title: A systematic review of interventions for eating and drinking problems following treatment for head and neck cancer suggests a need to look beyond swallowing and trismus.
abstract: OBJECTIVE
  The incidence of head and neck cancer (HNC) is increasing, and treatment advances have contributed to improvements in survival. However, a growing number of HNC survivors now live with the long-term consequences of cancer treatment, in particular, problems with eating. The combined effects of HNC cancer, intensive chemotherapy, radiotherapy and surgery have a profound impact on functional, psychological, social and physical aspects of eating. Evidence is needed to underpin new rehabilitation approaches to address these complex problems. This review aimed to identify and summarise the evidence for rehabilitation interventions aimed at alleviating eating problems after HNC treatment.
  
  
  METHODS
  A systematic review of studies indexed in Medline, CinAHL and PsycINFO using search terms relevant to a wide range of aspects of eating. Publications reporting empirical findings regarding physical, functional and/or psychosocial factors were included.
  
  
  RESULTS
  Twenty-seven studies were identified. Fifteen focussed on swallowing exercises, eight on interventions to improve jaw mobility and four on swallowing and jaw exercises. None included interventions to address the complex combination of functional, physical and psychological problems associated with eating in this patient group.
  
  
  CONCLUSIONS
  This review highlights that, whilst there is some evidence to support interventions aimed at improving swallowing and jaw mobility following treatment for HNC, studies are limited by their size and scope. Larger, high quality studies, which include patient-reported outcome measures, are required to underpin the development of patient-centred rehabilitation programmes. There is also a particular need to develop and evaluate interventions, which address the psychological and/or social aspects of eating.
authors.affiliation: School of Medicine, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK. n.l.cousins@dundee.ac.uk
authors.forename: Nadine
authors.initials: N
authors.lastname: Cousins
authors.forename: Fiona
authors.initials: F
authors.lastname: MacAulay
authors.forename: Heidi
authors.initials: H
authors.lastname: Lang
authors.forename: Steve
authors.initials: S
authors.lastname: MacGillivray
authors.forename: Mary
authors.initials: M
authors.lastname: Wells
mesh_terms: D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000534:rehabilitation; D004326:Drinking / Q000502:physiology*; D004435:Eating / Q000502:physiology* / Q000523:psychology; D001068:Feeding and Eating Disorders / Q000534:rehabilitation; D006258:Head and Neck Neoplasms / Q000534:rehabilitation / Q000628:therapy*; D006801:Humans; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D014313:Trismus / Q000534:rehabilitation