Electrical Stimulation for Treatment of Dysphagia Post Head Neck Cancer: A Systematic Review and Meta-Analysis

 

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Abstract

Introduction Dysphagia induced by radiotherapy in the head and neck region comprises a challenging scenario and sometimes difficult rehabilitation due to the severity of the adverse effects. Some resources such as electrical stimulation have emerged as an alternative to complement the therapeutic process, but there is still no consensus on its use.

Objective The purpose of the present study was to evaluate, through a meta-analysis, the effect of electrical stimulation on the rehabilitation of dysphagia generated after head and neck cancer treatment.

Data Synthesis Four randomized controlled trials with a total of 146 participants were included. The age of the participants was 58.37 ± 1.8 years old and there was a predominance of males. The time to start the intervention ranged from 50.96 ± 40.12 months after cancer treatment. The intervention showed great heterogeneity regarding the positioning of the electrodes, parameters, duration of the stimulus, number of sessions, and intensity. No difference was identified in the following aspects: oral transit time, hyoid elevation, penetration and/or aspiration after electrostimulation. The quality of the evidence ranged from very low to moderate and high risk of bias.

Conclusion In this meta-analysis, we found weak evidence for small and moderate swallowing benefits in patients after radiotherapy for head and neck cancer in short-term clinical trials.

Ethics Approval

The present review follows the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines and, subsequently, it was registered in the International Prospective Register of Systematic Reviews (PROSPERO), with the following identification: CRD42020200248

Publication History

Received: 15 June 2022

Accepted: 13 November 2022

Article published online:
14 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

