, and the specific domain of swallowing being measured. Of 109 papers retrieved, 33 were identified and reviewed. Evidence was primarily classified as either level III.2 (cohort studies) or level IV (case series). Methodological quality was found to be compromised in most studies. Although many researchers had investigated swallowing impairment, a wide variety of measurement tools were employed. There are limited data on swallowing outcomes after radiotherapy or chemoradiotherapy for head and neck cancer. Further work is needed to ascertain which aspects of swallowing should be measured, and then to use such measures in well-designed clinical trials and prospective cohort studies of this under-researched population.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2019
Publisher: Springer Science and Business Media LLC
Date: 15-06-2020
DOI: 10.1007/S00520-019-04921-Y
Abstract: Research investigating swallowing problems (dysphagia) and complications within the oral cavity in non-head and neck cancer patients is limited. The purpose of this study was to determine the prevalence of patient-reported dysphagia and oral complications in all cancer patients and to examine the relationships between cancer types, oral complications and dysphagia. A cross-sectional study was conducted at a specialist cancer centre in Australia. Data on patient-reported dysphagia and oral complications were collected using the Vanderbilt Head and Neck Symptom Survey (version 2.0) which was completed by participants in one of three settings: inpatients, ambulatory patients receiving chemotherapy, or ambulatory patients receiving radiotherapy. Data were collected on 239 patients, receiving treatment for 14 cancer types. The proportion of patients who reported dysphagic symptoms were as follows: any dysphagia (54%) dysphagia for liquids (20%) and dysphagia for solids (46%). Significantly more head and neck patients and significantly fewer breast patients reported dysphagia, but there were no differences between other tumour types. Oral symptoms across all cancer types were reported at the following rates: taste changes (62%) xerostomia (56%) voice changes (37%) smell changes (35%) thick mucous (33%) difficulty with teeth/dentures (25%) mouth/throat pain (20%) and trismus (19%). This is the first time comprehensive data on dysphagia and oral complications across all cancer patients have been collected. We have identified that dysphagic symptoms and oral complications-which have implications for quality of life and function-are common in all cancer patients, not just those with head and neck cancer.
Publisher: Wiley
Date: 16-08-2019
Abstract: Acute toxicities secondary to (chemo)radiation for head and neck cancer can substantially impact nutritional intake. Nutrition is usually managed by dietitians, although time constraints may limit capacity to sufficiently deal with complex nutritional issues. The aim of the present study was to determine the effectiveness of a nutrition assistant performing screening and intervention of patients in a multidisciplinary head and neck clinic. A model of care was developed to guide nutrition assistant practice within the clinic, with training provided to nutrition assistants prior to the clinic's implementation. Outcomes, including amount of dietitian time managing high risk patients, weight change over the duration of treatment, timing of initiation of enteral feeding and patient satisfaction were compared with pre- and post-implementation of the nutrition assistant role. Ninety-one patients were included, 43 pre-implementation and 48 post-implementation. Overall, (n = 21, 44%) of patients met criteria for nutrition assistant screening or intervention. Mean weight change between groups was comparable both during (-5.6% vs -4.7%, P = 0.3) and post-radiotherapy (-6.6% vs -6.49%, P = 0.9). Following implementation of the role significant improvement was found for overall patient satisfaction (4.0 ± 1.1 vs 4.6 ± 0.61, P = 0.03), and the dimensions: patient-perceived benefit (3.8 ± 0.69 vs 4.4 ± 0.62, P < 0.01) and dietitian/nutrition-assistant interpersonal skills (3.91 ± 1.1 vs 4.6 ± 0.55, P = 0.02). The nutrition assistant role resulted in improved patient satisfaction and maintenance of nutritional outcomes demonstrating the effectiveness of this role in supporting the management of head and neck cancer patients within a multidisciplinary treatment clinic.
Publisher: Springer Science and Business Media LLC
Date: 06-02-2008
DOI: 10.1007/S00455-008-9148-1
Abstract: The purpose of this study was to contrast the psychometric properties (stability, test-retest reliability, construct, and concurrent validity) of three different tools used for evaluating videofluoroscopy swallowing studies (VFSS): (1) rating the presence or absence of a swallowing disorder, (2) the Bethlehem Assessment Scale (BAS), and (3) biomechanical measures. These three tools were applied to the same three examinations of two different consistencies (liquid and semisolid), taken from 40 VFSSs of patients with head and neck (H&N) cancer. Stability of swallowing across three swallows was a concern for three measures with the liquid consistency and nine measures with the semisolid consistency. Test-retest reliability was found to vary considerably for the two consistencies (liquids, 0.53-1.00 semisolids, 0.45-1.00). Examination of construct validity of the BAS and biomechanical measures indicated that six factors represented swallowing function, but different factors represented swallowing under liquid and semisolid conditions. Concurrent validity of the presence/absence of disorder variables was less than adequate. These results are discussed in the following contexts: (1) psychometric properties of VFSS may not be adequate for clinical and research environments and (2) psychometric properties of VFSS measures appear to vary as a function of bolus consistency.
