Radiation therapy can damage salivary glands, causing salivary hypofunction and xerostomia. (Refer to the Oral Complications of Head and Neck Radiation section for more information.) In addition, selected chemotherapeutic agents (singly or in combination) have been implicated in causing salivary dysfunction and xerostomia. However, it has not been possible to draw consistent conclusions about the effects of cancer chemotherapy on salivary gland function.
Children with cancer need information that is right for their age.
Studies show that children with cancer want to know about their illness and how it will be treated. The amount of information a child wants depends in part on his or her age. Most children worry about how their illness and treatment will affect their daily lives and the people around them. Studies also show that children have less doubt and fear when they are given information about their illness, even if it is bad news.
Dysphagia and odynophagia are common in cancer patients and can exist before, during, and after treatment:
Dysphagia predisposes to aspiration and potentially life-threatening pulmonary complications.
Swallowing disorders may lead to unfavorable dietary changes and decreased oral intake, which may result in dehydration, malnutrition, delayed wound healing, and decreased resistance to infection.
Tube feeding may become necessary, which may further compromise swallowing.
Opioids administered for the management of odynophagia may cause xerostomia and constipation.
Difficulties with speaking, eating and drinking, or drooling may affect mental health and put patients and family members in social isolation.
All of these problems, plus the patient perception of swallowing difficulties, significantly decrease health-related quality of life.[3,4]
Dysphagia is most prominent in patients with head and neck cancers but may also develop in patients with other malignancies as a symptom of oropharyngeal or esophageal mucositis or infection. In addition, dysphagia can be associated with graft-versus-host disease.
The prevalence and severity of pretreatment dysphagia associated with head and neck tumors depend on tumor stage and localization. Pretreatment dysphagia is most prevalent in patients with pharyngeal and laryngeal cancers. Surgical interventions for head and neck tumors result in anatomic or neurologic insults with site-specific patterns of dysphagia. In general, the larger the resection, the more swallowing function will be impaired.
The severity of radiation-induced dysphagia depends on the following:
Total radiation dose.
Fraction size and schedule.
Treatment delivery techniques.
Feeding status (via percutaneous endoscopic gastrostomy [PEG] tube or nil per os [NPO, nothing by mouth]).
Psychological coping factors.
Intensified schedules and the use of chemoradiation therapy have been shown to improve locoregional control and survival but come at the cost of more severe acute and chronic side effects. Intensity-modulated radiation therapy (IMRT) has emerged as an effective technique to deliver the full radiation dose to the tumor and regions at risk while reducing exposure of surrounding healthy tissues. However, the preservation of anatomy does not necessarily translate into the preservation of swallowing function.