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Effects of Chemotherapy on Swallowing

Chemotherapeutic agents for head and neck cancer can also cause side effects that impact swallowing and nutrition.[24] They can cause nausea, vomiting, neutropenia, generalized weakness, and fatigue. Anorexia and weight loss are common. Mucositis may cause sufficient pain to require non-oral supplementation. The incidence rate of mucositis has been reported to be approximately 40% for chemotherapy patients; however, it approximates 100% in patients receiving chemoradiation.[25] Symptomatically, mucositis manifests itself in odynophagia (pain) during mastication and swallowing, oral bleeding, dysphagia, dehydration, heartburn, vomiting, nausea, and sensitivity to salty, spicy, and hot/cold foods. Stomatitis refers to chemotherapy-related oral cavity ulcers that result in eating difficulty. The cytotoxic agents most commonly associated with oral, pharyngeal, and esophageal symptoms of dysphagia are the antimetabolites such as methotrexate and fluorouracil. The radiosensitizer chemotherapies, designed to heighten the effects of radiation therapy, also heighten the side effects of the radiation mucositis.[26,27]

Considerable attention has been given to both prophylactic and treatment measures to counteract the adverse side effects of these medications. Prophylactic measures begin with an increased emphasis on improved oral hygiene. Oral cryotherapy, the therapeutic administration of cold, is a prophylactic measure for oral inflammation.[28] Cryotherapy can be provided in the form of ice chips just prior to chemotherapy and for 30 minutes after drug administration. A marked decrease in the incidence of stomatitis has been noted in patients utilizing cryotherapy. Therapeutic measures to control mucositis and stomatitis include the use of anesthetics, analgesics, anti-inflammatory agents, antimicrobial therapy, and coating agents. Anesthetics are usually used in tandem with mouthwashes or rinses. An oral suspension of diphenhydramine, lidocaine, and an antacid (Maalox) called "magic mouthwash" can be prescribed, which is swished and swallowed for symptom management.