When treating patients with head and neck cancer, there are many questions and pieces of the puzzle that need to be put together. You are always assessing:
- Location of cancer
- The type and amount of treatment received (surgery, chemotherapy, radiation therapy or CRT)
- Prior and current swallowing status
Timing of therapy is critical for rehabilitation.
Ideally, therapy should be initiated prior to cancer treatment so that a baseline status can be documented and a swallowing exercise program started early.
While research shows that it’s nearly impossible to completely avoid or reverse swallowing deficits following treatment, many studies have shown that doing something — including eating and drinking during therapy — may help improve outcomes.
Treatment Strategies for Head and Neck Cancer Patients
There are several effective treatment strategies to consider when managing dysphagia in this population. Here’s an overview of just a few.
Exercise Dosage
Dosing and compliance are hot topics in dysphagia management, and unfortunately, many swallowing exercises lack standardized dosing guidelines.
Swallowing Exercises
Messing et al. (2017) studied swallowing rehabilitation during and after CRT. They found that when exercises were completed twice daily, 7 days a week, patients showed the greatest improvement 3 months post-CRT, although gains weren’t sustained long-term.
Exercises included:
- Mouth open wide stretch with the Therabite — 10x/day
- Neck stretches
- Lip protrusion/retraction — 10x
- Tongue retraction with hold (3–5 seconds) — 10x
- Lingual elevation, depression, lateralization, protrusion, anterior/posterior motion — 10x each
- Masako Maneuver — 5x
- Mendelsohn Maneuver — 5x
- Effortful Swallow (with mist bottle or liquids) — 10x
- Frequent swallowing throughout the day
- Eat/drink by mouth (using compensations as needed)
- Use of dry mouth sprays/mist
- Stay hydrated
NMES (Neuromuscular Electrical Stimulation)
Langmore et al. (2017) examined whether e-stim enhances swallowing exercises in patients with head and neck cancer.
Spoiler alert: It didn’t.
In fact, patients who received e-stim had worse swallowing outcomes. The authors questioned the efficacy and dosing of swallowing exercises themselves, especially in this patient population.
Pharyngocise
Carnaby et al. (2012) developed the Pharyngocise program — a prophylactic exercise regimen initiated during CRT. Results in head and neck cancer populations have been promising.
Exercises include:
- Falsetto
- Tongue Press
- Hard Swallow
- Jaw resistance (TheraBite)
The patient continues eating orally (with modifications as needed).
Dosage:
- 10 reps
- 4 cycles of 10 minutes (45-minute sessions)
- 2x/day, 7 days a week during the 6-week CRT protocol
Benefits found in research:
- Less deterioration in swallowing, dietary intake, taste/smell, salivation, and nutritional status
- Fewer dysphagia-related complications
- Less muscle atrophy in key swallowing muscles: genioglossus, hyoglossus, mylohyoid
MD Anderson Swallowing Boot Camp
Malandraki and Hutcheson (2018) describe two intensive programs for dysphagia — one being the MD Anderson Swallowing Boot Camp, which launched in 2012.
This program is typically started after all other cancer treatments are completed, sometimes after initial swallowing therapy has commenced. Most participants had moderate-to-severe persistent or late-onset dysphagia, often due to radiation or surgery.
The Boot Camp has 4 stages:
- Evaluation:
Includes instrumental exams (e.g., MBSS or FEES), PSS-HN, MDADI, oral mech, cranial nerve exams, physician input, and tools like peak flow cough or nasopharyngoscopy. - Consensus & Planning:
Team-based review and checklist to ensure candidacy for Boot Camp. - Optimization Phase (Pre-Boot Camp):
Surgical or therapeutic prep, such as esophageal dilation, vocal fold medialization, dental rehab, or manual therapy. - Functional Phase (Boot Camp):
Clinician-directed, intensive functional therapy.- Daily sessions over 2–3 weeks
- 100+ swallows per session under progressively challenging conditions
- Device-driven (sEMG) and bolus-driven (MDTP) approaches available
The goal is to optimize functional status and help the patient adapt to their “new normal.”
Always Remember
When working with head and neck cancer patients:
- Assess prior to any treatment whenever possible.
- Instrumental assessment gives you a stronger baseline.
- Initiate swallowing therapy and home exercises before treatment, continue throughout CRT, and maintain post-treatment exercises.
Doing something — even just continuing to eat — may improve quality of life and long-term function.
Daele et al. found:
“Beginning a swallowing therapy program within one year of completing radiation therapy demonstrates more consistent improvement in quality of life and diet performance compared to later time periods.”
Download your Cheat Sheet to Neuroplasticity and Exercise Principles here.
Download your Guide to Treating Dysphagia in Head and Neck Cancer here.
Want to read more about the research behind Pharyngocise?
Have you seen the tools from TheraSIP to help your patients with cancer induced dysphagia? The PharyngoCARE kit provides tools for your patients to use to complete exercises prescribed before, during and after treatment for head and neck cancer.
Do you have patients that have trouble managing their oral secretions? Take a look at the Swik Oral Suction System.
Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!
References:
Wall, L. R., Ward, E. C., Cartmill, B., Hill, A. J., & Porceddu, S. V. (2017). Adherence to a prophylactic swallowing therapy program during (chemo) radiotherapy: impact of service-delivery model and patient factors. Dysphagia, 32(2), 279-292.
Pryor, J. C. (2018). Beyond “Pharyngocise” for Patients With Head and Neck Cancer: Does One Size Fit All?. JAMA Otolaryngology–Head & Neck Surgery, 144(6), 488-489.
Malandraki, G. A., & Hutcheson, K. A. (2018). Intensive therapies for dysphagia: implementation of the intensive dysphagia rehabilitation and the MD Anderson Swallowing Boot Camp Approaches. Perspectives of the ASHA Special Interest Groups, 3(13), 133-145.
*I did receive a free PharyngoCare kit to examine all of the tools that are included to write this post. The above article is also included in print form in the kit.
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