Publisher: Wiley
Date: 21-07-2021
Abstract: The purpose of this study was to describe the nature and impact of dysphagia and dysphonia in patients with limited‐stage small‐cell lung cancer (SCLC) before and after chemoradiation. A prospective cohort study was conducted on patients receiving chemoradiotherapy for limited‐stage SCLC. Patients received either 40, 45 or 50 Gy, commencing the second cycle of chemotherapy. Outcomes included: videofluoroscopy (VFSS) to investigate aspiration, swallowing function and oesophageal motility oral intake limitations patient‐reported dysphagia and patient‐reported dysphonia. Data were collected before treatment and one, three and six months post‐treatment. Twelve patients were enrolled. Oropharyngeal swallowing was safe and functional at all times. Three patients exhibited oesophageal motility disorders before treatment, and a further three post‐treatment. Oral intake was most compromised one month post‐treatment with five patients either tube dependent or eating very limited diets. At all other times patients were eating normal or near‐normal diets. Despite normal oropharyngeal swallowing on VFSS, three patients reported moderate or severe dysphagia one month post‐treatment. Three additional patients reported moderate or severe difficulties three and six months post‐treatment. Patients who reported dysphagia one month post‐treatment all received a mean and maximum oesophageal dose of ≥15.7 Gy and ≥42 Gy, respectively. Dose–response relationships were not apparent three and six months post‐treatment. Voice problems varied, with worst scores reported one month post‐treatment. This study identified discordance between observed swallowing function and patient‐reported problems, which has clinical implications for patient management, and highlights future research needs. Ongoing efforts to reduce mucosal toxicity in patients with lung cancer are essential.
Publisher: Research Square Platform LLC
Date: 22-12-2020
DOI: 10.21203/RS.3.RS-131840/V1
Abstract: Purpose : To describe the nature and impact of dysphagia (difficulty swallowing) and dysphonia (impaired voice) in patients with limited-stage small cell lung cancer (SCLC) before and after chemoradiation. Methods : A prospective cohort study was conducted on patients receiving chemoradiotherapy for limited-stage SCLC. Patients received either 40Gy in 15 fractions, 45Gy in 30 fractions (delivered BD) or 50Gy in 25 fractions, commencing the second cycle of carboplatin/etoposide or cisplatin/etoposide chemotherapy. Outcomes included: videofluoroscopy swallowing studies (VFSS) to investigate aspiration, swallowing function, and oesophageal motility disorders limitations to oral intake patient-reported swallowing problems and patient-reported voice problems. Data were collected before treatment and at one, three and six months post-treatment. Results : Twelve patients were enrolled. The oropharyngeal swallow was safe and functional at all time points. Three patients exhibited oesophageal motility disorders before treatment, while a further three exhibited disorders post-treatment. Oral intake was most compromised one month post-treatment with five patients being either tube dependent or eating only very limited diets. At all other times patients were eating a normal or near-normal diet. Despite normal oropharyngeal swallowing on VFSS, three patients reported moderate or severe swallowing difficulties one month post-treatment. Three additional patients reported moderate or severe difficulties three and six months post-treatment. Patients who reported swallowing difficulties one month post-treatment had all received a mean and maximum radiation dose to the oesophagus of ≥15.7Gy and ≥42Gy respectively. Dose-response relationships were no longer apparent three and six-months post treatment. Voice problems were variable, with the worst scores reported one month post-treatment. Conclusions : Although patient numbers are small, this study identified discordance between observed swallowing function and patient-reported problems, which has clinical implications for the management of patients with SCLC, as well as identifying areas for future research. Ongoing efforts to reduce mucosal toxicity in lung cancer patients are essential.
Publisher: Wiley
Date: 26-06-2016
DOI: 10.1002/HED.23991
Abstract: This prospective study evaluated long-term swallowing outcomes and associated risk factors 5 years postchemoradiotherapy for head and neck cancer. Following an earlier study of 69 patients, 39 patients had patient-reported activity and quality of life (QOL) data collected. Twenty-one patients also underwent a videofluoroscopy swallowing study (VFSS). Between 6 months and 5 years posttreatment, patient-reported activity for solid foods significantly improved (p < .001), returning to pretreatment levels for 74% of patients. On VFSS, swallowing function for semisolids declined, with 5 patients demonstrating a clinically significant deterioration. Factors that predicted poorer long-term swallowing were the same as at 6 months, with the addition of older age and disease stage. Although long-term patient-reported activity improves and swallowing-related QOL is high, up to 24% of patients may demonstrate a clinically significant deterioration in swallowing function at 5 years posttreatment. This ergence suggests a degree of adaptation that patients develop, which warrants further investigation. © 2015 Wiley Periodicals, Inc. Head Neck 38: E307-E315, 2016.
Publisher: Elsevier BV
Date: 07-0009
DOI: 10.1016/J.JVOICE.2017.08.025
Abstract: The aim of this study was to investigate long-term voice outcomes and voice-related quality of life (QOL) for early glottic cancer treated with radiotherapy. Long-term exploratory follow-up study of a prospective patient cohort comparing outcomes at a mean of 11 years postradiotherapy with the original 1-year posttreatment results. Eight patients completed voice tasks for auditory perception and acoustic and aerodynamic measures. Patient-reported voice-related QOL (VR-QOL) and voice quality were measured. Changes in outcomes over time were analysed using repeated-measures linear mixed models. Acoustic and aerodynamic outcomes remained stable from 1 year postradiotherapy to long-term follow-up, with only jitter mildly increasing from 1.9% at 1 year posttreatment to 2.8% (difference = 1.0%, 95% confidence interval [CI] = 0.1-1.9). Perceptually, voice remained relatively stable with only phonation breaks slightly increasing within the normal range, from 1.1 to 1.7 (difference = 0.6, 95% CI = 0.3-0.9) and breathy quality increasing from normal to slight impairment, with scores increasing from 1.8 to 2.4 (difference = 0.6, 95% CI = 0.3-1.1). QOL scores indicate a good level of VR-QOL that were unchanged at long-term follow-up when compared with 1 year posttreatment. Improvement in voice outcomes found at 1 year postradiotherapy were largely maintained long term, with only minor changes observed. QOL scores indicate that a high level of VR-QOL was maintained many years after curative radiotherapy.
No related grants have been discovered for Jacqui Frowen.