Table 1.
Summary of articles detailing prevalence and/or characteristics of dysphagia post NPC.
| Author | Sample size (gender) | Age (years, Mean ± SD) | Tumour staging of participants | Treatment techniques (n) | Main objectives | Outcome measures | Main findings | MMAT quality rating |
|---|---|---|---|---|---|---|---|---|
| Chang et al20 | 12 (1F:11M) and 12 age-matched controls | 45.42 | Stage Ⅱ – 1; Stage Ⅲ – 4; Stage Ⅳ – 7 |
RT (12); Induction chemotherapy (10); Concurrent chemotherapy (11) | Evaluate the effects of RT on tongue function | IOPI | No difference of tongue function compared with normal pre- and post-RT; decreases in tongue function may not start until 2 months post-RT | 4/5 |
| Chang et al8 | 184 (47F:137M) | 48.3 ± 11.6 | Stage Ⅰ – 24; Stage Ⅱ – 45; Stage Ⅲ – 41; Stage Ⅳ – 71 |
60Co (46); Linear accelerator (138); Neoadjuvant chemotherapy (23);Combination of radiosensitizer (45) | Evaluate swallowing status and the factors influencing swallowing | VFSS and interview of participants for clinical symptoms | Swallowing abnormalities were noted in both acute and chronic groups. Swallowing function continues to deteriorate over time, even many years after RT | 5/5 |
| Chang et al27 | 76 (19F:57M) | 47.9 ± 10.7 | Stage Ⅰ – 4; Stage Ⅱ – 9; Stage Ⅲ – 21; Stage Ⅳ – 42 |
2D RT (68); 3D-RT (8); Induction chemotherapy (55); Concurrent chemotherapy (65) | Evaluate over a 2-year period the serial swallowing function NPC patients post-RT | VFSS and purpose-built questionnaire rating clinical swallowing performance | At 2 years, patients had a progressively increasing pharyngeal transit time. Dysphagia symptoms subjectively identified decreased after the first month post RT | 4/5 |
| Cheng et al24 | 40 (9F:31M) | 53.9 | Stage Ⅰ – 9; Stage Ⅱ – 11; Stage Ⅲ – 12; Stage Ⅳ – 8 |
2D-RT (18); IMRT (22); Chemotherapy (20) | Assess the relationship between suprahyoid muscle contraction, hyoid bone displacement, and penetration-aspiration status | Ultrasound and VFSS | Anterior hyoid displacement and pharyngeal constriction ratio were significantly associated with penetration-aspiration | 4/5 |
| Fong et al10 | 134 (43F:91M) | 63.0 ± 11 | T1-T2 – 48, T3-T4 -46; N0–N1 – 54, N2-3 – 40 |
Chemotherapy (90) | Investigate the prevalence and associated factors of cervical esophageal clearance issues | VFSS | Esophageal clearance issues are highly prevalent and may co-exist with more severe oral/pharyngeal deficits | 4/5 |
| Hughes et al19 | 50 (11F:39M) | 49 | Not available | RT only (50) | Investigate the prevalence of long-term dysphagia in patients treated forNPC | Questionnaire, Clinical assessment, VFSS | Both Subjective and objective swallowing abnormalities are common after RT for NPC | 4/5 |
| Ku et al21 | 100 (32F:68M) | 58 | Stage Ⅰ – 8; Stage Ⅱ – 25; Stage Ⅲ – 35; Stage Ⅳ – 13 |
RT only (100) | Investigate the laryngopharyngeal sensory deficits and aspiration | FEESST | Impaired pharyngeal contraction are more significantly related to aspiration than laryngopharyngeal sensory deficits | 4/5 |
| Ku et al26 | 20 (6F:14M) | 43.9 | Stage Ⅰ-Ⅱ – 9; Stage Ⅲ-Ⅳ – 11 |
RT (20); Boost dose for parapharyngeal extension (17); Concurrent chemotherapy (11) | Study the incidence and the degree of swallowing dysfunction in patients with NPC after RT | Self-rated questionnaire; VFSS | Swallowing problems persisted after 12 months of RT, predominantly having problems with pharyngeal stasis | 3/5 |
| Ng et al23 | 85 (23F:63M) | 56.8 ± 10.9 | Not available | Not available | Establish silent aspiration occurrence, safe bolus consistency, and their relationship with swallowing physiology in NPC patients post-RT | FEES | Silent aspiration of thin fluids is a common occurrence in dysphagic NPC post-RT, with least aspiration noted on soft diet | 5/5 |
| Patterson et al7 | 18 (4F:14M) | 52.5 ± 13.06 | T1-T2 – 11, T3-T4 – 7; N0–N1 – 12, N2–N3 – 6 |
RT only (5); Concurrent C/RT (13); Neoadjuvant chemotherapy (2) | Evaluate swallowing function in NPC patients with IMRT done | FEES and clinical assessment AusTOMs Oral health-related QoL |
Characterised by bolus residue and delay, but no aspiration. Dysphagia was of mild or moderate severity on all measures | 2/5 |
| Phua et al25 | 18 (7F:11M) | 57.3 ± 8.1 | Not available | RT only (18) | Examine the effects of RT on dysphagia and dysphagia rehabilitation | Clinical assessment and VFSS | Non-oral feeding was needed in over half of the participants and following intervention, half of them could resume oral feeding | 2/5 |
| Wang et al22 | 33 (8F:25M) and 10 controls | 55.5 ± 8.8 | Stage Ⅰ – 3; Stage Ⅱ – 4; Stage Ⅲ – 11; Stage Ⅳ – 15 |
RT only (33) | Quantitatively assess the movement of the hyoid bone and pyriform sinus stasis | VFSS | NPC patients experienced a reduction in hyoid bone displacement, occurring in a forward direction. The displacement of the hyoid bone was less in the aspiration subjects than in those without aspiration | 4/5 |
| Xiong et al38 | 217 (55F:162M) | 56 | Stage Ⅰ – 22; Stage Ⅱ – 67; Stage Ⅲ – 74; Stage Ⅳ – 54 |
RT only (84); C/RT (133) | Identify patients with NPC at risk of developing SRCIs | Retrospective chart review | Swallowing-related chest infection is common in NPC patients. Advanced age, C/RT and recurrent cancer were strong risk factors for NPC patients with RT done to develop SRCIs | 4/5 |
| Yen et al37 | 3818 (970F:2844M) | 49.2 ± 12.4 | Not available | RT only (533); C/RT (3,281); Single RT (3,285), 2nd course of RT (529) | Assess the incidence of late-onset pneumonia | Retrospective chart review | Late-onset pneumonia is not uncommon in patients with NPC after radiotherapy | 4/5 |
NPC: nasopharyngeal cancer; MMAT: Mixed Methods Appraisal Tool; RT: radiation therapy; IOPI: Iowa Oral Performance Instrument; VFSS: videofluoroscopic swallowing study; IMRT: Intensity modulated radiation therapy; FEES: fiberoptic endoscopic evaluation of swallowing; C/RT: chemo-radiation therapy; QoL: quality of life; SRCIs: swallowing-related chest infections.