Journal Article

Respiratory muscle training reduces painful swallowing and opioid use during radiation therapy for head and neck cancer: a matched pair analysis

Nastiuk, Kent L., Mador, M. Jeffrey, Flores, Ann Marie, Iovoli, Austin J., Yu, Han, Jacobson, Hillary, Fulfaro, Julia, Farrugia, Mark K., Spinelli, Bryan, Attwood, Kristopher, Singh, Anurag K., Schlecht, Nicolas F., Ray, Andrew D., Hong, Chi-Chen

2025

Overview

Background Patients with head and neck cancer (HNC) receiving radiation therapy (RT) are at increased risk for symptoms of oral mucositis (OM), opioid use, and declines in physical function, outcomes that contribute to increased morbidity and mortality. The study objective was to determine the effects of respiratory muscle training (RMT) on OM and opioid use, as well as functional performance in patients with HNC receiving RT with or without concurrent chemotherapy (CCRT). Methods Patients aged ≥ 18 years of age with stage I to IV HNC being treated with RT or CCRT receiving a home-based respiratory muscle training (RMT) ( n  = 20) were compared to a 5:1 matched historical group ( n  = 100) who did not receive RMT. RMT was delivered using the commercially available Power Lung AireStream device (Houston, TX) via a standardized home-based inspiratory and expiratory muscle-training program requiring ~ 20–30 min/day, five days per week, with a progressively increasing workload. Primary endpoints collected from all patients included changes in OM symptoms and use of opioids for pain control following start of RT. Secondary outcomes collected on RMT patients included respiratory muscle strength and functional performance (Six-Minute Walk Test, 6MWT; Short Physical Performance Battery, SPPB). All measures were assessed before and within 1–2 weeks following a standard 7-week RT regimen. Results RMT reduced the impact of self-reported swallowing soreness ( p  = 0.032), eating soreness ( p  = 0.036), and opioid use ( p  = 0.015). RMT maintained inspiratory muscle strength (+ 0.6 ± 18 cmH2O, p  = 0.87), expiratory muscle strength (+ 0.7 ± 12.7 cmH2O, p  = 0.197), and improved the 6MWT (+ 20 ± 39.9 m, p  = 0.025), with no change in the SPPB total score ( p  = 0.262). Conclusions RMT is a low-cost intervention that is easy to perform among patients undergoing RT/RTCC for HNC and is likely to reduce OM pain/symptoms and opioid, as well as to preserve respiratory muscle strength and physical function during cancer treatment. Trial registration Not applicable. This was a matched retrospective cohort study not registered as it was a nonrandomized trial with a historical control group.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Analgesics / Analgesics, Opioid - adverse effects / Analgesics, Opioid - therapeutic use / Antacids / Biomedical and Life Sciences / Biomedicine / Body mass index / Breathing Exercises - methods / Cancer Research / Cancer therapies / Care and treatment / Chemoradiotherapy - adverse effects / Chemotherapy / Deglutition - radiation effects / Deglutition Disorders - etiology / Demographic aspects / Demographics / Diagnosis / Diaphragm / Drug dosages / Exercise / Female / Head & neck cancer / Head and neck / Head and neck cancer / Head and Neck Neoplasms - complications / Head and Neck Neoplasms - radiotherapy / Health Promotion and Disease Prevention / Humans / Influence / Male / Matched-Pair Analysis / Medical records / Medicine/Public Health / Middle Aged / Morbidity / Mucositis / Muscle strength / Narcotics / Nonsteroidal anti-inflammatory drugs / Oncology / Opioids / Oral / Pain / Patient outcomes / Patients / Physical fitness / Quality of life / Quality of life and supportive care in cancer / Radiation therapy / Radiotherapy / Respiratory muscle / Respiratory muscles / Respiratory Muscles - physiopathology / Stomatitis - etiology / Stomatitis - prevention & control / Surgical Oncology / Swallowing / Tomography / Training