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Toft K, McLachlan K, Winton M, Mactier K, Hare N, Nugent C, Wincott L, Srinivasan D, Mackenzie J, Nailon B, Noble D. Global assessment of swallow function (GASF) following VMAT radiotherapy for head and neck squamous cell carcinoma. Tech Innov Patient Support Radiat Oncol 2024; 32:100272. [PMID: 39346655 PMCID: PMC11439550 DOI: 10.1016/j.tipsro.2024.100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/06/2024] [Accepted: 08/21/2024] [Indexed: 10/01/2024] Open
Abstract
Aim This study aimed to conduct a global assessment of swallow function (GASF) using a range of swallow outcome tools, in a cohort of patients pre- and post-treatment with image-guided volumetric modulated arc therapy (VMAT) radiotherapy. Materials and methods All patients receiving radical (chemo)radiation for SCC of the larynx, oro-, hypo- or nasopharynx between October 2016 - 2021 were eligible for inclusion.Patients were treated with VMAT radiotherapy according to institutional and national protocols.Patients underwent GASF pre- and 6 months post-treatment. Data were collated from the MD Anderson Dysphagia Inventory (MDADI), the Functional Oral Intake Scale (FOIS), the Performance Status Scale-Head and Neck: Normalcy of Diet scale (PSS-NoD), the 100 ml water swallow test (WST) for capacity and maximal interincisal opening (MIO). Results One hundred and seventy-five patients were included. 55.2 % of patients experienced a fall in MDADI-Composite score greater than the published meaningful clinical important difference (MCID).A trend for a decrease in FOIS score reflects a decrease in range of diet textures and increase in reliance on enteral feeding at 6 months post-treatment.Mean PSS-NoD score decreased reflecting increased restriction in diet textures.20 patients' WST capacity improved by the minimal clinically important difference of > 4mls whilst 37 % of patients experienced a decrease in WST capacity of 4mls or more. 12.6 % of patients developed trismus following radiotherapy. Conclusions This paper adds new detail to the understanding of the decline in measured eating, drinking and swallowing function that patients treated with VMAT radiotherapyexperience at 6 months post treatment. However, gaps are highlighted in the evidence base in terms of interpretation of swallow outcomes tool scores; future research in HNC should include ongoing discussion and development around robust outcomes tools and data collection.
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Affiliation(s)
- Kate Toft
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Department of Speech and Hearing Science, Queen Margaret University, Queen Margaret University Drive, Musselburgh EH21 6UU, UK
| | - Kirsty McLachlan
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Mark Winton
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Karen Mactier
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- School of Cancer Sciences, College of Medicine, Veterinary Medicine and Life Sciences, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - Nadine Hare
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Claire Nugent
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Lucie Wincott
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Devraj Srinivasan
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Joanna Mackenzie
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Bill Nailon
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- The Institute for Imaging, Data and Communications (IDCOM), School of Engineering, The University of Edinburgh, Edinburgh EH9 3BF, UK
- The Department of Biomedical Engineering, Fulton Building, University of Dundee, Dundee DD1 4HN, UK
- Edinburgh Cancer Research Centre, The Institute of Genetics and Cancer, Crewe Road South, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - David Noble
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Edinburgh Cancer Research Centre, The Institute of Genetics and Cancer, Crewe Road South, University of Edinburgh, Edinburgh EH4 2XU, UK
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Toft K, Best C, Donaldson J. Assessment of patients with head and neck cancer using the MD Anderson Dysphagia Inventory: Results of a study into its comprehensiveness, comprehensibility and relevance to clinical practice. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38441996 DOI: 10.1111/1460-6984.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The MD Anderson Dysphagia Inventory (MDADI) is a widely used patient-reported outcome measure (PROM) which assesses dysphagia-related quality of life (QoL) in head and neck cancer (HNC). Despite its common use in HNC research and clinical practice, few of its psychometric properties have been reappraised since its inception. The aim of this study was to perform a survey-based qualitative analysis of UK HNC clinicians' perceptions of the content validity of the MDADI, evaluating it across the parameters of relevance, comprehensiveness and comprehensibility as per the COSMIN guideline for PROM assessment. RESULTS Four themes relating to the content validity of the MDADI were identified: (1) MDADI items lack clarity of definition of the terms 'swallowing', 'eating' and 'dysphagia'; (2) the MDADI is perceived to be overly negative in tone including items that service users may find distressing or disempowering; (3) items in the tool are exclusory to specific subgroups of patients, such as those who are nil by mouth or socially isolated; and (4) modifications to the MDADI were suggested and encouraged to make it more clinically useful and patient-centred. CONCLUSIONS This study indicates that MDADI's content validity is 'insufficient' when rated by COSMIN parameters. This has significant implications for its continued use in HNC research and clinical practice. Further re-evaluation of the content validity of the MDADI is warranted, with potential future amendment of items being indicated if the results of this study are corroborated in subsequent research. WHAT THIS PAPER ADDS What is already known on the subject The MD Anderson Dysphagia Inventory (MDADI) patient-reported outcome measure of dysphagia-related quality of life is widely used in clinical practice and international clinical trials. Content validity is considered to be the most important property of a tool when assessing its psychometric strengths and weaknesses; however, the MDADI's content validity has not been reappraised since its initial development. What this paper adds to existing knowledge This study presents UK speech and language therapists' opinions and experience of the content validity of the MDADI and this first reappraisal of its content validity since its initial development highlights several issues with this psychometric parameter of the tool. This study highlights that further re-evaluation of the content validity of the MDADI is warranted, with potential future amendment of items being indicated if the results of this study are corroborated in subsequent research. What are the potential or actual clinical implications of this work? Clinicians cannot assume that commonly used outcomes tools have strong psychometric profiles. Consideration of the content validity of outcomes tools during selection for use in clinical and research practice should be key, as this will encourage use of tools that produce relevant, valid data that can contribute meaningfully to patient-centred care.
