Adherence to Swallowing Rehabilitation Exercises in Head and Neck Cancer

头颈癌患者坚持吞咽康复训练

• 批准号: 8535541
• 负责人: EILEEN H SHINN
• 金额: $ 30.27万
• 依托单位: UNIVERSITY OF TX MD ANDERSON CAN CTR
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-18 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8535541
• 关键词: Accounting; Adherence; Adverse effects; Anatomy; Articular Range of Motion; Barium swallow; Breathing; Cancer Patient; Cancer Survivor; Chronic; Community Hospitals; Control Groups; Data; Deglutition; Deglutition Disorders; Dental; Dental Hygiene; Diagnosis; Eating; Exercise; Fatigue; Gold; Head and Neck Cancer; Incidence; Informal Social Control; Intensity-Modulated Radiotherapy; Intervention; Intervention Studies; Larynx; Low income; Malignant Neoplasms; Malnutrition; Measures; Mediator of activation protein; Mental Depression; Minority; Morbidity - disease rate; Motor; Mucositis; Nausea; Operative Surgical Procedures; Oral cavity; Oropharyngeal; Pain; Pamphlets; Participant; Patient Self-Report; Patients; Pharyngeal structure; Preventive; Procedures; Publishing; Radiation; Radiation therapy; Randomized; Recruitment Activity; Regimen; Rehabilitation therapy; Reporting; Research; Research Design; Risk; Saliva; Sampling; Severities; Social support; Staging; Stroke; Structure; Survival Rate; Targeted Radiotherapy; Testing; Time; Tongue; Treatment Efficacy; Utility Theories; Visit; Xerostomia; base; cancer diagnosis; cancer therapy; comparative efficacy; coping; efficacy testing; experience; follow-up; head and neck cancer patient; high risk; illness perceptions; improved; malignant oropharynx neoplasm; men; mortality; prevent; theories; treatment as usual

Head and neck cancer patients who are treated with large-field radiation are at high risk to develop permanent swallowing disorders. To prevent this, patients can perform motor exercises that strengthen the tongue and increase range of motion in oropharyngeal structures. However, adherence to swallowing exercises is low in dysphagic patients; our preliminary data indicated that just 9.5% of the participants were adherent to swallowing exercises during radiation (n=97). Our intervention pilot intervention, PREPARE (n=16) indicates that it is highly effective and feasible. Identifying key mediators and moderators in adherence to swallowing exercises would be valuable to head and neck cancer patients. Primary Aims Aim1) To compare the efficacy of a Self- Regulation intervention with an Enhanced Usual Care control group in increasing adherence to prescribed swallowing exercises in a sample of irradiated head and neck cancer patients. Aim1a) To evaluate the mediators of the proposed intervention on adherence to self-reported swallowing exercises at 6 week and twelve month follow-up. The mediators to be tested will be perception of illness, coping procedures and appraisal of coping procedures. Aim1b) To determine whether depression, pain, fatigue and social support moderate the impact of the intervention on adherence at 6 week follow-up or 12 month follow-up or both. Aim 2a) To test the impact of the PREPARE intervention on anatomic swallowing function as assessed by gold-standard radiographic Modified Barium Swallow (MBS), which is scored with the OPSE. Aim 2b) To test the impact of the PREPARE intervention on self-reported swallowing function as assessed by the MDADI and the PSS-HN. Study design: 288 patients recruited from M. D. Anderson and Lyndon Baines Johnson Community hospital, which serves primarily minority, low-income patients, will be randomized into one of two groups: 1) Enhanced Usual care plus an informational brochure about the importance of swallowing exercises, and 2) PREPARE, an intervention based on the Theory of Self-Regulation delivering objective and motivational coping strategies for mucositis, xerostomia, fatigue, nausea and dysphagia. Assessment timepoints are at baseline entry into the study, 6 weeks after the end of radiation therapy, and 12 months post-radiation. To measure the impact of the intervention on swallowing anatomic function, a subsample of 100 participants will be measured by modified barium swallow at baseline and at 12 month follow-up. Summary: The resulting longitudinal data will yield important information about adherence to swallowing exercises and its relationship to anatomic swallowing function within a theoretical framework.

接受大场放射治疗的头颈癌患者罹患头颈癌的风险很高 永久性吞咽障碍。为了防止这种情况，患者可以进行运动锻炼 强化舌头并增加口咽结构的运动范围。然而， 吞咽困难患者对吞咽练习的依从性较低；我们的初步数据表明 只有 9.5% 的参与者在放射期间坚持进行吞咽练习 (n=97)。我们的 干预试点干预PREPARE（n=16）表明其高度有效和可行。 确定坚持吞咽练习的关键调节因素和调节因素将很有价值 头颈癌患者。主要目标 目标 1) 比较自我评估的功效 通过增强日常护理对照组进行监管干预，以提高对药物的依从性 对接受辐射的头颈癌患者样本进行吞咽练习。目标1a) 评估拟议干预措施对自我报告吞咽依从性的调节因素 在 6 周和 12 个月的随访中进行锻炼。要测试的中介变量将是对 疾病、应对程序和应对程序评估。目标 1b) 确定是否 抑郁、疼痛、疲劳和社会支持减轻了干预对依从性的影响 在 6 周随访或 12 个月随访或两者同时进行。目标 2a) 测试 PREPARE 的影响 通过黄金标准放射线照相改良评估的解剖吞咽功能干预 吞钡 (MBS)，用 OPSE 评分。目标 2b) 测试影响 根据 MDADI 和 MDADI 的评估，准备对自我报告的吞咽功能进行干预 PSS-HN。研究设计：从 M.D. Anderson 和 Lyndon Baines Johnson 招募的 288 名患者 主要为少数族裔、低收入患者服务的社区医院将被随机分为 两组之一：1) 增强的日常护理以及关于以下重要性的信息手册 吞咽练习，以及 2) PREPARE，一种基于自我调节理论的干预措施 针对粘膜炎、口干症、疲劳、恶心提供客观和激励性的应对策略 和吞咽困难。评估时间点是在进入研究的基线时、结束后 6 周 放射治疗期间以及放射治疗后 12 个月。衡量干预措施的影响 吞咽解剖功能，100 名参与者的子样本将通过修改后的方法进行测量 基线和 12 个月随访时吞钡。摘要：由此产生的纵向数据 将产生有关坚持吞咽练习及其关系的重要信息 理论框架内的解剖吞咽功能。

项目成果

Simulating Time-Dependent Patterns of Nonadherence by Patients With Breast Cancer to Adjuvant Oral Endocrine Therapy.

模拟乳腺癌患者对辅助口服内分泌治疗不依从的时间依赖性模式。

• DOI: 10.1200/cci.18.00091
• 发表时间: 2019
• 期刊: JCO clinical cancer informatics
• 影响因子: 4.2
• 作者: Shinn,EileenH;Broderick,Gordon;Fellman,Bryan;Johnson,Ainslee;Wieland,Elizabeth;Moulder,Stacy;Symmans,WilliamFraser
• 通讯作者: Symmans,WilliamFraser