BRAIN TUMORS CAN CAUSE SWALLOWING DIFFICULTIES, THEN PNEUMONIA

COLUMBUS, Ohio -- Far more patients with primary brain tumors have trouble swallowing food and liquids than physicians previously thought, recent research shows.

Many of these patients, in fact, are unaware that they are swallowing improperly. And in those who do realize it, the problem is often more serious than their symptoms would indicate.

The finding is important because people who swallow improperly often inhale -- aspirate -- food and liquids and they may not even know it. Inhalation of food can then lead to aspiration pneumonia, a type of pneumonia that can be difficult to treat.

The study, published in a recent issue of the journal Neurology , evaluated 117 brain tumor patients over a 13-month period. Of those, 14.5 percent complained of difficulty swallowing.

"Clinicians need to be aware that swallowing problems occur more often in primary brain tumor patients than anyone previously suspected," said Herbert Newton, neuro-oncologist and assistant professor of neurology with the Ohio State University

Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Research Institute.

"We want to prevent aspiration and all its complications -- people can die from aspiration pneumonia," said Newton. "It's a very nasty problem."

About half of those in the study who had difficulty swallowing had to change the way they ate. "We changed either the type of food they ate or how they were feeding themselves," said Newton. Some were taught techniques to help them swallow more safely; others had to use feeding tubes.

"In many of these patients, we couldn't tell from their symptoms that they were aspirating; their symptoms were often very mild compared to what we found during actual examinations," said Newton.

This is a unique study in brain tumor patients. Swallowing problems are common in patients suffering from strokes, Lou Gehrig's disease and many neurological problems. But the problem has been unrecognized in patients with primary brain tumors, said Newton. A primary brain tumor is one that originates in the brain, unlike a metastatic brain tumor, which has spread to the brain from a tumor elsewhere in the body.

Previously, it was thought that only tumors in a deeper area of the brain -- those in the brain stem -- caused abnormal swallowing, or dysphagia.

"This research shows that tumors outside the brain stem can also cause dysphagia. That's something no one appreciated before," Newton said.

Newton worked with a team of researchers that included a speech and language pathologist who specialized in treating swallowing disorders.

The evaluation began during a patient's initial interview upon admission to the hospital. They were asked if they experienced coughing when eating or drinking, or having food stuck in the throat.

They were given a formal "bedside" evaluation after admission if they had swallowing difficulties. For this, a speech and language pathologist tested patients for their ability to chew and swallow properly.

If problems were found, many of the patients were examined using video fluoroscopy, an X-ray taken while a person eats. "It's a very sensitive test for finding swallowing abnormalities and for identifying people who are experiencing subtle, silent aspirations," said Newton.

Unfortunately, video fluoroscopy was done on only about half the patients. Some were too sick, and some refused, said Newton. "So our study probably underestimates the number of people who really have swallowing problems."

Why don't these patients cough when they aspirate food? The reason is that many brain tumor patients lose the neurological feedback needed to cough or to swallow properly. They may have lost sensation in the mouth or throat, or they may have a reduced level of consciousness, or they may have lost the coordination to chew and swallow properly.

"These patients might think they are eating and swallowing just fine. But when we evaluate them, we find food stuck in the back of throat, and they are aspirating often but don't know it."

Newton's research also showed that patients who had swallowing problems prior to surgery or during tumor progression showed little improvement in swallowing function with time.

On the other hand, patients who developed swallowing difficulties following surgery proved to have very mild problems, and showed significant improvement with time. These patients tended to have tumors that occurred external to the brain.

In these people, said Newton, "the dysphagia was probably due to post-operative swelling of the brain, which tends to improve with time."

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Contact: Herbert Newton, (614) 293-8930

Written by Darrell E. Ward, (614) 292-8456