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Affiliation(s)
- Kate Toft
- University of Stirling, Stirling, UK
- NHS Lothian; Western General Hospital, Edinburgh, UK
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3
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Yifru TA, Kisa S, Dinegde NG, Atnafu NT. Dysphagia and its impact on the quality of life of head and neck cancer patients: institution-based cross-sectional study. BMC Res Notes 2021; 14:11. [PMID: 33413623 PMCID: PMC7791825 DOI: 10.1186/s13104-020-05440-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/29/2020] [Indexed: 12/02/2022] Open
Abstract
Objective Impaired swallowing is a primary medical concern in head and neck cancer (HNC) patients. Swallowing therapy and supportive care to relieve swallowing problems among HNC patients are recommended. However, no data shows the effect of dysphagia on the quality of life (QoL) among Ethiopian patients. This cross-sectional study aimed to assess swallowing function and its impact on QoL. Results The sample included 102 HNC patients who visited oncology clinics at Tikur Anbessa Specialized Hospital. Majority were male (53.90%), employed (70.6%), single (57.80%), and completed some level of formal education (66.60%) with a mean age of 42.58 years (SD ± 14.08). More than half of the patients (69.6%) medical expenses were covered by the government. Most were suffering from advanced stage HNC (59.80%), squamous cell carcinoma (62.70%), and the most prevalent tumor location was nasopharynx (40.20%). The mean MDADI score was 53.29 (SD ± 15.85). Being female, low income, suffering from laryngeal cancer, advanced tumor, and undergoing a single modality therapy were crucial determinants of poor QoL related to swallowing problems. It is recommended to assess swallowing related QoL of patients using a validated tool and be included in treatment protocols.
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Affiliation(s)
- Tseganesh Asefa Yifru
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sezer Kisa
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Negalign Getahun Dinegde
- Department of Nursing, School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Niguse Tadele Atnafu
- Department of Nursing, School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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Tuomi L, Fransson P, Wennerberg J, Finizia C. A longitudinal study of the Swedish MD Anderson Dysphagia Inventory in patients with oral cancer. Laryngoscope Investig Otolaryngol 2020; 5:1125-1132. [PMID: 33364403 PMCID: PMC7752062 DOI: 10.1002/lio2.490] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate whether the Swedish MD. Anderson Dysphagia Inventory (MDADI) is able to detect changes in dysphagia symptoms over time for patients with head and neck cancer (HNC). METHODS One hundred and forty-two patients with resectable tumors of the oral cavity were included prior to treatment. The patients filled out the MDADI, European Organization for Research and Treatment of Cancer Quality of Life questionnaire Core 30 (EORTC QLQ-C30) and the HNC module (H&N35) at baseline and at least one follow-up at 6 and/or 12 months after oncologic treatment. A control group without dysphagia (n = 115) was included. RESULTS Self-perceived swallowing function decreased in all domains at 6 months, and improved between 6 and 12 months. The changes were similar to the changes of the EORTC domains, indicating a sensitivity to change. However, even if improvements were seen at 12 months, the values were still inferior compared to baseline values, and the values of a control group without dysphagia. Convergent validity was found with values of the MDADI and EORTC domains producing similar results, and moderate correlations as hypothesized. Patients with moderate-severe dysphagia according to the MDADI (<60 points) demonstrated inferior values of the EORTC domains compared to patients with scores above 60 points. CONCLUSION The Swedish MDADI was found to be sensitive to change, and showed convergent results when compared to other established instruments. The threshold value for the MDADI (<60 points) indicating moderate-severe dysphagia may be a valuable addition in the clinical use. LEVEL OF EVIDENCE 1.
