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. Symptom profile of nasopharyngeal cancer patients during radiation therapy. Toxicities affecting quality of life after chemo-IMRT of oropharyngeal cancer: prospective study of patient-reported, observer-rated, and objective outcomes. Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Health-related quality of life in patients with pharyngeal carcinoma: a five-year follow-up. Assessment of quality of life and oral function of patients participating in a phase II study of radioprotection of oral and pharyngeal mucosa by the prostaglandin E(1) analog misoprostol (RTOG 96-07). Can IMRT or brachytherapy reduce dysphagia associated with chemoradiotherapy of head and neck cancer? The Michigan and Rotterdam experiences. The efficacy of pilocarpine and bethanechol upon saliva production in cancer patients with hyposalivation following radiation therapy. A prospective study on quality of life of patients with cancer of the oral cavity or oropharynx treated with surgery with or without radiotherapy. Characteristics of response of oral and pharyngeal mucosa in patients receiving chemo-IMRT for head and neck cancer using hypofractionated accelerated radiotherapy. Late dysphagia after IMRT for head and neck cancer and correlation with dose-volume parameters. Aspiration pneumonia after chemo-intensity-modulated radiation therapy of oropharyngeal carcinoma and its clinical and dysphagia-related predictors. "Pharyngocise": randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. The effect of education in managing side effects in women receiving chemotherapy for treatment of breast cancer. A prospective trial of short-course radiotherapy plus chemotherapy for palliation of dysphagia from advanced esophageal cancer. Dysphagia Screening and Intensified Oral Hygiene Reduce Pneumonia After Stroke Development and pilot testing of a psychoeducational intervention for oral cancer patients.
OBJECTIVE To design a reliable and vali date d self-administered question naire whose purpose is to assess dysphagia 's effects on the quality of life ( QOL ) of patients with head and neck cancer . DESIGN Cross-sectional survey study . METHODS Focus groups were convened for question naire development and design . The M. D. And erson Dysphagia Inventory ( MDADI ) included global , emotional , functional , and physical subscales . One hundred consecutive adult patients with a neoplasm of the upper aerodigestive tract who underwent evaluation by our Speech Pathology team completed the MDADI and the Medical Outcomes Study 36-Item  Short Form Health Survey  ( SF-36 ) . Speech pathologists completed the Performance Status Scale for each patient . Validity and reliability properties were calculated . Analysis of variance was used to assess how well the MDADI discriminated between groups of patients . RESULTS The internal consistency reliability of the MDADI was calculated using the Cronbach alpha coefficient . The Cronbach alpha coefficients of the MDADI subscales ranged from 0.85 to 0.93 . Test-retest reliability coefficients of the subscales ranged from 0.69 to 0.88 . Spearman correlation coefficients between the MDADI subscales and the SF-36 subscales demonstrated construct validity . Patients with primary tumors of the oral cavity and oropharynx had significantly greater swallowing disability with an adverse impact on their QOL compared with patients with primary tumors of the larynx and hypopharynx ( P<.001 ) . Patients with a malignant lesion also had significantly greater disability than patients with a benign lesion ( P<.001 ) . CONCLUSIONS The MDADI is the first vali date d and reliable self-administered question naire design ed specifically for evaluating the impact of dysphagia on the QOL of patients with head and neck cancer . St and ardized question naires that measure patients ' QOL offer a means for demonstrating treatment impact and improving medical care . The development and validation of the MDADI and its use in prospect i ve clinical trials allow for better underst and ing of the impact of treatment of head and neck cancer on swallowing and of swallowing difficulty on patients ' QOL PURPOSE This prospect i ve , longitudinal study was aim ed to describe the prevalence , severity , and pattern of symptoms over the course of radiation therapy in persons with nasopharyngeal carcinoma and to explore symptom severity by treatment modality . DESCRIPTION OF STUDY Thirty-seven patients completed this study , and 46 % received chemotherapy before radiation therapy .  