{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:18:43Z","timestamp":1792642723109,"version":"4.5.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2022,10,1]]},"abstract":"Importance<\/jats:title>Previously published work reported independent benefit of maintenance of oral intake (eat<\/jats:italic>) and swallowing exercise adherence (exercise<\/jats:italic>) during radiotherapy (RT) on diet and functional outcomes. The current study seeks to validate the authors\u2019 previously published findings in a large contemporary cohort of patients with oropharynx cancer (OPC) and address limitations of the prior retrospective study using prospective, validated outcome measures.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine the longitudinal association of oral intake and swallowing exercise using validated, clinician-graded and patient-reported outcomes.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>Secondary analysis of a prospective OPC registry including patients who underwent primary RT\/chemoradiotherapy (CRT) or primary transoral robotic surgery plus RT\/CRT for OPC at a single-institution comprehensive cancer center.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Adherence to speech pathology swallowing intervention during RT coded as (1)eat:<\/jats:italic>oral intake at end of RT (nothing by mouth [NPO]; partial oral intake [PO], with feeding tube [FT] supplement; full PO); and (2)exercise:<\/jats:italic>swallowing exercise adherence (nonadherent vs partial\/full adherence).<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Feeding tube and diet (Performance Status Scale for Head and Neck Cancer) patient-reported swallowing-related quality of life (MD Anderson Dysphagia Inventory; MDADI) and clinician-graded dysphagia severity grade (videofluoroscopic Dynamic Imaging Grade of Swallowing Toxicity; DIGEST) were collected at baseline, 3 to 6 months, and 18 to 24 months post-RT.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 595 patients (mean [SD] age, 65 [10] years; 532 [89%] male) who underwent primary RT (111 of 595 [19%]), CRT (434 of 595 [73%]), or primary transoral robotic surgery plus RT\/CRT (50 of 595 [8%]) were included in this cohort study. At the end of RT, 55 (9%) patients were NPO, 115 (19%) were partial PO, 425 (71%) were full PO, and 340 (57%) reported exercise adherence. After multivariate adjustment, subacute return to solid diet and FT were independently associated with oral intake (odds ratio [OR], 2.0; 95% CI, 1.0-4.1; OR, 0.1; 95% CI, 0.0-0.2, respectively) and exercise (OR, 2.9; 95% CI, 1.9-4.5; OR, 0.3; 95% CI, 0.1-0.5, respectively). Subacute MDADI (\u03b2\u2009=\u20096.5; 95% CI, 1.8-11.2), FT duration (days; \u03b2\u2009=\u2009\u2212123.4; 95% CI,\u2009\u2212148.5 to \u221298.4), and less severe dysphagia per DIGEST (OR, 0.6; 95% CI, 0.3-1.0) were independently associated with oral intake, while exercise was independently associated with less severe laryngeal penetration\/aspiration per DIGEST-safety (OR, 0.7; 95% CI, 0.4-1.0). DIGEST grade associations with oral intake were not preserved long-term; however, exercise was associated with a higher likelihood of solid diet intake and better swallow safety per DIGEST.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The findings of this cohort study extend the authors\u2019 previously published findings that oral intake and swallowing exercise during RT are associated with favorable functional outcomes, now demonstrated with broader domains of function using validated measures. Patterns of benefit differed in this study. Specifically, better subacute recovery of swallow-related quality of life and less severe dysphagia were found among patients who maintained oral intake independent of exercise adherence, and shorter FT utilization and better long-term diet and swallowing safety were found among those who exercised independent of oral intake.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2022.2313","type":"journal-article","created":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T15:33:11Z","timestamp":1662651191000},"page":"956","source":"Crossref","is-referenced-by-count":40,"title":["Adhering to Eat and Exercise Status During Radiotherapy for Oropharyngeal Cancer for Prevention and Mitigation of Radiotherapy-Associated Dysphagia"],"prefix":"10.1001","volume":"148","author":[{"given":"Carly E. A.","family":"Barbon","sequence":"first","affiliation":[{"name":"Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine B.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston"},{"name":"Graduate School of Biomedical Sciences, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy C.","family":"Moreno","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen Y.","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston"},{"name":"Graduate School of Biomedical Sciences, Baylor College of Medicine, Houston, Texas"},{"name":"Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay P.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariana","family":"Sahli","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosemary","family":"Martino","sequence":"additional","affiliation":[{"name":"Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada"},{"name":"Krembil Research Institute, University Health Network, Toronto, Ontario, Canada"},{"name":"Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faye M.