Radiotherapy (RT) can be an effective treatment or component of treatment for HPV-related oropharyngeal cancer, but it can damage tissues and cause long-term swallowing problems for patients.

A group of researchers sought to expand upon their findings from an earlier study that suggested patients who underwent radiotherapy for oropharyngeal cancer might benefit from oral intake and swallowing exercise. Findings from this study were published in JAMA Otolaryngology-Head and Neck Surgery.

This study is a secondary analysis of prospective registry data, with a cohort of 595 patients with oropharyngeal cancer who were treated with primary RT/chemoradiotherapy (CRT), or primary transoral robotic surgery plus RT/CRT.

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The patients were referred to a speech-language pathologist for a modified barium swallow study (MBS) and swallowing therapy prior to RT. As part of swallowing therapy, the patients were giving 2 goals: eat and exercise. They were instructed in a set of swallowing exercises and asked to demonstrate adherence at follow-up visits. Diet modifications were also included to help them when necessary so they could consume the most challenging levels of oral intake they can manage safely throughout RT.

Data such as clinician-graded dysphagia severity and patient-reported swallowing-related quality of life (QOL) were analyzed at baseline, 3 to 6 months, and between 18 to 24 months after radiotherapy.

The original study showed benefits to maintaining oral intake and adherence to swallowing exercise, including shorter duration of feeding tube use, better diet outcomes, lower dysphagia severity, and better swallowing safety. “The results [of this study] partially validate the findings of the original study regarding dietary outcomes, but using prospectively collected and validated outcomes,” noted the researchers.

“Beyond dietary outcomes, maintaining [partial oral intake] throughout RT (eat) was independently associated with better recovery of swallow-related QOL by 3 to 6 months,” the researchers concluded. “Results therefore validate and extend prior findings that swallowing therapy facilitating a ‘use it or lose it’ goal to mitigate pharyngeal inactivity should continue to be an integral party of head and neck care.”

The researchers noted a limitation for this study was in the data. “[M]issing long-term MBS data reflect attrition that is common in large prospective registries,” they wrote, adding that missing data may also represent a type of attrition bias.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Barbon CEA, Peterson CB, Moreno AC, et al. Adhering to eat and exercise status during radiotherapy for oropharyngeal cancer for prevention and mitigation of radiotherapy-associated dysphagia. JAMA Otolaryng Head Neck Surg. 2022;148(10):956-964. doi:10.1001/jamaoto.2022.2313