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Cancer related Feeding and Swallowing Issues · Talking FACS

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  Welcome to Talking FACS, and thank you for tuning in to Cancer Conversations
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  on Talking FACS, a podcast collaboration between the University of Kentucky
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  Markey Cancer Center and the UK Martin Gatton College of Agriculture,
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  Food, and Environment's Cooperative Extension Service.
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  We will share with you the latest developments in cancer prevention,
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  diagnosis, treatment, and research from the experts at Markey Cancer Center,
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  Kentucky's only National Cancer Institute Institute-designated comprehensive cancer center.
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  Talking FACS is hosted by the UK Family and Consumer Sciences Extension Program.
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  Our educators share research knowledge with individuals, families,
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  and communities to improve quality of life.
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  Hello and welcome to Cancer Conversations on Talking FACS.
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  This is your host, Dr. Jennifer Hunter, Assistant Director for Family Consumer
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  Sciences Extension at the University of Kentucky.
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  Today, I'm pleased to be joined by Tammy Wigginton, a speech-language pathologist
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  and board-certified specialist in swallowing and swallowing disorders.
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  Welcome, Tammy. Thank you for having me. So today we're going to talk about
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  managing cancer-related feeding and swallowing issues.
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  And we're specifically going to be talking about dysphagia.
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  And I'd like to start for our listeners, because you've coached me before we
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  started recording to make certain that I was pronouncing it correctly,
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  but I would just like to start for our listeners of helping them understand
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  what is dysphagia because it could be a very new term for many.
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  Okay, so dysphagia is really just a fancy word for difficulty swallowing.
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  And swallowing is a deceptively complex and highly regulated and coordinated
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  physiological act that really most of us take for granted.
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  We don't think about how much effort that it actually takes to eat and drink.
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  So normal swallowing function is really dependent on having normal structural
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  anatomy, like like having a normal tongue, having a normal palate,
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  having a normal throat, as well as normal.
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  Volitional, which is like you can have a volitional swallow,
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  which is you put something in your mouth and you think to yourself, I need to swallow this.
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  And some parts of swallowing are reflexive in that it just automatically takes place.
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  So there are about 30 nerves and muscles that are involved in swallowing and
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  disruption in any part of the system, like the anatomy or the nerves or the muscles,
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  can really impact overall swallowing function.
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  And it can take something that is normally a pleasant activity and make it very
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  unpleasant and stressful and difficult.
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  I mean, you are right that swallowing is something that most of us certainly
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  never ever think about that we just do.
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  So how common is dysphagia among cancer patients?
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  Interestingly enough, it is actually very common.
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  So greater than 50% of patients that are being treated for cancer complain of
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  difficulty eating and swallowing.
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  The prevalence is highest in patients with head and neck cancer with approximately
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  90% of head and neck cancer patients having difficulty swallowing.
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  And that makes sense because a lot of what happens with swallowing is,
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  you know, the food goes in your mouth, your tongue pushes the food from the
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  front of your mouth to the back of your throat, your teeth are involved,
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  your throat is involved.
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  And so patients with head and neck cancer have cancers in the region that is
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  most commonly dedicated to eating and swallowing.
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  There's also a high rate of dysphagia in patients with cancers of the brain
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  because the brain is the computer system for all activities that we do,
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  and the brain controls the nerves that are involved in swallowing.
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  Also, patients that have lung cancer, bone cancer.
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  Cancers of the soft tissue, and the upper gastrointestinal tract,
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  like the esophagus, tend to have a high rate of dysphagia, feeding and swallowing disorders.
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  Disorders colorectal skin and gynecological cancer patients can still have trouble
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  swallowing but it's typically to a lesser degree and it's more frequently related
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  to the treatment that they're getting for the cancer versus the tumor itself.
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  So you have addressed this to some extent on why cancer patients struggle with swallowing and eating.
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  So some of it may be the specific type of cancer, some of it may be associated with the treatment.
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  Anything additional to add there? For many patients, the first sign that they
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  have cancer is difficulty swallowing.
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  So for patients that have cancers of the head and neck, and for patients that
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  have cancers in the esophagus, sometimes the first symptom of their cancer is
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  having trouble swallowing.
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  And so they have trouble with their swallowing function before they're even
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  diagnosed with their cancer.
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  On the other aspect of that, any modality that we use to treat the cancer can
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  also impact a patient's swallowing function.
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  So for patients that have to have part of important structures to swallowing
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  resected or removed, they're going to have an immediate onset of difficulty swallowing.
