Management of dysphagia in head and neck cancer: current and future perspectives

Dysphagia is a highly prevalent and disabling complication in patients with head and neck cancer (HNC). Both (chemo)radiotherapy (C)RT and surgical interventions contribute to swallowing dysfunction through mechanisms such as muscle disuse, fibrosis, neuropathy and anatomical alterations. Given its profound impact on nutrition, morbidity and quality of life, effective dysphagia rehabilitation is essential. This narrative review aims to summarize current knowledge on swallowing rehabilitation in HNC and to discuss recent and ongoing clinical trials. Strength-based rehabilitation is well-established, with both prophylactic and reactive interventions demonstrating benefits for muscle strength and swallowing function. However, transfer of these gains to oral intake is suboptimal. Recent research emphasizes the possible benefits of combined approaches integrating strength, functional and skill-based exercises. In surgically treated populations, timing and content of therapy may vary, yet exercise-based protocols generally improve swallowing-related quality of life and oral intake. Swallowing rehabilitation in patients after total laryngectomy remains insufficiently studied, nevertheless evidence indicates that retraining of swallowing-related muscles is feasible. Recent literature reveals several strategies for management of HNC-dysphagia that go beyond strength, skill and functional training with special interest in radiation-induced fibrosis, edema, lower cranial nerve neuropathy, cough reflex and neuromuscular electrical stimulation. Despite the growing body of evidence supporting swallowing rehabilitation in HNC, significant gaps persist regarding optimal intervention content and timing. Ongoing advances in medical treatment, e.g. immunotherapy and radiotherapy de-escalation, necessitate adaptable rehabilitation strategies. Future research should focus on patient-centered approaches and consider the impact of evolving oncological therapies on swallowing outcomes.