Prophylactic Swallow Therapy for Patients with Head and Neck Cancer Undergoing Chemoradiotherapy: A Randomized Trial.

Only 60 of 135 eligible patients consented, and the authors state the cohort cannot be considered representative of all patients who may benefit. The sample size was set at 30 participants per group to detect a 1.0 point change on the main diet scale, and some confidence intervals were large, which the authors state may reflect imprecision or small sample size. Swallow physiology was measured only at baseline and 3 months, so long-term physiological benefit is unknown. Adherence declined during treatment: 72% completed less than 40% of daily exercises across 6 weeks, and daily exercise sets fell from an average of 6 in week 1 to 2 in week 7. The exercise group received exercises, weekly therapy, diet advice, and TheraBite, while the control group also received TheraBite, so the contribution of any single component cannot be separated. Four control participants received swallow therapy after 3 months, although they were analyzed in the control group. The study was done at one center, and chemoradiotherapy regimens changed during recruitment, although the proportion receiving each regimen did not differ significantly between groups. Missing data occurred over time, and the analysis assumes missing values were completely at random, which may not hold.

Do not conclude that prophylactic swallow exercises reliably improve eating or shorten PEG tube use. The primary functional outcome at 3 months did not show a statistically significant difference, and the exercise group also received weekly therapy, diet advice, and TheraBite while the control group also received TheraBite.