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The study includes patients with tumors of the oropharynx, larynx and hypopharynx scheduled to receive radiotherapy with curative intent (+/- chemotherapy). The patients will be randomized into either an intervention group (performing a preventive jaw- and swallowing exercise protocol before and during radiotherapy) or a control group no performing a exercise protocol. All patients will be encouraged to eat or drink for as long as possible during the therapy. All patients will meet with a speech-language therapist weekly during radiotherapy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Preventive intervention | Experimental | Patient will perform daily exercise: jaw and swallwing exercises, as well as are encouraged to eat and drink for as long as possible during treatment |
|
| Control group | No Intervention | No intervention, only encouragement to eat and drink for as long as possible during treatment |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Preventive intervention | Behavioral | Preventive, structured exercise protocol |
|
| Measure | Description | Time Frame |
|---|---|---|
| Maximal Interincisal opening (MIO) | Jaw opening measured in millimeters. A MIO <36 mm is considered as trismus. i.e. limited jaw-opening. | 1 month post radiotherapy |
| Swallowing ability | Swallowing ability measured with Functional Endoscopic Examination of Swallowing (FEES) | 1 month after radiotherapy |
| Measure | Description | Time Frame |
|---|---|---|
| Trismus and jaw related symptoms | Patient Reported Outcomes (PRO) measured with Gothenburg Trismus Questionnaire (GTQ). The GTQ consists of 21 items divided into 3 domains; Jaw related problems, Eating limitations and Muscular tension and eight single items concerning facial pain, limitations in mouth opening and inabilities to function on social and working contexts. The GTQ domains range from 0-100 where 0 equals to absence of symtoms and 100 equals worst possible symptoms. |
| Measure | Description | Time Frame |
|---|---|---|
| Cost | The cost of intervention compared to usual care. Costs in Swedish crowns (SEK) for the intervention and all visits to healthcare during 5 years will be recorded. | Up to 5 years post radiotherapy |
| Quality of life for cost-effectiveness analysis |
Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sahlgrenska University Hospital | Gothenburg | 41345 | Sweden |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39576571 | Result | Saghafi E, Kadhim K, Andas CA, Cahlin BJ, Finizia C, Axelsson T, Kjeller G, Tuomi L. Jaw exercise in head and neck cancer patients for prevention of temporomandibular disorders: a randomized controlled trial. J Cancer Surviv. 2026 Jun;20(3):1145-1156. doi: 10.1007/s11764-024-01717-w. Epub 2024 Nov 22. | |
| 39091121 | Result |
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| ID | Term |
|---|---|
| D006258 | Head and Neck Neoplasms |
| D014313 | Trismus |
| D003680 | Deglutition Disorders |
| ID | Term |
|---|---|
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D013035 | Spasm |
| D020879 | Neuromuscular Manifestations |
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| Up to 5 years post radiotherapy |
| Dysphagia related symtoms | PRO measured with M.D Anderson Dysphagia Inventory (MDADI). This is a cancer-specific instrument measuring dysphagia, social function and quality of life in head and neck cancer patients. It consists of 19 items in four domains; emotional, physical, functional and global quality of life. The range for each subscale is 20-100 where 100 indicates best possible swallowing, i.e. better outcome. | Up to 5 years post radiotherapy |
| Health related quality of life (HRQL) | Measured with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) core questionnaire (c30). Consists of 30 items divided into six functional domains (Physical, Role, Cognitive, Emotional, and Social Functioning and Global Quality of life), three symptom scales (Fatigue, Pain, and Nausea/Vomiting) and six single items (Constipation, Diarrhea, Insomnia, Dyspnea, Appetite Loss, and Financial Difficulties). All domains range from 0-100. For the functional domains a higher score indicates good function, while for all other domains a high score indicates a high prevalence of symtoms, i.e. worse HRQL. | Up to 5 years post radiotherapy |
| Health related quality of life (HRQL) | Measured with the EORTC QLQ Head and neck module (HN35). It consists of 35 questions regarding symptoms more specific to the head and neck cancer population, and domain scores range from 0-100, where a higher score represents the prevalence of more symtoms, i.e. worse HRQL. | Up to 5 years post radiotherapy |
| Swallowing ability | Swallowing ability measured with FEES | Up to 5 years post radiotherapy |
| Maximal Interincisal opening (MIO) | Jaw opening measured in millimeters | Up to 5 years post radiotherapy |
The outcomes of intervention compared to usual care using European Quality of life 5 dimensions (EQ5D).
| Up to 5 years post radiotherapy |
| Quality Adjusted Life Years (QALY) | QALY is a measurement that combines health-related quality of life (HRQL) and life expectancy in one index. The index range between 0 and 1, where 0 equals death and 1 represents perfect health. Thus, 1 QALY corresponds to 1 year of perfect health. This is calculated using the EQ-5D. | Up to 5 years post radiotherapy |
| Incremental Cost Effectiveness Ratio (ICER) | Incremental cost for each QALY for the intervention group will be calculated using a Markov model which combines the costs and EQ-5D. The ICER will then be compared to the maximum willingness to pay level which is SEK 500,000 (€55,000) according to the Swedish National Board of Health and Welfare. | Up to 5 years post radiotherapy |
| Petersson K, Finizia C, Pauli N, Tuomi L. Preventing radiation-induced dysphagia and trismus in head and neck cancer-A randomized controlled trial. Head Neck. 2025 Jan;47(1):159-174. doi: 10.1002/hed.27886. Epub 2024 Aug 1. |
| D009461 |
| Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D004935 | Esophageal Diseases |
| D005767 | Gastrointestinal Diseases |
| D004066 | Digestive System Diseases |
| D010608 | Pharyngeal Diseases |
| D010038 | Otorhinolaryngologic Diseases |