Dr. Jolie Ringash   &   Dr. Rosemary Martino

A PRO-ACTIVE Approach to Swallowing Problems

Head and neck cancer patients report feeling challenged and limited by the swallowing problems that often occur as a result of their cancer treatments. Although these treatments successfully manage the cancer, their ensuing problems with eating and drinking negatively impact their ability to maintain good health and also to enjoy the social aspects of life.

The PRO-ACTIVE clinical trial wants to change that with early intervention to prevent the onset of a swallowing problem and increase patients' quality of life.

This large behavioural study caught the attention of the international Patient Centered Outcomes Research Institute (PCORI) who provided The Princess Margaret $8.5 million USD to complete the five-year study. The PRO-ACTIVE study is led by The Princess Margaret and executed with collaborations from the MD Anderson Cancer Center in Texas and five other cancer hospitals across Canada and the U.S.

A research award of this large amount is not common and even more rare in that it addresses a behavioural intervention. This study is one of only a few, at The Princess Margaret and elsewhere, that actively seeks advise on its design and conduct from survivors of cancer, their families, their clinicians as well as local and national healthcare policy makers. As a result, the findings from this study will be immediately available and meaningful to patients and their families.

“We also need these type of trials, which can change things today and tomorrow for patients that are undergoing treatment now as well as the ones that may make dramatic changes in 10 or 20 years,” says Dr. Jolie Ringash, the Radiation Oncologist working on the study.

Researchers began recruiting patients for the study this fall, with the goal to have 1,000 patients in total from the seven participating centres across North America.

The study will look at the timing and intensity of early intervention for swallowing, which requires working with a speech pathologist to complete exercises to strengthen muscles in the mouth and throat.

“Cancer clinicians everywhere are struggling with how to minimize and perhaps even eliminate the swallowing problems common for head and neck cancer survivors,” says Dr. Rosemary Martino, Speech Pathologist and lead on this trial. “We have several interventions to treat swallowing problems, all of which are useful, however our dilemma is knowing which is the better one and for whom. This dilemma is experienced by patients and clinicians around the world and not an isolated issue for only The Princess Margaret. The PRO-ACTIVE trial will directly address this global problem.”

Additionally, the trial will establish an innovative hub of excellence, the Central-VFS Lab, under the direction of Dr. Martino, which will be where speech pathology experts objectively analyze videofluoroscopic swallowing (VFS) exams (a special type of X-ray to assess the swallow) for this and future studies.

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