A self-reported radiation symptom checklist and an objective mucositis assessment tool were used weekly to document oropharyngeal , skin , nose or ear , or more general side effects , and mucositis . RESULTS Oropharyngeal problems were the most severe complaints during radiation therapy . All patients experienced dry mouth , taste change , difficulty in swallowing , difficulty in opening their mouths , hoarseness , sore throat , and observable mucositis . Most reported moderate-to-severe dry mouth , difficulty in swallowing , and sore throat from weeks 3 through 7 . Skin problems were not prominent until week 4 . Patients also lost an average of 3.9 kg during the therapy . Sequential chemotherapy and radiation therapy was associated with more severe oropharyngeal problems than radiation therapy alone , but no significant differences in other problems were found . CLINICAL IMPLICATION S Despite recognition of the oropharyngeal side effects associated with irradiation , effective management protocol s for such symptoms have not been implemented in the studied institution . The frequency and intensity of the symptoms reported indicate an urgent need for increased vigilance about radiation-related side effects and pain management . As well , patient education about expected side effects may help mitigate the anxiety that patients experience when these symptoms occur PURPOSE To test the hypothesis that intensity modulated radiation therapy ( IMRT ) aim ing to spare the salivary gl and s and swallowing structures would reduce or eliminate the effects of xerostomia and dysphagia on quality of life ( QOL ) . METHODS AND MATERIAL S In this prospect i ve , longitudinal study , 72 patients with stage III-IV oropharyngeal cancer were treated uniformly with definitive chemo-IMRT  sparing the salivary gl and s and swallowing structures . Overall QOL was assessed by summary scores of the Head Neck QOL ( HNQOL ) and University of Washington QOL ( UWQOL ) question naires , as well as the HNQOL " Overall Bother " question . Quality of life , observer-rated toxicities ( Common Toxicity Criteria Adverse Effects scale , version 2 ) , and objective evaluations ( videofluoroscopy assessing dysphagia and saliva flow rates assessing xerostomia ) were recorded from before therapy through 2 years after therapy . Correlations between toxicities/ objective evaluations and overall QOL were assessed using longitudinal repeated measures of analysis and Pearson correlations . RESULTS All observer-rated toxicities and QOL scores worsened 1 - 3 months after therapy and improved through 12 months , with minor further improvements through 24 months . At 12 months , dysphagia grade s 0 - 1 , 2 , and 3 , were observed in 95 % , 4 % , and 1 % of patients , respectively . Using all posttherapy observations , observer-rated dysphagia was highly correlated with all overall QOL measures ( P<.0001 ) , whereas xerostomia and mucosal and voice toxicities were significantly correlated with some , but not all , overall QOL measures , with lower correlation coefficients than dysphagia . Late overall QOL ( ≥6 or ≥12 months after therapy ) was primarily associated with observer-rated dysphagia , and to a lesser extent with xerostomia . Videofluoroscopy scores , but not salivary flows , were significantly correlated with some of the overall QOL measures . CONCLUSION After chemo-IMRT , although late dysphagia was on average mild , it was still the major correlate of QOL . Further efforts to reduce swallowing dysfunction are likely to yield additional gains in QOL PURPOSE To present initial results of a clinical trial of intensity-modulated radiotherapy ( IMRT ) aim ing to spare the swallowing structures whose dysfunction after chemoradiation is a likely cause of dysphagia and aspiration , without compromising target doses . METHODS AND MATERIAL S This was a prospect i ve , longitudinal study of 36 patients with Stage III-IV oropharyngeal ( 31 ) or nasopharyngeal ( 5 ) cancer .  