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Affiliation(s)
- Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck SurgeryInstitute of Clinical Sciences, Sahlgrenska Academy, Gothenburg UniversityGothenburgSweden
- Region Västra GötalandSahlgrenska University Hospital, Department of OtorhinolaryngologyGothenburgSweden
| | - Per Fransson
- Department of NursingUmeå University and Cancercentrum, Norrlands University HospitalUmeåSweden
| | - Johan Wennerberg
- Division of OtorhinolaryngologyHead and Neck Surgery, Clinical Sciences, Lund University and University Hospital of ScaniaLundSweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck SurgeryInstitute of Clinical Sciences, Sahlgrenska Academy, Gothenburg UniversityGothenburgSweden
- Region Västra GötalandSahlgrenska University Hospital, Department of OtorhinolaryngologyGothenburgSweden
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Zuydam AC, Rogers SN, Grayson K, Probert CF. Routine Use of Swallowing Outcome Measures Following Head and Neck Cancer in a Multidisciplinary Clinic Setting. Int Arch Otorhinolaryngol 2020; 25:e185-e192. [PMID: 33968218 PMCID: PMC8096508 DOI: 10.1055/s-0040-1708896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 01/09/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction
Chemoradiotherapy treatment for head and neck cancer (HNC) can have a major impact on swallowing function and health-related quality of life.
The use of outcome measures in early detection of patients with swallowing problems provides the opportunity for targeting speech and language therapy (SLT) interventions to aid adaption and promote better clinical outcomes. Objective
The purpose of the present study was to assess relationships between four outcomes measures over time, in a cohort of HNC patients, treated by (chemo-)radiotherapy.
Methods
Data were collected at 3 months and 12 months, on 49 consecutive patients with primary squamous cell cancer of the oropharynx, nasopharynx or hypopharynx stage T1–4, N0–2b, M0 disease.
Results
Out of 49 eligible patients, 45 completed assessment at 3 months and 20 at 12 months. The 3-month outcomes gave a strong indication of performance at 1 year. There were several strong correlations found between measures. The strongest was between the 3-month Performance Status Scale for Head and Neck Cancer (PSSHN) and the 12-month PSSHN (rs = 0.761,
n
= 17), the 12-month PSSHN and the 12-month Functional Oral Intake Scale (FOIS) (rs = 0.823,
n
= 20), and the 12-month University of Washington Head and Neck Quality of Life (UWQoL) swallow and the 12-month Water Swallow Test (WST) capacity (rs = 0.759,
n
= 17).
Conclusion
The UW-QoL swallow item and WST are easy to incorporate into routine care and should be used as part of a standard assessment of swallow outcome. These measures can serve to help screen patients for dysfunction and focus allocation of resources for those who would benefit from more comprehensive assessment and intervention by SLT.
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Affiliation(s)
| | - Simon N Rogers
- Evidence-Based Practice Research Centre, Faculty of Health and Social Care, Edge Hill University, Ormskirk, United Kingdom.,Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, United Kingdom
| | | | - Clare F Probert
- Shrewsbury and Telford NHS Trust, Shrewsbury, United Kingdom
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Chhabria K, Kansara S, Badr H, Stach C, Vernese M, Lerner A, Harms A, Hernandez DJ, Huang AT, Chen G, Parke RB, Charnitsky S, Sandulache VC. Gastrostomy Utilization by Oropharyngeal Cancer Patients Is Partially Driven by Swallowing Function. Laryngoscope 2019; 130:2153-2159. [PMID: 31566749 DOI: 10.1002/lary.28312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/26/2019] [Accepted: 09/03/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Oropharyngeal squamous cell carcinoma (OPSCC) incidence is rapidly increasing, as are survival rates, in large part due to the human papillomavirus (HPV). Treatment intensity, however, has remained unchanged, making treatment-related toxicity (i.e., dysphagia) a critical problem for an increasing number of patients. The primary objective of this study was to determine whether pretreatment objective swallowing measures can predict percutaneous fluoroscopic guided gastrostomy tube (PFG) utilization during OPSCC treatment. METHODS Forty-one newly diagnosed OPSCC patients treated with radiation underwent evaluation of swallow function with modified barium swallow study (MBSS) prior to and at completion of radiation treatment using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST); a subset of patients were evaluated using the MD Anderson Dysphagia Inventory (MDADI). RESULTS Patients were male (100%), primarily Caucasian (85.4%) and p16 positive (85.4%) with mean age of 65.7 years. PFG were placed in 70.7% patients (n = 29) and used by 63.4% (n = 26). Pre- and post-treatment DIGEST scores were associated with T-classification (t = -2.9, p = .001, t = -2.7, p = .01) and indicated deteriorating swallow function during treatment (mean change = 0.46 [t = -2.7, p = .01]). DIGEST and MDADI scores were generally not associated with patient PFG utilization. DIGEST and MDADI scores were significantly correlated prior to, but not following completion of treatment. CONCLUSION Pre-treatment DIGEST and patient reported swallowing outcomes (MDADI) can be useful in identifying patients with unsafe and/or grossly inefficient swallowing function. However, objectively measured swallow function was not associated with PFG utilization. Development of PFG placement algorithms (reactive vs. prophylactic) therefore require additional inputs/metrics. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2153-2159, 2020.