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Graduate School of Biomedical Sciences, Baylor College of Medicine, Houston, Texas"},{"name":"Department of Thoracic\u2013Head & Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifton David","family":"Fuller","sequence":"additional","affiliation":[{"name":"Graduate School of Biomedical Sciences, Baylor College of Medicine, Houston, Texas"},{"name":"Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Hutcheson","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston"},{"name":"Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"11","key":"ooi220052r1","doi-asserted-by":"publisher","first-page":"2151","DOI":"10.1002\/hed.v39.11","article-title":"Symptom burden as a driver of decisional regret in long-term oropharyngeal carcinoma survivors.","volume":"39","author":"Goepfert","year":"2017","journal-title":"Head Neck"},{"issue":"1","key":"ooi220052r2","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1056\/NEJMoa0912217","article-title":"Human papillomavirus and survival of patients with oropharyngeal cancer.","volume":"363","author":"Ang","year":"2010","journal-title":"N Engl J Med"},{"issue":"3","key":"ooi220052r3","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1016\/j.radonc.2018.06.013","article-title":"Radiotherapy dose-volume parameters predict videofluoroscopy-detected dysphagia per DIGEST after IMRT for oropharyngeal cancer: results of a prospective registry.","volume":"128","author":"Kamal","year":"2018","journal-title":"Radiother Oncol"},{"issue":"5","key":"ooi220052r4","doi-asserted-by":"publisher","first-page":"1425","DOI":"10.1016\/j.ijrobp.2004.05.050","article-title":"Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT?","volume":"60","author":"Eisbruch","year":"2004","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"2","key":"ooi220052r5","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1002\/hed.25412","article-title":"Two-year prevalence of dysphagia and related outcomes in head and neck cancer survivors: an updated SEER-Medicare analysis.","volume":"41","author":"Hutcheson","year":"2019","journal-title":"Head Neck"},{"issue":"1","key":"ooi220052r6","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1002\/hed.v36.1","article-title":"Aspiration pneumonia after chemo-intensity-modulated radiation therapy of oropharyngeal carcinoma and its clinical and dysphagia-related predictors.","volume":"36","author":"Hunter","year":"2014","journal-title":"Head Neck"},{"issue":"23","key":"ooi220052r7","doi-asserted-by":"publisher","first-page":"5793","DOI":"10.1002\/cncr.v118.23","article-title":"Late dysphagia after radiotherapy-based treatment of head and neck cancer.","volume":"118","author":"Hutcheson","year":"2012","journal-title":"Cancer"},{"issue":"11","key":"ooi220052r8","doi-asserted-by":"publisher","first-page":"1634","DOI":"10.1002\/hed.v35.11","article-title":"Gastrostomy tube placement in patients with oropharyngeal carcinoma treated with radiotherapy or chemoradiotherapy: factors affecting placement and dependence.","volume":"35","author":"Bhayani","year":"2013","journal-title":"Head Neck"},{"issue":"1","key":"ooi220052r9","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s40463-020-00486-7","article-title":"Prehabilitation in head and neck cancer patients: a literature review.","volume":"50","author":"Loewen","year":"2021","journal-title":"J Otolaryngol Head Neck Surg"},{"issue":"4","key":"ooi220052r10","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1001\/archoto.2012.187","article-title":"Prophylactic swallowing exercises in patients with head and neck cancer undergoing chemoradiation: a randomized trial.","volume":"138","author":"Kotz","year":"2012","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"8","key":"ooi220052r11","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1097\/PHM.0b013e31829b4afe","article-title":"Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes.","volume":"92","author":"Silver","year":"2013","journal-title":"Am J Phys Med Rehabil"},{"issue":"4","key":"ooi220052r12","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1016\/S0273-1177(02)00395-2","article-title":"Gravitational unloading effects on muscle fiber size, phenotype and myonuclear number.","volume":"30","author":"Ohira","year":"2002","journal-title":"Adv Space Res"},{"issue":"10","key":"ooi220052r13","doi-asserted-by":"publisher","first-page":"1869","DOI":"10.1249\/MSS.0b013e3181a645a6","article-title":"In vivo alterations in skeletal muscle form and function after disuse atrophy.","volume":"41","author":"Clark","year":"2009","journal-title":"Med Sci Sports Exerc"},{"issue":"2","key":"ooi220052r14","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/j.ijrobp.2018.01.097","article-title":"Dysphagia treatment for patients with head and neck cancer undergoing radiation therapy: a meta-analysis review.","volume":"101","author":"Greco","year":"2018","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"11","key":"ooi220052r15","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1001\/jamaoto.2013.4715","article-title":"Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it.","volume":"139","author":"Hutcheson","year":"2013","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"8","key":"ooi220052r16","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1097\/00005537-200408000-00008","article-title":"Swallowing-related quality of life after head and neck cancer treatment.","volume":"114","author":"Gillespie","year":"2004","journal-title":"Laryngoscope"},{"issue":"9","key":"ooi220052r17","doi-asserted-by":"crossref","first-page":"2390","DOI":"10.1002\/hed.26250","article-title":"Eat All Through Radiation Therapy (EAT-RT): structured therapy model to facilitate continued oral intake through head and neck radiotherapy\u2014user acceptance and content validation.","volume":"42","author":"Hutcheson","year":"2020","journal-title":"Head Neck"},{"issue":"3","key":"ooi220052r18","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1002\/1097-0142(19900801)66:3<564::AID-CNCR2820660326>3.0.CO;2-D","article-title":"A