Definitive chemo-IMRT spared salivary gl and s and swallowing structures : pharyngeal constrictors ( PC ) , glottic and supraglottic larynx ( GSL ) , and esophagus . Lateral but not medial retropharyngeal nodes were considered at risk . Dysphagia endpoints included objective swallowing dysfunction ( videofluoroscopy ) , and both patient-reported and observer-rated scores . Correlations between doses and changes in these endpoints from pre-therapy to 3 months after therapy were assessed . RESULTS Significant correlations were observed between videofluoroscopy-based aspirations and the mean doses to the PC and GSL , as well as the partial volumes of these structures receiving 50 - 65 Gy ; the highest correlations were associated with doses to the superior PC ( p = 0.005 ) . All patients with aspirations received mean PC doses > 60 Gy or PC V(65 ) > 50 % , and GSL V(50 ) > 50 % . Reduced laryngeal elevation and epiglottic inversion were correlated with mean PC and GSL doses ( p < 0.01 ) . All 3 patients with strictures had PC V(70 ) > 50 % . Worsening patient-reported liquid swallowing was correlated with mean PC ( p = 0.05 ) and esophageal ( p = 0.02 ) doses . Only mean PC  doses were correlated with worsening patient-reported solid swallowing ( p = 0.04 ) and observer-rated swallowing scores ( p = 0.04 ) . CONCLUSIONS These dose-volume-effect relationships provide initial IMRT optimization goals and motivate further efforts to reduce swallowing structures doses to reduce dysphagia and aspiration PURPOSE The purpose was to evaluate the health-related quality of life ( HRQL ) of patients with pharyngeal carcinoma at diagnosis and after 1 and 5 years in relation to tumor location and treatment modality in a prospect i ve multicenter study . METHODS Eighty-nine patients with pharyngeal carcinoma ( mean age , 60.0 years ; 76 % men ) were evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Question naire-Core 30 ( EORTC QLQ-C30 ) and the European Organization for Research and Treatment of Cancer Quality of Life Question naire Head and Neck Cancer Module ( EORTC QLQ-H&N35 ) . RESULTS Problems with dry mouth and teeth became worse between diagnosis and the 5-year follow-up . Problems with thick secretions and teeth increased between 1 and 5 years . The HRQL at diagnosis was associated with survival .  Patients with oropharyngeal carcinoma reported better HRQL than patients with hypopharyngeal carcinoma . CONCLUSIONS For patients with pharyngeal carcinoma , the HRQL at diagnosis seems to be an important factor for the prognosis of both HRQL over time and survival . Treatment of pharyngeal carcinoma often results in long-term side effects such as dry mouth , problems with teeth , and thick secretions PURPOSE The oral complications associated with radiotherapy to the head and neck are a significant dose-limiting factor . The goals of this study were to determine whether oropharyngeal rinsing and ingestion of misoprostol protect mucous membranes from the acute effects of irradiation , and to evaluate the quality -of-life ( QOL ) outcomes of patients receiving misoprostol .  We report the results of the QOL outcomes of patients in this study . METHODS AND MATERIAL S A total of 33 patients with resected or intact cancer of the oral cavity , oropharynx , supraglottic larynx , or hypopharynx were registered to receive postoperative radiotherapy plus misoprostol or primary radiotherapy plus misoprostol .  All patients were scheduled to receive 60 - 70 Gy at 2 Gy/d within 6 - 7 weeks . QOL and function were evaluated . RESULTS A decrease in the QOL and function occurred in all areas covered by the question naire at the 6-week interval . This decrease was significant for eating , saliva , taste , and mucous . Of these significant factors , taste , saliva , and mucous consistency had not resolved by 12 weeks . CONCLUSION Increased underst and ing of the impact of treatment on QOL and symptoms will formulate the rational design of toxicity interventions and enhance the multidisciplinary care of head- and -neck patients PURPOSE Dysphagia is a major late complication of intensive chemoradiotherapy of head and neck cancer . The initial clinical results of intensity-modulated radiotherapy ( IMRT ) , or brachytherapy , planned specifically to reduce dysphagia are presented . PATIENTS AND METHODS Previous research at Michigan University has suggested that the pharyngeal constrictors and glottic and supraglottic larynx are likely structures whose damage by chemo-RT causes dysphagia and aspiration . In a prospect i ve Michigan trial , 36 patients with oropharyngeal ( n = 31 ) or nasopharyngeal ( n = 5 ) cancer underwent chemo-IMRT . IMRT cost functions included sparing noninvolved pharyngeal constrictors and the glottic and supraglottic larynx . After a review of published studies , the retropharyngeal nodes at risk were defined as the lateral , but not the medial , retropharyngeal nodes , which facilitated sparing of the swallowing structures . In Rotterdam , 77 patients with oropharyngeal cancer were treated with IMRT , three dimensional RT , or conventional RT ; also one-half received brachytherapy . The dysphagia endpoints included videofluoroscopy and observer-assessed scores at Michigan and patient-reported quality -of-life instruments in both studies . RESULTS In both studies , the doses to the upper and middle constrictors correlated highly with the dysphagia endpoints . In addition , doses to the glottic and supraglottic larynx were significant in the Michigan series . In the Rotterdam series , brachytherapy ( which reduced the doses to the swallowing structures ) was the only significant factor on multivariate analysis . CONCLUSION The dose-response relationships for the swallowing structures found in these studies suggest that reducing their doses , using either IMRT aim ed at their sparing , or brachytherapy , might achieve clinical gains in dysphagia PURPOSE Pilocarpine and bethanechol have been reported as potentially effective sialogogues for xerostomic patients . The purpose of the present study was to compare the efficacy of bethanechol to that of pilocarpine in patients with dry mouth following cancer therapy . STUDY DESIGN Patients with documented hyposalivation were provided pilocarpine or bethanechol for 2 - 3 weeks in an open-label r and omized crossover study . Baseline and weekly whole resting saliva ( WRS ) and whole stimulated saliva ( WSS ) were obtained for 5 minutes . Subjective response and side effects were recorded . RESULTS Forty-two xerostomic patients who had received radiation therapy to the head and neck participated . The increase in the WRS and WSS with each medication independently was limited . Statistically significant increase in WRS was seen for both medications when all patients using either agent were analyzed , but no statistically significant increase in WSS was found . Twenty-seven patients completed the crossover protocol . No significant difference in the effect was noted between each of the 2 drugs whether they were prescribed as the first or second drug in the crossover . Statistically significant improvement in subjective report of saliva production/mouth wetness was seen for patients on either medication . This study suggests that subjective improvement in symptoms of dry mouth may be related to resting saliva production , and not to stimulated saliva production . No statistically significant differences in adverse side effects were reported between the medications prescribed . The most common side effects were minor and included frequent urination , dizziness , and increased sweating . CONCLUSIONS The findings indicate that head and neck radiation-treated patients with established hyposalivation will respond minimally to systemic sialagogues and while they may experience an increase in resting saliva little change in stimulated saliva may occur . It is not known whether relatively small increases in saliva are beneficial in maintaining oral health ; however , subjective improvement suggests improved quality of life . While it is not known if prolonged use of a sialagogue will have increased effects , the limited increase in saliva seen following the second drug of the crossover suggests that prolonged use of a sialagogue may further increase saliva production The aim of this study was to describe prospect ively quality of life and mood in patients with oral or oropharyngeal cancer treated with surgery + /- radiotherapy . Seventy-five patients completed the EORTC Core Question naire , the EORTC Head and Neck Cancer module and the Center for Epidemiologic Studies ' Depression Scale before treatment and 6 and 12 months later . There was a significant deterioration of physical functioning , fatigue and almost all head and neck symptoms except pain , which improved . Patients with stage III/IV and patients receiving combined treatment had significantly worse physical symptoms compared to patients with stage I/II and patients treated