Respiratory-swallow training in head and neck cancer

You might be able to take part in this study if you've been told by a speech and language therapist that you have swallowing difficulties, or if you've had a swallow test confirming this. You should have finished your first course of head and neck cancer treatment (like surgery, radiotherapy, or chemotherapy) at least three months ago, and your treatment was given with the aim of curing the cancer. You also need to be 18 years old or over.

It’s important that you can still drink liquids, no matter how thick they are, and that you are able to hold a drink in your mouth and continue breathing through your nose. There are some situations where you wouldn't be able to join, for example, if you have certain medical devices like a feeding tube through your nose, if you have a known brain or nerve condition affecting swallowing, or severe long-term lung conditions. Also, if your breathing-swallowing pattern or swallowing ability is already considered normal, or if you've recently had a chest infection from aspiration (food or drink going down the wrong way) within the last three months, you wouldn't be able to participate.

If you decide to take part, your first visit will check if the study is right for you. This will involve testing your breathing-swallowing patterns using special monitors placed under your chin, nose, and around your chest and stomach (about 15 minutes). We'll also measure your lung capacity by asking you to blow into a device. If you haven't had a recent swallow test, like an X-ray (videofluoroscopy) or a camera test down your nose (FEES), we might ask you to have a FEES test, which takes about 15-20 minutes, to see how you swallow. This first appointment takes around 15-35 minutes in total, depending on whether you need a FEES test. If you need a FEES, this appointment will be at an NHS clinic; otherwise, we can come to your home if you prefer.

If you can take part, a computer will randomly place you into one of two groups: a training group or a control group (who won't receive the training initially). You have an equal 50/50 chance of being in either. At your second appointment, you’ll complete some questionnaires about your swallowing and have your breathing-swallow pattern measured (about 30 minutes). You’ll also have a video X-ray of your swallowing (videofluoroscopy), where you'll swallow foods and drinks with a special liquid to make them show up on the X-ray (about 15 minutes). Both of these initial appointments will be at an NHS clinic.

If you're in a training group, a speech and language therapist will see you once a week for up to an hour, for up to six weeks. The training will focus on coordinating your breathing and swallowing while you drink often using a special belt around your chest. These sessions can be at an NHS clinic or at your home. Even if you're in the control group, you'll have two follow-up appointments – one week and three months after how long the training period would be. These 45-minute appointments will repeat the questionnaires, X-ray swallow test, and breathing-swallowing pattern assessments, all at an NHS clinic. You might also be invited for an optional interview (up to an hour) about your experience. You will receive £20 and travel expenses for every appointment you attend once you are formally taking part in the study.