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Dysphagia in head and neck cancer: prevention and treatment

Starmer, Heather M.

Current Opinion in Otolaryngology & Head and Neck Surgery: June 2014 - Volume 22 - Issue 3 - p 195–200
doi: 10.1097/MOO.0000000000000044
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Purpose of review Swallowing difficulties are among the most problematic outcomes associated with head and neck cancer (HNCA) and the strategies employed to treat it. With a rising incidence of human papilloma virus-associated HNCA, a larger number of patients are expected to survive their cancer, and therefore will be more susceptible to long-term treatment toxicities. Optimization of long-term swallowing outcomes is an important objective for those working with patients with HNCA.

Recent findings The role of the swallowing therapist in the management of patients with HNCA cannot be overstated. This begins with pretreatment evaluation of swallowing. At the time of initial assessment, education should be provided regarding treatment toxicities and the importance of prophylactic swallowing exercises and oral intake. Recent evidence suggests that maintaining an oral diet and engaging in swallowing exercise during radiation have a positive impact on diet level, swallowing physiology, patient-perceived swallowing-related quality of life, and reduced feeding tube use. Although treatment strategies such as radiation de-intensification and transoral surgical treatments show promise for reducing toxicities, evidence regarding their impact is still being amassed.

Summary Maintaining an oral diet and performing prophylactic swallowing exercises are currently the most evidence-based strategies for dysphagia prevention in HNCA.

Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

Correspondence to Heather M. Starmer, MA, CCC-SLP, Assistant Professor, Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins Medical Institutions, 601 North Caroline St., Suite 6265, Baltimore, Maryland 21287, USA. Tel: +1 410 955 1175; fax: +1 410 955 0035; e-mail:

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