performance status scale for head and neck cancer patients.","volume":"66","author":"List","year":"1990","journal-title":"Cancer"},{"issue":"7","key":"ooi220052r19","first-page":"870","article-title":"The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory.","volume":"127","author":"Chen","year":"2001","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"4","key":"ooi220052r20","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1002\/lary.26153","article-title":"Predicting two-year longitudinal MD Anderson Dysphagia Inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma.","volume":"127","author":"Goepfert","year":"2017","journal-title":"Laryngoscope"},{"issue":"1","key":"ooi220052r21","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1002\/cncr.30283","article-title":"Dynamic Imaging Grade of Swallowing Toxicity (DIGEST): scale development and validation.","volume":"123","author":"Hutcheson","year":"2017","journal-title":"Cancer"},{"issue":"7","key":"ooi220052r22","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1002\/cncr.34079","article-title":"Refining measurement of swallowing safety in the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) criteria: validation of DIGEST version 2.","volume":"128","author":"Hutcheson","year":"2022","journal-title":"Cancer"},{"issue":"4","key":"ooi220052r23","doi-asserted-by":"crossref","first-page":"222","DOI":"10.4103\/2229-3485.167092","article-title":"Common pitfalls in statistical analysis: odds versus risk.","volume":"6","author":"Ranganathan","year":"2015","journal-title":"Perspect Clin Res"},{"issue":"5","key":"ooi220052r24","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1177\/0194599811414506","article-title":"Dysphagia after nonsurgical head and neck cancer treatment: patients\u2019 perspectives.","volume":"145","author":"Wilson","year":"2011","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"8","key":"ooi220052r25","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1002\/cncr.31920","article-title":"Priorities, concerns, and regret among patients with head and neck cancer.","volume":"125","author":"Windon","year":"2019","journal-title":"Cancer"},{"issue":"6","key":"ooi220052r26","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1097\/01.mlg.0000217278.96901.fc","article-title":"Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life.","volume":"116","author":"Kulbersh","year":"2006","journal-title":"Laryngoscope"},{"issue":"12","key":"ooi220052r27","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1002\/hed.23255","article-title":"Adherence to preventive exercises and self-reported swallowing outcomes in post-radiation head and neck cancer patients.","volume":"35","author":"Shinn","year":"2013","journal-title":"Head Neck"},{"issue":"11","key":"ooi220052r28","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1002\/hed.23199","article-title":"Gastrostomy tube placement in patients with hypopharyngeal cancer treated with radiotherapy or chemoradiotherapy: factors affecting placement and dependence.","volume":"35","author":"Bhayani","year":"2013","journal-title":"Head Neck"},{"issue":"6","key":"ooi220052r29","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1177\/0194599813502310","article-title":"Swallow preservation exercises during chemoradiation therapy maintains swallow function.","volume":"149","author":"Duarte","year":"2013","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"2","key":"ooi220052r30","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1002\/hed.23570","article-title":"Effects of 2 different swallowing exercise regimens during organ-preservation therapies for head and neck cancers on swallowing function.","volume":"37","author":"Virani","year":"2015","journal-title":"Head Neck"},{"issue":"4","key":"ooi220052r31","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s00455-017-9790-6","article-title":"Prophylactic swallow therapy for patients with head and neck cancer undergoing chemoradiotherapy: a randomized trial.","volume":"32","author":"Messing","year":"2017","journal-title":"Dysphagia"},{"issue":"4","key":"ooi220052r32","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1002\/hed.23913","article-title":"Significant preservation of swallowing function in chemoradiotherapy for advanced head and neck cancer by prophylactic swallowing exercise.","volume":"38","author":"Ohba","year":"2016","journal-title":"Head Neck"},{"issue":"1","key":"ooi220052r33","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/MLG.0b013e31815659b0","article-title":"Pretreatment swallowing exercises improve swallow function after chemoradiation.","volume":"118","author":"Carroll","year":"2008","journal-title":"Laryngoscope"},{"issue":"1","key":"ooi220052r34","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1186\/s12885-021-08826-0","article-title":"The PRO-ACTIVE trial protocol: a randomized study comparing the effectiveness of PROphylACTic swallow InterVEntion for patients receiving radiotherapy for head and neck cancer.","volume":"21","author":"Martino","year":"2021","journal-title":"BMC Cancer"}],"container-title":["JAMA Otolaryngology\u2013Head & Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2795739\/jamaotolaryngology_barbon_2022_oi_220052_1664995483.59936.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,26]],"date-time":"2023-11-26T18:54:45Z","timestamp":1701024885000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2795739"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,1]]},"references-count":34,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2022,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2022.2313","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2022,10,1]]}}}