with surgery only , respectively . Before and after treatment there was a high level of depressive symptomatology . However , after treatment a gradual improvement in emotional functioning occurred . Surgical treatment for oral or oropharyngeal cancer results in significant deterioration of physical functioning and symptoms during the first year , especially when combined with radiotherapy . Despite this , there is an improvement of emotional functioning after treatment , probably as a result of adaptation and coping processes PURPOSE This study describes the acute response of oral and pharyngeal mucosa to chemo-IMRT schedules using different doses per fraction . MATERIAL S AND METHODS Patients , treated in prospect i ve trials of concomitant chemo-IMRT with 2.17 Gy , 2.25 Gy and 2.4 Gy per fraction and identical dose of cisplatin , were included in this study .  Acute toxicity was recorded prospect ively using the CTCAE v2.0 . We describe the incidence and prevalence of grade 3 oral mucositis and dysphagia over time and report the influence of overall treatment time ( OTT ) . The association between the lengths of pharyngeal mucosa receiving 50 Gy ( L50 ) and 60 Gy ( L60 ) and grade 3 dysphagia was tested . RESULTS The incidence and the peak prevalence of grade 3 dysphagia were significantly higher in patients receiving 2.4 Gy per fraction . The peak prevalence of grade 3 dysphagia was higher and the recovery was slower in patients with lower OTT ( median 38 days vs. 42 days ) treatment . There was a significant correlation between L50 , L60 and grade 3 dysphagia . A L50 and L60 greater than 8 cm result ed in greater than 60 % and 70 % incidence of grade 3 dysphagia , respectively . CONCLUSION The length of pharyngeal mucosa receiving doses close to the prescription dose correlates with grade 3 dysphagia . It was observed that incidence of grade 3 dysphagia was lower and recovery from it was quicker in patients with greater OTT BACKGROUND AND PURPOSE Many head and neck cancer ( HNC ) survivors experience diminished quality of life due to radiation-induced dysphagia . The aim of this study was to investigate frequency , intensity and dose-volume dependency for late dysphagia in HNC patients treated with curative IMRT .  MATERIAL S AND METHODS C and i date s for the study were 294 patients treated with primary IMRT from 2006 to 2010 ; a total of 259 patients accepted to participate by answering the EORTC QLQ-C30 and H&N35 question naires . A total of 65 patients were further examined with modified barium swallow ( MBS ) and saliva collection . Data on patient , tumor and treatment characteristics were prospect ively recorded in the DAHANCA data base . Dose-volume histograms ( DVH ) of swallowing-related structures were retrospectively analyzed . RESULTS QoL data showed low degree of dysphagia ( QoL subscales scores of 17 and below ) compared to objective measures . The most frequent swallowing dysfunction was retention ; penetration and aspiration was less common . In general , objective measurements and observer-assessed late dysphagia correlated with dose to pharyngeal constrictor muscles ( PCM ) , whereas QoL endpoints correlated with DVH parameters in the glottis/supraglottic larynx . Both xerostomia and dysphagia has been reduced after introduction of IMRT . CONCLUSIONS Radiation-induced dysphagia is still important , with a high degree of retention and penetration . Introduction of parotid-sparing IMRT has reduced the severity of dysphagia , primarily through a major reduction in xerostomia . Dose-response relationships were found for specific dysphagia endpoints BACKGROUND The purpose of this study was to assess aspiration pneumonia ( AsPn ) rates and predictors after chemo-irradiation for head and neck cancer . METHODS The was a prospect i ve study of 72 patients with stage III to IV oropharyngeal cancer treated definitively with intensity-modulated radiotherapy ( IMRT ) concurrent with weekly carboplatin and paclitaxel .  