title: Swallowing assessment and management pre and post head and neck cancer treatment.
abstract: OBJECTIVE
  Head and neck cancer (HNC) imposes significant structural, functional, and cosmetic burdens upon those affected. Although advances in multimodality organ preservation therapy have assisted in ameliorating a number of previous treatment-related sequelae, dysphagia remains a foremost concern for members of the multidisciplinary team. Given its acute and long-term impact on physical and psychological wellbeing, and subsequent bearing on delivery of treatment, treatment-related morbidity and overall mortality, prompt recognition, and accurate assessment and optimization of management are pivotal.
  
  
  RESULTS
  Qualitative research has provided greater insight into the psychosocial burdens dysphagia imposes on HNC patients and carers, highlighting the need for holistic strategies of management. There is a growing body of evidence to support dietary alterations and preventive swallowing exercise regimens for maintenance of oral intake throughout and following HNC therapy. The role of prophylactic enteral feeding, however, remains uncertain, with conflicting institutional data and lack of high-quality prospective studies for meaningful systematic literature assessment. Endoscopic surgical techniques hold promise in relieving stricture-related dysphagia; however, multiple treatments are required and recurrence is common.
  
  
  CONCLUSIONS
  Swallowing rehabilitation encompassing education, dietary modification, and swallowing exercises comprise the mainstay of current evidence-based dysphagia management in HNC patients.
authors.affiliation: aDepartment of Otolaryngology, Head and Neck Surgery bCrown Princess Mary Cancer Centre, Westmead Hospital cUniversity of Sydney dChris O'Brien Lifehouse, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Faruque
authors.initials: F
authors.lastname: Riffat
authors.forename: Dakshika A
authors.initials: DA
authors.lastname: Gunaratne
authors.forename: Carsten E
authors.initials: CE
authors.lastname: Palme
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000209:etiology* / Q000628:therapy*; D004724:Endoscopy; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy; D005774:Gastrostomy; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000628:therapy; D006801:Humans; D008487:Medical History Taking; D010808:Physical Examination; D026741:Physical Therapy Modalities; D011183:Postoperative Complications; D011878:Radiotherapy / Q000009:adverse effects
chemical_list: D000970:Antineoplastic Agents