The effects of Phoniatric PREhabilitation in Head and Neck Cancer patients on Aspi-ration and Preservation of Swallowing (PREHAPS): Study protocol of a monocentric prospective randomized interventional outcome-blinded trial.

Abstract

Abstract Background: Dysphagia, with its negative impact on life expectancy and quality of life, is a major side effect of head and neck squamous cell carcinoma (HNSCC). In a typical Head and Neck Cancer Center, more than half of patients are affected. Improving treatment, and ideally prevention respectively prehabilitation, therefore seems more than desirable. Methods: The study is planned as a monocentric, prospective, outcome-blinded, randomized interventional study comparing an advanced phoniatric-logopedic prehabilitation with a control (standard of care). Sixty patients (control group 30/intervention group 30) with an initial diagnosis of invasive HNSCC and curative treatment intention will be included over a period of 17 months. In addition to the previous standard, both groups will undergo both, detailed subjective assessment of swallowing function and quality of life by means of various questionnaires, as well as objective analyses by bioelectrical impedance measurements and phoniatric endoscopic swallowing examinations. In the intervention group, risk-related nutritional counseling (face-to-face) and phoniatric-logopedic prehabilitation are provided: Detailed counseling with video demonstration and exercises to strengthen and improve range of motion of the oral, pharyngeal, and laryngeal muscles (guided by exercise diary). Controls are performed 6 weeks, 3 and 6 months, as well as 9 or 12 months after the end of therapy during the regular tumor follow-up. Primary study endpoints are swallowing function and emotional distress at 6 weeks control visit. Discussion: Prehabilitation measures have already proven successful in other patient groups, e.g. transplant patients. In the field of head and neck oncology, interest in such concepts has increased significantly in recent years. However, usually only subgroups, e.g. patients with swallowing problems after radiochemotherapy alone, are in focus. Our study aims to investigate the general benefit of prehabilitation with regard to swallowing function, which is so important for protection of aspiration and quality of life. Trial registration: DRKS00029676 (German Clinical Trials Register https://drks.de/search/de/trial/DRKS00029676; International Clinical Trials Registry Platform https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00029676).