AsPn was recorded prospect ively and dysphagia was evaluated longitudinally through 2 years posttherapy by observer-rated ( Common Toxicity Criteria version [ CTCAE ] ) scores , patient-reported scores , and videofluoroscopy . RESULTS Sixteen patients ( 20 % ) developed AsPn . Predictive factors included T classification ( p = .01 ) , aspiration detected on videofluoroscopy ( videofluoroscopy-asp ; p = .0007 ) , and patient-reported dysphagia ( p = .02-.0003 ) , but not observer-rated dysphagia ( p = .4 ) . Combining T classification , patient reported dysphagia , and videofluoroscopy-asp , provided the best predictive model . CONCLUSION AsPn continues to be an under-reported consequence of chemo-irradiation for head and neck cancer . These data support using patient-reported dysphagia to identify high-risk patients requiring videofluoroscopy evaluation for preventive measures . Reducing  videofluoroscopy-asp rates , by reducing swallowing structures radiation doses and by trials reducing treatment intensity in patients predicted to do well , are likely to reduce AsPn rates PURPOSE Dysphagia after chemoradiotherapy is common . The present r and omized clinical trial studied the effectiveness of preventative behavioral intervention for dysphagia compared with the " usual care . " METHODS AND MATERIAL S A total of 58 head- and -neck cancer patients treated with chemoradiotherapy  were r and omly assigned to usual care , sham swallowing intervention , or active swallowing exercises ( pharyngocise ) . The intervention arms were treated daily during chemoradiotherapy . The primary outcome measure was muscle size and composition ( determined by T(2)-weighted magnetic resonance imaging ) . The secondary outcomes included functional swallowing ability , dietary intake , chemosensory function , salivation , nutritional status , and the occurrence of dysphagia-related complications . RESULTS The swallowing musculature ( genioglossus , hyoglossuss , and mylohyoid ) demonstrated less structural deterioration in the active treatment arm . The functional swallowing , mouth opening , chemosensory acuity , and salivation rate deteriorated less in the pharyngocise group . CONCLUSION Patients completing a program of swallowing exercises during cancer treatment demonstrated superior muscle maintenance and functional swallowing ability PURPOSE / OBJECTIVES To determine the effectiveness of informational audiotapes on self-care behaviors , state anxiety , and use of self-care behaviors ; to describe the occurrence and intensity of common side effects in patients with breast cancer . DESIGN R and omized clinical trial . SETTING Outpatient chemotherapy clinics operated by a university center in a rural area . SAMPLE 70 women receiving their first treatment of chemotherapy .  METHODS Subjects completed demographic data and the Spielberger State-Trait Anxiety instrument ( stai ) . The experimental group received two audiotapes . At one and three months , subjects completed the modified nail self-care diary  and  stai via telephone . MAIN RESEARCH VARIABLES State anxiety , side-effect severity , and use and efficacy of self-care behaviors . FINDINGS The most frequent side effects were fatigue , nausea and vomiting , and taste change . The experimental group reported symptom improvements that were not found in the control group . The experimental group increased the use of recommended self-care behaviors , whereas the control group continued to use the same self-care behaviors without effectiveness . State anxiety for both groups diminished over time ; however , anxiety in the control group was consistently higher . CONCLUSIONS Audiotapes are effective teaching tools . Self-care behaviors can be taught and can be effective in managing side effects . Anxiety was high in both groups , but the symptom decreased in the women who received audiotapes and telephone calls . IMPLICATION S FOR NURSING Constraints on nurses decrease the length of teaching time available , but audiotapes provide effective teaching and reinforcement of education . Anxiety in clinical environments interferes with patient learning . Teaching effective self-care behaviors enhances patients ' independence , comfort , control , and quality of life PURPOSE Between 1994 and 1997 , 22 patients with dysphagia from advanced incurable esophageal cancer were enrolled in a phase I/II prospect i ve study to assess the palliative benefit and toxicity of a short course of radiotherapy with chemotherapy . METHODS The study population included 17 men and five women with a median age of 69 ( range 43 - 84 ) . Patients were treated with 30 Gy in ten fractions to the mediastinum with a concurrent single course of chemotherapy ( 5-FU , 1000 mg/m(2 ) , days 1 - 4 and mitomycin-C 10 