BRAIN TUMORS CAN CAUSE SWALLOWING DIFFICULTIES, THEN PNEUMONIA

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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

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

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