Adherence to Prophylactic Swallowing Exercises in Patients with Head and Neck Cancer Receiving (Chemo) Radiotherapy Across Two Service Delivery Modes in South India

Jasmine Lydia Selvaraj; Lakshmi Venkatesh; Laurelie R Wishart; Satish Srinivas Kondaveeti

doi:10.1007/s00455-026-10953-4

Adherence to Prophylactic Swallowing Exercises in Patients with Head and Neck Cancer Receiving (Chemo) Radiotherapy Across Two Service Delivery Modes in South India

Dysphagia. 2026 Apr 27. doi: 10.1007/s00455-026-10953-4. Online ahead of print.

Authors

Jasmine Lydia Selvaraj¹, Lakshmi Venkatesh², Laurelie R Wishart³, Satish Srinivas Kondaveeti⁴

Affiliations

¹ Sri Ramachandra Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India. jasminelydia@sriramachandra.edu.in.
² Sri Ramachandra Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India. lakshmiv@sriramachandra.edu.in.
³ School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
⁴ Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.

PMID: 42036465
DOI: 10.1007/s00455-026-10953-4

Abstract

This study aimed to investigate adherence to a six-week prophylactic swallowing exercise (PSE) program delivered in two service delivery modes among patients with head and neck cancer (HNC) undergoing (chemo)radiotherapy (C)RT in South India. The study also explored the influence of patient-related and clinical factors on adherence rates. In a prospective study at a quaternary care hospital, 104 HNC patients were randomized to clinician-directed (n = 53) or self-directed (n = 51) PSE programs. The clinician-directed group received weekly in-person supervision by a speech-language pathologist, while the self-directed group practiced independently at home with weekly phone counseling. All received pre-treatment counseling and standardized instructions for a 6-week PSE program involving 10 exercises (mobility & swallowing), performed three times daily, six days a week. Adherence was tracked using weekly logs and calculated as a percentage of completed repetitions (1,800/week; 10,800 total), categorized as high (≥ 76%), moderate (51-75%), or low (< 50%). Overall adherence was higher in the clinician-directed group (87.7%) than in the self-directed group (61.6%, p = .004), and declined over time in both groups. Participants adhered more to mobility exercises than swallowing exercises across all weeks (p < .01), with large effect sizes in weeks 4-6 (r =0.441-0.464). Chi-square analysis showed adherence classification was significantly associated with service delivery mode (p = .006). No significant associations were found with patient-related (age, gender, lifestyle) or clinical factors (tumor site, treatment type). HNC patients demonstrated moderate adherence to PSEs, higher in clinician-directed programs. Declining adherence, particularly in self-directed programs, underscores the need for strategies that promote self-monitoring and motivation to optimize rehabilitation in resource-limited settings.

Keywords: Exercise adherence; Patient engagement; Prevention; Quality of life; Service delivery models; Swallowing Rehabilitation; Swallowing disorders; Well-being.