A Randomized, Single-Center Study to Determine Swallow Outcomes in Subjects With Head and Neck Lymphedema Receiving Early Intervention With Pneumatic Compression
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Head and Neck Lymphedema
- Sponsor
- Tactile Medical
- Enrollment
- 22
- Locations
- 1
- Primary Endpoint
- Swallow outcomes via modified barium swallow - Pharyngeal Constriction Ratio (PCR)
- Status
- Terminated
- Last Updated
- 3 years ago
Overview
Brief Summary
The objective of the study is to assess the effect early pneumatic compression (prior to confirming cancer-free status via PET or CT imaging) has on swallow outcomes, positron emission tomography (PET) measurements, function, and complication rate post-radiotherapy in subjects treated for oropharyngeal cancer.
Detailed Description
This is a single-center, prospective, randomized, two-arm, wait-list control study that plans to enroll a total of 24 subjects in the United States. A baseline screening will take place where all subjects who provide consent and meet the eligibility criteria following completion of radiotherapy will begin a 6 weeks regimen of in-home swallow exercises. They will then return to the clinic for final screening and randomization into one of two treatment groups: Flexitouch Plus Cellular Connectivity (FT-CC) and Swallow Exercises (Intervention) or Swallow Exercises alone (Standard Care). A total of 3 in-clinic visits and 1 phone call will be conducted over a 12-week period. The Standard Care group will be offered an optional 6 week follow-up period to use the device in-home and will be seen in the clinic for one additional follow-up Visit 2. A reading center with personnel blinded to treatment assignment will be used to interpret the MBS and PET study results.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Age ≥ 18 years
- •A previous diagnosis of oropharyngeal carcinoma requiring treatment with radiation therapy
- •Diagnosis/evidence of lymphedema stage 1a or higher by clinical presentation based upon MD Anderson Cancer Center Head and Neck Lymphedema rating scale
- •EAT-10 score \>4 at Baseline and Randomization Visits (prior to randomizing subject)
- •The head and neck garments must fit appropriately (for patients with a tracheostomy, the fit will be assessed to ensure that the garments do not interfere with their tracheostomy)
- •Ability to perform swallow exercises
- •Willing and able to comply with the study protocol requirements and all study-related visit requirements
- •Willing and able to provide informed consent prior to study participation
Exclusion Criteria
- •Synchronous treatment for cancer (may or may not have successfully complete prior cancer treatment)
- •Other known causes of dysphagia such as previous radiation to the head and neck, or neuromuscular or neurodegenerative known to have a strong association with dysphagia (i.e., Parkinsons, ALS, MS, OPMD)
- •Poorly controlled: kidney disease (glomerular filtration rate \< 30 mls per minute), hypoproteinemia, pulmonary hypertension, hypothyroidism or parathyroidism, cyclic edema, or Munchausen Syndrome (for which endocrinologist recommends against neck compression)
- •Carotid sinus hypersensitivity syndrome
- •Symptomatic carotid artery disease, as manifested by a recent transient ischemic attack (within 30 days), ischemic stroke, or amaurosis fugax (monocular visual ischemic symptoms or blindness)
- •Symptomatic bradycardia in the absence of a pacemaker
- •Internal jugular venous thrombosis (within 3 months)
- •Increased intracranial pressure or other contraindications to internal or external jugular venous compression
- •Acute radiation dermatitis, unhealed surgical scar, unhealed or open wounds, surgical flap less than 6-8 weeks post-operative
- •Facial or head and neck dermal metastasis
Outcomes
Primary Outcomes
Swallow outcomes via modified barium swallow - Pharyngeal Constriction Ratio (PCR)
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
PCR is calculated by dividing the pharyngeal area (cm2) of the bolus hold frame (PAHOLD) by the maximum pharyngeal contraction frames (PAMAX). Min value = 0, Max value = 1. The lower the score, the better the outcome.
Swallow outcomes via patient reported outcome measure - Eating Assessment Tool (EAT-10) Questionnaire Score
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
Min value = 0, max value = 4. The lower the score the better the outcome.
Patient Reported Function - Voice Handicap Index (VHI-10)
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
A survey that quantifies the functional, physical, and emotional impacts of a voice disorder on a subject's quality of life. It captures the subject's subjective rating of a series of 10 questions. Min value = 0, max value = 40. The lower the score the better the outcomes.
Swallow outcomes via modified barium swallow - Esophageal Bolus Transit Time (ETT)
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
The time it takes the bolus to get through the cricopharyngeal muscle (where the esophageal phase is initiated) to the bottom of the esophagus (at the junction of the lower esophageal sphincter). Min value = 0, max value = 60. The lower the score, the better the outcome (seconds).
Swallow outcomes via modified barium swallow - Posterior Pharyngeal Wall Thickness (PPW)
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
PPW is the thickness of the posterior pharyngeal wall in lateral view while holding a 1-ml liquid bolus in oral cavity prior to swallow (PPWhold). Min value = 0, max value = 30. The lower the score the better the outcomes (mm)
Function - Stimulated Saliva Secretion Rate
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
Stimulated Saliva Secretion Rate is the measure of total saliva collected in 3 minutes while chewing gum.
Complications - Treatment Interruptions
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
Number/days of treatment interruptions
Complications - Pulmonary Infections
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
Number/days of pulmonary infections
Swallow outcomes via modified barium swallow - Normalized residue ratio scale (NRRS)
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
Pharyngeal residue is the term used to describe material that remains in the pharynx post swallow (also called retention or stasis). The NRRS is calculated using ImageJ pixel area measures of residue in the valleculae. Min value = 0, max value = 1. The lower the score, the better the outcomes.
Nutrition - Weight
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
Weight
Swallow outcomes via modified barium swallow - Penetration-Aspiration Scale (PAS)
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
PAS is an eight-point ordinal severity scale scoring the depth of airway invasion by the bolus, whether it is expelled from the airway as well as any patient reaction. It ranges from one (material does not enter the airway) to eight (material enters the airway, passes below the vocal folds, and no effort is made to eject). Min value = 1, Max value = 8, the lower the score the better.
Swallow outcomes via modified barium swallow - Upper Esophageal Sphincter Opening (UESmax)
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
UES measurements will include the: (1) maximum width of the UES opening as defined by the line between the anterior and posterior walls of the pharyngoesophageal segment at its narrowest area during its maximum opening in a lateral view, and (2) the maximum width of the UES opening as viewed anteriorly. Min value = 0, max value = 2. Greater the score, the better the outcome.
Nutrition - Body Mass Index (BMI)
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
BMI
Complications - Hospitalizations
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
Number/days of hospitalizations
Complications - Adverse Events
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
Total number of adverse events
Patient Reported Function - Functional Assessment of Cancer Therapy - Head and Neck (FACT HN)
Time Frame: Changes between Baseline, 6-Week Follow-Up, 12-Week Follow-Up, and 18-Week Follow-Up
A survey which inquires on a series of concerns related to the head and neck region including oral comfort, breathing, voice, eating, appearance, tobacco, alcohol, and communication. The subject is asked to indicate how important each of the 39 listed concerns have been in the past 7 days. Min value = 0, max value = 148. The higher the score the better the quality of life.