Interventions for Esophageal Dysphagia Improved Swallowing Dysfunction in Patients With Esophageal Cancer

By Dustin Samples - Last Updated: January 31, 2023

Aspiration pneumonia, described as the inhalation of gastric contents, is a common complication in patients undergoing esophageal cancer (EC) treatment. Because of the high incidence of swallowing dysfunction, known as dysphagia, these patients are at high risk of inhaling gastric contents. Aspiration pneumonia can significantly increase the risk of mortality in this patient population.

A group of researchers at the Chang Gung Memorial Hospital in Taiwan developed an education and training program to address the high incidence of aspiration pneumonia in patients undergoing treatment for EC. They recently published the results of their study in Cancer Nursing.

The researchers enrolled 63 participants with EC who met the inclusion criteria: “(1) diagnosed with middle and/or higher EC, (2) age older than 18 years, (3) had at least one of the symptoms in an oral water test, (4) score of more than 3 on the 10-item Eating Assessment Tool (EAT-10), (5) clinical history of progressive dysphagia, and (6) scheduled to receive CCRT under the protocol (radiation therapy dose of 3000 cGY/15 fraction for 3 weeks * 1 cycle and chemotherapy of cisplatin 75 mg/m2/day + 5-FU 1000 mg/m2/day * 4 days/every 3 weeks * 2 cycles).” Patients were randomly assigned to either the control or experimental group. At the end of the study, 30 participants in each group had completed the assessments and were included in the results.

The experimental intervention consisted of a 2-part strategy. First, participants were given a picture book of the anatomy, physiology, and pathophysiology of swallowing. A single nurse practitioner educated the participants using this book within 5 days of study enrollment and followed up with each participant in the experimental group until the participants were deemed to have an adequate understanding of the book’s content. Next, the same nurse practitioner educated each participant on their personalized intervention based on the researchers’ previously validated interventions for esophageal dysphagia. Interventions consisted of a combination of physical exercises related to swallowing as well as dietary restrictions based on the results of each participant’s oral water test and EAT-10.

At the end of the intervention, the participants in the experimental group had a 3.3% prevalence of aspiration pneumonia, and the participants in the control group had a 26.7% incidence (P=0.012). In addition, the researchers noted that “the average aspiration pneumonia-free survival duration was 49.27 + 4.02 days in the experimental group and 39.00 + 19.70 days in the control group, indicating significantly longer survival time in the experimental group than in the control group (Table 2; t = −2.79, P = .007). The Kaplan-Meier survival curve results also showed a significant delay in the onset of aspiration pneumonia in the experimental group (Figure 4; Log-rank = 7.727, P = .005).”

Although this study had a relatively small sample size from a single institution in Taiwan, the researchers believe these results should be included in nursing education “to help them become familiar with these interventions and to provide these strategies to patients.”


Effectiveness of a protocol intervention for aspiration pneumonia prevention in patients with esophageal cancer during concurrent chemoradiotherapy: a randomized control trial.