• References

• 1 Hutcheson KA, Lewin JS, Barringer DA. et al. Late dysphagia after radiotherapy-based treatment of head and neck cancer. Cancer 2012; 118 (23) 5793-5799 DOI: 10.1002/cncr.27631.
  CrossrefPubMedGoogle Scholar
• 2 Rinkel RN, Verdonck-de Leeuw IM, Doornaert P. et al. Prevalence of swallowing and speech problems in daily life after chemoradiation for head and neck cancer based on cut-off scores of the patient-reported outcome measures SWAL-QOL and SHI. Eur Arch Otorhinolaryngol 2016; 273 (07) 1849-1855 DOI: 10.1007/s00405-015-3680-z.
  CrossrefPubMedGoogle Scholar
• 3 Van den Steen L, Van Gestel D, Vanderveken O. et al. Evolution of self-perceived swallowing function, tongue strength and swallow-related quality of life during radiotherapy in head and neck cancer patients. Head Neck 2019; 41 (07) 2197-2207 DOI: 10.1002/hed.25684.
  CrossrefPubMedGoogle Scholar
• 4 Jung SJ, Kim DY, Joo SY. Rick factors associated with aspiration in patients with head and neck cancer. Ann Rehabil Med 2011; 35 (06) 781-790 DOI: 10.5535/arm.2011.35.6.781.
  CrossrefPubMedGoogle Scholar
• 5 Rancati T, Schwarz M, Allen AM. et al. Radiation dose-volume effects in the larynx and pharynx. Int J Radiat Oncol Biol Phys 2010; 76 (3, Suppl) S64-S69 DOI: 10.1016/j.ijrobp.2009.03.079.
  CrossrefPubMedGoogle Scholar
• 6 Im I, Carnaby GD, Takahashi N, Dungan S, Crary MA. Clinical Swallowing Profile Change in HNC Patients Treated with C/RT. Laryngoscope 2021; 131 (06) E1873-E1880 DOI: 10.1002/lary.29266.
  CrossrefPubMedGoogle Scholar
• 7 Jeans C, Ward EC, Brown B. et al. Association between external and internal lymphedema and chronic dysphagia following head and neck cancer treatment. Head Neck 2021; 43 (01) 255-267 DOI: 10.1002/hed.26484.
  CrossrefPubMedGoogle Scholar
• 8 Hunter KU, Schipper M, Feng FY. et al. Toxicities affecting quality of life after chemo-IMRT of oropharyngeal cancer: prospective study of patient-reported, observer-rated, and objective outcomes. Int J Radiat Oncol Biol Phys 2013; 85 (04) 935-940 DOI: 10.1016/j.ijrobp.2012.08.030.
  CrossrefPubMedGoogle Scholar
• 9 Kakoei S, Haghdoost AA, Rad M. et al. Xerostomia after radiotherapy and its effect on quality of life in head and neck cancer patients. Arch Iran Med 2012; 15 (04) 214-218
  PubMedGoogle Scholar
• 10 Keilmann A, Wach FS, Konerding U. Outcome of Phoniatric Rehabilitation of Dysphagia in Patients with Head and Neck Cancer. Laryngorhinootologie 2021; 100 (04) 270-277 DOI: 10.1055/a-1353-6293.
  Article in Thieme ConnectPubMedGoogle Scholar
• 11 Speyer R, Baijens L, Heijnen M, Zwijnenberg I. Effects of therapy in oropharyngeal dysphagia by speech and language therapists: a systematic review. Dysphagia 2010; 25 (01) 40-65 DOI: 10.1007/s00455-009-9239-7.
  CrossrefPubMedGoogle Scholar
• 12 Roe JW, Ashforth KM. Prophylactic swallowing exercises for patients receiving radiotherapy for head and neck cancer. Curr Opin Otolaryngol Head Neck Surg 2011; 19 (03) 144-149 DOI: 10.1097/MOO.0b013e3283457616.
  CrossrefPubMedGoogle Scholar
• 13 Krekeler BN, Rowe LM, Connor NP. Dose in Exercise-Based Dysphagia Therapies: A Scoping Review. Dysphagia 2021; 36 (01) 1-32 DOI: 10.1007/s00455-020-10104-3.
  CrossrefPubMedGoogle Scholar
• 14 Starmer HM. Dysphagia in head and neck cancer: prevention and treatment. Curr Opin Otolaryngol Head Neck Surg 2014; 22 (03) 195-200
  CrossrefPubMedGoogle Scholar
• 15 Baudelet M, Van den Steen L, Duprez F. et al; Member of the Belgian PRESTO Group. Study protocol for a randomized controlled trial: prophylactic swallowing exercises in head-and-neck cancer patients treated with (chemo)radiotherapy (PRESTO trial). Trials 2020; 21 (01) 237 DOI: 10.1186/s13063-020-4171-0.
  CrossrefPubMedGoogle Scholar
• 16 Long YB, Wu XP. A randomized controlled trail of combination therapy of neuromuscular electrical stimulation and balloon dilatation in the treatment of radiation-induced dysphagia in nasopharyngeal carcinoma patients. Disabil Rehabil 2013; 35 (06) 450-454 DOI: 10.3109/09638288.2012.697250.
  CrossrefPubMedGoogle Scholar
• 17 Lin PH, Hsiao TY, Chang YC. et al. Effects of functional electrical stimulation on dysphagia caused by radiation therapy in patients with nasopharyngeal carcinoma. Support Care Cancer 2011; 19 (01) 91-99 DOI: 10.1007/s00520-009-0792-2.
  CrossrefPubMedGoogle Scholar
• 18 Langmore SE, McCulloch TM, Krisciunas GP. et al. Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: A randomized clinical trial. Head Neck 2016; 38 (Suppl 1): E1221-E1231 DOI: 10.1002/hed.24197.
  CrossrefPubMedGoogle Scholar
• 19 Ryu JS, Kang JY, Park JY. et al. The effect of electrical stimulation therapy on dysphagia following treatment for head and neck cancer. Oral Oncol 2009; 45 (08) 665-668 DOI: 10.1016/j.oraloncology.2008.10.005.
  CrossrefPubMedGoogle Scholar
• 20 Peng G, Masood K, Gantz O, Sinha U. Neuromuscular electrical stimulation improves radiation-induced fibrosis through Tgf-Β1/MyoD homeostasis in head and neck cancer. J Surg Oncol 2016; 114 (01) 27-31 DOI: 10.1002/jso.24265.
  CrossrefPubMedGoogle Scholar
• 21 Sun Y, Chen X, Qiao J. et al. Effects of Transcutaneous Neuromuscular Electrical Stimulation on Swallowing Disorders: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil 2020; 99 (08) 701-711 DOI: 10.1097/PHM.0000000000001397.