mg/m(2 ) , day 1 ) . Swallowing ability was recorded each day on a self-administered diary card using the five point dysphagia index of the MRC ( UK ) . The median baseline MRC swallowing score was 4 ( can not swallow solids ) . RESULTS Treatment was generally well tolerated , but seven ( 32 % ) patients had transient worsening of dysphagia scores immediately following treatment because of esophagitis ; fifteen ( 68 % ) achieved a complete response ( score 1 : no difficulty on swallowing ) with a median time to normalization of swallowing of 5 weeks . For these patients , the median dysphagia-free interval from time of onset of improvement was 11 weeks ( range 1 - 131 weeks ) and 11 ( 73 % ) remained dysphagia-free until death . The remaining patients had no or marginal improvement . Univariate analysis showed no difference between responders and non-responders with respect to age , gender , or histology . Median survival for the entire study population was 20 weeks ( range 3 - 135 weeks ) . CONCLUSIONS This prospect i ve trial shows that a short course of radiotherapy plus chemotherapy may produce complete relief of swallowing difficulties in a substantial proportion of patients with acceptable toxicity ABSTRACT Objectives : Dysphagia occurs in approximately 51%–78 % of patients with acute stroke . The incidence of pneumonia caused by aspiration in dysphagic patients increases both mortality and the need for hospitalization . The aim of this study was to investigate whether the incidence of aspiration pneumonia could be reduced in such patients by an early screening for dysphagia and intensified oral hygiene . Material and Methods : In this controlled trial , 146 hospitalized acute stroke patients with moderate or severe dysphagia were included in three groups : an intervention group ( n = 58 ) , one internal control group ( n = 58 , retrospectively selected from same clinic ) , and one external control group ( n = 30 ) from a comparable stroke unit in a neighboring hospital . The intervention consisted of early screening with a clinical method of dysphagia screening , the Gugging Swallowing Screen , and intensified oral hygiene . Results : The incidence of x-ray verified pneumonia was 4 of 58 ( 7 % ) in the intervention group compared with 16 of 58 ( 28 % ) in the internal control group ( p < .01 ) and with 8 of 30 ( 27 % ) in the external control group ( p < .05 ) . Conclusions : Early and systematic dysphagia screening by the Gugging Swallowing Screen method and intensified oral hygiene reduced the incidence of x-ray verified pneumonia OBJECTIVE Oral cancer elicits considerable distress in both the pre and post-treatment periods . This paper details the development , validation and pilot-testing of a psychoeducational intervention for oral cancer patients . METHOD An educational booklet covering information about oral cancer and its treatment and effective coping strategies was developed by a multi-disciplinary team . It was evaluated by patient focus groups and content/educational experts , delivered to subjects in pre and post-operative presentations by a health educator , and pilot-tested in a r and omized controlled trial versus st and ard care . RESULTS Pilot data from 19 subjects ( 10 psychoeducation , nine st and ard care )  indicates that the intervention is feasible and highly acceptable . At follow-up the intervention group showed a gain in knowledge , less body image disturbance , lower anxiety and a trend toward higher wellbeing . CONCLUSION This program , which is currently being evaluated in a larger RCT with extended follow-up , should prove useful in reducing the psychosocial burden of oral cancer and its treatment
Attempts to prevent dysgeusia through the prophylactic use of zinc sulfate or amifostine have been of limited benefit .
Nutritional counseling may be helpful to some patients in minimizing the symptoms of dysgeusia .
Conclusions Dysgeusia is a common oral side effect of cancer therapy ( radiotherapy , chemotherapy , or combined modality therapy ) and often impacts negatively on quality of life .
From the current literature , there does not appear to be a predictable way of preventing or treating dysgeusia
Purpose The purpose was to review relevant scientific papers written since 1989 which focused on the prevalence and management of  dysgeusia as an oral side effect of cancer treatment .