The Hutcheson Laboratory's research focus is split between outcome measurement and therapeutic strategies to improve head and neck cancer survivorship. With a large network of interdisciplinary global collaborators, we developed a program of research focused on measuring, predicting, and improving head and neck cancer survivorship - with emphasis on swallowing and communication outcomes. At the heart of this work is patient-centered and provider-informed strategies developed with real-world clinical dissemination and implementation in mind.
DIGEST™ is an analysis method used to grade the severity of pharyngeal dysphagia based on results of a modified barium swallow (MBS) study. DIGEST uses a basic flowsheet and rubric to summarize the patterns of penetration/aspiration and pharyngeal residue observed on the MBS as markers of swallowing safety and efficiency. This process, therefore, provides a reproducible way to achieve a summary grading of dysphagia from the MBS observations (i.e., none, mild, moderate, severe, or profound/life threatening pharyngeal dysphagia) that aligns to the NCI’s CTCAE framework for clinician-grading of toxicity in oncology.
DIGEST was initially developed for videofluoroscopy or MBS. Version 2.
- Version 2 of DIGEST validation presented at the 2020 Annual Dysphagia Research Society
- DIGEST-FEES adaptation and validation presented at 2021 Annual Dysphagia Research Society and published in Journal of Speech, Language, and Hearing Research
- DIGEST (version 2) validation in ALS (for videofluoroscopy) led by lab collaborator Dr. Emily Plowman presented at 2021 Annual Dysphagia Research Society
*Reliable and valid application of DIGEST assumes competency with MBS administration, adherence to a standard MBS acquisition protocol, familiarity with anatomy and physiology of the oropharyngeal swallow, and reliable application of Rosenbek’s Penetration-Aspiration Scale.
The Hutcheson Laboratory runs supportive care clinical trials that seek to evaluate strategies to improve functional outcomes after head and neck cancer - with particular emphasis on swallowing outcomes. Our trials span the continuum of survivorship from preventive or proactive therapy strategies to management of late effects of cancer therapy.
Expiratory Muscle Strength Training (ESMT) pilot trial - Effects of Expiratory Muscle Strength Training on Airway Protection and Swallowing in Chronic Dysphagia After Radiation Therapy
- Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: A case series
- Expiratory muscle strength training evaluated with simultaneous high-resolution manometry and electromyography
- Cough strength and expiratory force in aspirating and nonaspirating postradiation head and neck cancer survivors
PRO-ACTIVE is an international multi-site pragmatic randomized clinical trial comparing ideal timing and intensity of swallowing therapy for patients receiving head and neck radiotherapy. PRO-ACTIVE (high and low intensity) and RE-ACTIVE swallowing therapies are compared during radiotherapy. Earlier and more intensive swallowing therapy may help lessen days on feeding tube after radiation or improve swallowing outcomes.
STOP is a phase I/II dose finding trial examining the side effect and best dose of steroid therapy (prednione or methylprednisolone) in improving symptoms of late radiation-associated lower cranial neuropathy in head and neck cancer survivors. High dose steroid may help improve symptoms associated with late radiation-associated cranial neuropathy.
MANTLE is a pilot trial to study how well manual therapy works in treating fibrosis-related late-radiation associated dysphagia. Manual therapy is the use of massage and stretching exercises to increase blood flow and muscle movement in the neck, throat, jaw and mouth, which may help to improve swallowing ability and range of motion in participants experiencing fibrosis as a side effect of head and neck cancer treatment.
Functional outcomes measurement for oncology clinical trials
We provide longitudinal functional outcome measurement for cooperative group, multi-site trials as well as investigator-initiated trials in the MD Anderson Multidisciplinary Head and Neck Cancer Program. The lab uses a mix of validated patient-reported and clinician-graded measures, with particular emphasis on swallowing related outcomes.
Cooperative group/multi-site trials
MD Anderson Head and Neck trials
- Prospective, longitudinal digital activity monitoring before and after treatment of low-risk oropharyngeal squamous cell carcinoma: A feasibility study.
- Magnetic Resonance-based Response Assessment and Dose Adaptation in Human Papilloma Virus Positive Tumors of the Oropharynx treated with Radiotherapy (MR-ADAPTOR): An R-IDEAL stage 2a-2b/Bayesian phase II trial
- A Phase I Trial of Stereotactic HYpofractionateD RadioAblative (HYDRA) Treatment of Laryngeal Cancer - NCT03114462
- Phase II Randomized Trial of Stereotactic Onco-Ablative Reirradiation versus Conventionally Fractionated Conformal Radiotherapy for Patients with Small Inoperable Head and Neck Tumors (SOAR-HN) - NCT03164460
- Immuno-Chemotherapy as single treatment modality for Larynx Preservation (ICoLP) - NCT04030455
- Ipilimumab, Nivolumab, and Radiation Therapy in Treating Patients With HPV Positive Advanced Oropharyngeal Squamous Cell Carcinoma - NCT03799445
Oropharynx Registry Patient-Reported Outcomes/Function (PROF) Core
With support from the Charles and Daneen Stiefel Oropharynx Fund, the Hutcheson lab leads the Patient Reported Outcomes/Function (PROF) Core of the MD Anderson Oropharynx Database.
Since 2015, the PROF Core prospectively tracks PROs and functional outcomes of patients from baseline through 5 years’ survival, with particular emphasis on swallowing outcomes.
Longitudinal outcomes include diverse PRO instruments (including MDASI-HN, MDADI, EQ-5D), the modified barium swallow study (including with DIGEST grading), and functional status measures (including PSS-HN, feeding tube).