  CrossrefPubMedGoogle Scholar
• 22 Russell JA, Connor NP. Effects of age and radiation treatment on function of extrinsic tongue muscles. Radiat Oncol 2014; 9: 254 DOI: 10.1186/s13014-014-0254-y.
  CrossrefPubMedGoogle Scholar
• 23 Burkhead LM, Sapienza CM, Rosenbek JC. Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia 2007; 22 (03) 251-265 DOI: 10.1007/s00455-006-9074-z.
  CrossrefPubMedGoogle Scholar
• 24 Dalbem Paim É, Costa Batista Berbert M, Gonzales Zanella V, Beatris Martins V, Edler Macagnan F. Effects of transcutaneous electrical nerve stimulation on the salivary flow of patients with hyposalivation induced by radiotherapy in the head and neck region-A randomised clinical trial. J Oral Rehabil 2019; 46 (12) 1142-1150 DOI: 10.1111/joor.12851.
  CrossrefPubMedGoogle Scholar
• 25 Paim ED. et al. Efeito agudo da|Transcutaneous Electric Nerve Stimulation(TENS) sobre a hipossalivação induzida pela radioterapia na região de cabeça e pescoço: um estudo preliminar. CoDAS 2018; 30 (03) e20170143 DOI: 10.1590/2317-1782/20182017143. https://www.scielo.br/j/codas/a/66s53cKt4NGQJzkZff57zgB/?lang=en#
  CrossrefPubMedGoogle Scholar
• 26 Linkov G, Branski RC, Amin M. et al. Murine model of neuromuscular electrical stimulation on squamous cell carcinoma: potential implications for dysphagia therapy. Head Neck 2012; 34 (10) 1428-1433 DOI: 10.1002/hed.21935.
  CrossrefPubMedGoogle Scholar
• 27 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097 DOI: 10.1371/journal.pmed.1000097.
  CrossrefPubMedGoogle Scholar
• 28 Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia 1996; 11 (02) 93-98 DOI: 10.1007/BF00417897.
  CrossrefPubMedGoogle Scholar
• 29 Hedges LV, Olkin I, Hedges LV. Eds. Statistical Methods for Meta-Analysis. New York: Academic Press; 1985
  Google Scholar
• 30 Cohen J. Statistical power analysis for the behavioral sciences. Routledge; 1988
  Google Scholar
• 31 Sterne JAC, Savović J, Page MJ. et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898 DOI: 10.1136/bmj.l4898.
  CrossrefPubMedGoogle Scholar
• 32 Sterne JA, Hernán MA, Reeves BC. et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: i4919 . Published 2016 Oct 12. DOI: 10.1136/bmj.i4919.
  CrossrefPubMedGoogle Scholar
• 33 Atkins D, Best D, Briss PA. et al; GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ 2004; 328 (7454): 1490 DOI: 10.1136/bmj.328.7454.1490.
  CrossrefPubMedGoogle Scholar
• 34 Jones S, Man WD, Gao W, Higginson IJ, Wilcock A, Maddocks M. Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease. Cochrane Database Syst Rev 2016; 10 (10) CD009419 DOI: 10.1002/14651858.CD009419.pub3.
  CrossrefPubMedGoogle Scholar
• 35 Peckham PH, Knutson JS. Functional electrical stimulation for neuromuscular applications. Annu Rev Biomed Eng 2005; 7: 327-360 DOI: 10.1146/annurev.bioeng.6.040803.140103.
  CrossrefPubMedGoogle Scholar
• 36 Vromans M, Faghri PD. Functional electrical stimulation-induced muscular fatigue: Effect of fiber composition and stimulation frequency on rate of fatigue development. J Electromyogr Kinesiol 2018; 38: 67-72 DOI: 10.1016/j.jelekin.2017.11.006.
  CrossrefPubMedGoogle Scholar
• 37 Maffiuletti NA. Physiological and methodological considerations for the use of neuromuscular electrical stimulation. Eur J Appl Physiol 2010; 110 (02) 223-234 DOI: 10.1007/s00421-010-1502-y.
  CrossrefPubMedGoogle Scholar
• 38 Nagano H, Yoshifuku K, Kurono Y. Polymyositis with dysphagia treated with endoscopic balloon dilatation. Auris Nasus Larynx 2009; 36 (06) 705-708 DOI: 10.1016/j.anl.2009.04.007.
  CrossrefPubMedGoogle Scholar
• 39 Steele NP, Tokayer A, Smith RV. Retrograde endoscopic balloon dilation of chemotherapy- and radiation-induced esophageal stenosis under direct visualization. Am J Otolaryngol 2007; 28 (02) 98-102 DOI: 10.1016/j.amjoto.2006.07.003.
  CrossrefPubMedGoogle Scholar
• 40 Stubblefield MD. Radiation fibrosis syndrome: neuromuscular and musculoskeletal complications in cancer survivors. PM R 2011; 3 (11) 1041-1054 DOI: 10.1016/j.pmrj.2011.08.535.
  CrossrefPubMedGoogle Scholar
• 41 Jurdana M, Cemazar M, Pegan K, Mars T. Effect of ionizing radiation on human skeletal muscle precursor cells. Radiol Oncol 2013; 47 (04) 376-381 DOI: 10.2478/raon-2013-0058.
  CrossrefPubMedGoogle Scholar
• 42 Mancinelli R, Toniolo L, Di Filippo ES. et al. Neuromuscular Electrical Stimulation Induces Skeletal Muscle Fiber Remodeling and Specific Gene Expression Profile in Healthy Elderly. Front Physiol 2019; 10: 1459 DOI: 10.3389/fphys.2019.01459.
  CrossrefPubMedGoogle Scholar
• 43 Ogura M, Matsumoto S, Ohama R. et al. Immediate Effects of Electrical Stimulation on Oropharyngeal Structure and Laryngeal Vestibular Closure: A Pilot Study in Healthy Subjects. Prog Rehabil Med 2022; 7: 20220033 DOI: 10.2490/prm.20220033.
  CrossrefPubMedGoogle Scholar
• 44 Hughes SM, Chi MM, Lowry OH, Gundersen K. Myogenin induces a shift of enzyme activity from glycolytic to oxidative metabolism in muscles of transgenic mice. J Cell Biol 1999; 145 (03) 633-642 DOI: 10.1083/jcb.145.3.633.
  CrossrefPubMedGoogle Scholar

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