Exercise-based dysphagia rehabilitation for adults with oesophageal cancer: A systematic review

Dysphagia is prevalent in oesophageal cancer with signifcant clinical and psychosocial complications. The purpose of this study was i) to examine the impact of exercise-based dysphagia rehabilitation on clinical and quality of life outcomes in this population and ii) to identify key rehabilitation components that may inform future research in this area.
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Exercise-based dysphagia rehabilitation for adults with oesophageal cancer: A systematic reviewGillmanetal. BMC Cancer (2022) 22:53https://doi.org/10.1186/s12885-021-09155-y RESEARCH ARTICLE Open AccessExercise-based dysphagia rehabilitationforadults withoesophageal cancer: asystematicreviewAnnaGillman1, MichelleHayes2, GregSheaf3, MargaretWalshe1, JohnV.Reynolds4and JulieRegan1*    Abstract:  Background:  Dysphagia is prevalent in oesophageal cancer with significant clinical and psychosocial complications. The purpose of this study was i) to examine the impact of exercise-based dysphagia rehabilitation on clinical and quality of life outcomes in this population and ii) to identify key rehabilitation components that may inform future research in this area. Methods:  Randomised control trials (RCT), non-RCTs, cohort studies and case series were included. 10 databases (CINAHL Complete, MEDLINE, EMBASE, Web of Science, CENTRAL, and ProQuest Dissertations and Theses, Open- Grey, PROSPERO, RIAN and SpeechBITE), 3 clinical trial registries, and relevant conference abstracts were searched in November 2020. Two independent authors assessed articles for eligibility before completing data extraction, qual- ity assessment using ROBINS-I and Downs and Black Checklist, followed by descriptive data analysis. The primary outcomes included oral intake, respiratory status and quality of life. All comparable outcomes were combined and discussed throughout the manuscript as primary and secondary outcomes. Results:  Three single centre non-randomised control studies involving 311 participants were included. A meta- analysis could not be completed due to study heterogeneity. SLT-led post-operative dysphagia intervention led to sig- nificantly earlier start to oral intake and reduced length of post-operative hospital stay. No studies found a reduction in aspiration pneumonia rates, and no studies included patient reported or quality of life outcomes. Of the reported secondary outcomes, swallow prehabilitation resulted in significantly improved swallow efficiency following oesoph- ageal surgery compared to the control group, and rehabilitation following surgery resulted in significantly reduced vallecular and pyriform sinus residue. The three studies were found to have ‘serious’ to ‘critical’ risk of bias. Conclusions:  This systematic review highlights a low-volume of low-quality evidence to support exercise-based dysphagia rehabilitation in adults undergoing surgery for oesophageal cancer. As dysphagia is a common symp- tom impacting quality of life throughout survivorship, findings will guide future research to determine if swallowing rehabilitation should be included in enhanced recovery after surgery (ERAS) programmes. This review is limited by the inclusion of non-randomised control trials and the reliance on Japanese interpretation which may have resulted in bias. The reviewed studies were all of weak design with limited data reported. Keywords:  Oesophageal cancer, Curative treatment, Dysphagia - swallowing rehabilitation, Swallow exercises Background Oesophageal cancer has an overall poor survival com- pared with many other malignancies. Recent reports*Correspondence: juregan@tcd.ie1 Department ofClinical Speech andLanguage Studies, Trinity College indicate an approximate 5-year survival of between 15Dublin, 7‑9 South Leinster Street, Dublin 2, Ireland and 25% [1–3]. However, 5-year survival has increasedFull list of author information is available at the end of the article to approximately 50% amongst those who can be treated © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line ...