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  Like if we have to take out someone's tongue or part of their voice box or larynx
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  or their esophagus, those patients are going to have difficulty swallowing.
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  Typically, the bigger the cancer surgery,
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  the more likely the person is to have difficulty swallowing,
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  and the more important the structure is to swallowing, like the tongue or the
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  palate or the esophagus,
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  those patients are going to have greater difficulty than other patients.
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  The other aspect is that some of the other modalities like radiation therapy
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  and chemotherapy can also negatively impact swallowing function.
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  So chemotherapy can cause alterations in a person's smell and taste sensation,
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  which can impact their swallowing function. Chemotherapy can,
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  can also cause ulcers inside the oral cavity in the throat and the esophagus
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  that makes it very uncomfortable and painful to eat and drink.
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  Radiation therapy can also cause fatigue, and sometimes it can cause swelling
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  in the throat that makes it hard to swallow.
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  The more modalities required to treat the cancer, so if somebody has to get
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  surgery, chemo, and radiation, the higher the probability that they're going
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  to have difficulties over the long haul.
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  What are some of the symptoms an individual may experience if they have dysphagia?
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  So a lot of times patients will notice that they're getting strangled or they're
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  coughing when they're trying to eat.
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  This is often a sign that they're having trouble coordinating their breathing and swallowing.
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  So they'll note that they get strangled, especially on thin liquids.
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  Liquids some patients will complain that it
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  feels like foods and liquids and maybe sometimes
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  their medication is getting stuck in their
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  throat and it's hard to get it down sometimes that can obstruct their airway
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  so they'll feel like their air is getting cut off when they're swallowing sometimes
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  people will say that they have to swallow five or six times to get like just
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  one little bite of food down.
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  Sometimes patients regurgitate or their food comes back up on them.
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  And then also we see patients that have repeated episodes of pneumonia,
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  which is a specific aspiration type pneumonia where food or liquid is actually
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  going into their lungs versus down their esophagus and into their stomach like it's supposed to.
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  And aspiration pneumonia can be a a life-threatening condition.
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  If an individual feels like that they may be struggling with swallowing issues,
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  what would be their next step?
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  What is the referral process? Who do they reach out to?
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  You should really talk to your cancer care team and tell them that you're having
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  difficulty swallowing.
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  They're probably closely monitoring you anyway, but if you're losing weight,
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  If it's taking longer to eat a meal, you're getting choked and strangled,
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  you should talk to your provider and ask for a referral for an evaluation.
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  If an individual is diagnosed with dysphagia, how is it managed?
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  So in some instances, we're trying to mitigate some of the problems that they're
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  having by maybe giving them some exercises to help them maintain their muscles
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  and swallowing functions while they're going through treatment.
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  For some patients, especially patients that have had portions of their body surgically removed,
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  like if a person has tongue cancer, sometimes we can help them compensate by
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  putting the food on the side of their oral cavity where they still have intact structures.
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  Sometimes if people are having things get stuck in their throat,
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  we teach them to alternate liquids and solids or swallow with more effort.
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  A lot of patients are put into a rehabilitation program where we're giving them
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  exercises to target the specific areas where they have deficits.
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  And so for our team, we don't just jump in to treat somebody.
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  Body, we want to put them through a diagnostic process to figure out what the
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  cause of their swallowing problems are.
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  And that usually entails something we call a modified barium swallow,
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  where we have patients swallow different consistencies of barium while we're
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  doing an x-ray and we're watching and seeing what's happening.
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  Or sometimes we'll take a flexible endoscope and put it in the person's nose
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  and drop it down to the top part of their voice box and then have them eat and
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  drink and watch what happens so that we can target the specific deficits.
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  Tammy, thank you so much for joining us today and bringing awareness to the
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  topic of dysphagia and helping individuals understand that if they or a family
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  member may be struggling that that there are resources available to reach out
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  to. You're welcome. Thank you for having me.
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  Thank you for listening to Cancer Conversations on Talking FACS.
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  Our goal is to connect you with the latest advances in cancer research in the Commonwealth.
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  If you enjoyed today's podcast and have a suggestion for a future show topic,
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  please message us on the UK Markey Cancer Center Facebook page at facebook.com
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  forward slash UK Markey or visit our website at markey.uky.edu for more information.
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  You can find University of Kentucky Family and Consumer Sciences Extension programs
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  at your local Extension office or online at fcs.uky.edu.
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  Building strong families. Building Kentucky.
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  Music.