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Affiliation(s)
- Karishma Chhabria
- Department of Medicine, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Sagar Kansara
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Hoda Badr
- Department of Medicine, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Carol Stach
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,Speech Pathology Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Madeline Vernese
- Speech Pathology Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Allison Lerner
- Speech Pathology Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Aaron Harms
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - David J Hernandez
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Andrew T Huang
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - George Chen
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Robert B Parke
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Scott Charnitsky
- ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
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Correlation of Patient- and Physician-Scored Dysphagia with Videofluoroscopies in Patients Treated with Radiotherapy for Head and Neck Cancer. Dysphagia 2018; 33:684-690. [DOI: 10.1007/s00455-018-9888-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 02/27/2018] [Indexed: 10/17/2022]
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Achim V, Bolognone RK, Palmer AD, Graville DJ, Light TJ, Li R, Gross N, Andersen PE, Clayburgh D. Long-term Functional and Quality-of-Life Outcomes After Transoral Robotic Surgery in Patients With Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg 2017; 144:18-27. [PMID: 29075740 DOI: 10.1001/jamaoto.2017.1790] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance In recent years, transoral robotic surgery (TORS) has emerged as a useful treatment for oropharyngeal squamous cell carcinoma (OPSCC). In appropriately selected patients, the use of TORS may allow avoidance of adjuvant chemotherapy and/or radiotherapy, thereby avoiding the long-term adverse effects of these therapies. Objective To compare functional speech, swallowing, and quality-of-life outcomes longitudinally between those undergoing TORS only and those undergoing TORS and adjuvant radiotherapy (TORS+RT) or TORS and chemoradiotherapy (TORS+CRT). Design, Setting, and Participants This prospective, longitudinal cohort study performed from June 1, 2013, through November 31, 2015, included 74 patients undergoing TORS for initial treatment of OPSCC at a single tertiary academic hospital. Main Outcomes and Measures Data were collected at baseline, postoperatively (7-21 days), at short-term follow-up (6-12 months), and at long-term follow-up (>12 months). The quality-of-life metrics included the 10-item Eating Assessment Tool and the University of Michigan Head and Neck Quality of Life instrument. Data were also collected on tumor staging, surgical and adjuvant therapy details, patient comorbidities, tracheostomy and feeding tube use, and functional speech and swallowing status using the Performance Status Scale for Head and Neck Cancer Patients. Results Seventy-four patients were enrolled in the study (mean [SD] age, 61.39 [7.99] years; 68 [92%] male). Median long-term follow-up was 21 months (range, 12-36 months). The response rates were 86% (n = 64) postoperatively, 88% (n = 65) at short-term follow-up, and 86% (n = 64) at long-term follow-up. In all 3 groups, there was a significant worsening in pain and all swallowing-related measures postoperatively. There was subsequent improvement over time, with different trajectories observed across the 3 intervention groups. Postoperative dysphagia improved significantly more quickly in the TORS-only group. At long-term follow-up, weight loss differed between the TORS-only and TORS+RT groups (mean difference, -16.1; 97.5% CI, -29.8 to -2.4) and the TORS-only and TORS+CRT groups (mean difference, -14.6; 97.5% CI, -29.2 to 0) in a clinically meaningful way. In addition, the TORS-only group had significantly better scores than the TORS+CRT group on the Performance Status Scale-Eating in Public scale (mean difference, 21.8; 97.5% CI, 4.3-39.2) and Head and Neck Quality of Life-Eating scale (mean difference, 21.2; 97.5% CI, 4.0-38.3). Conclusions and Relevance Patients who underwent TORS+CRT demonstrated poorer long-term outcomes, with continued dysphagia more than 1 year after surgery. These findings support the investigation of adjuvant de-escalation therapies to reduce the long-term adverse effects of treatment.
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Affiliation(s)
- Virginie Achim
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Rachel K Bolognone
- The Northwest Clinic for Voice and Swallowing, Oregon Health and Science University, Portland
| | - Andrew D Palmer
- The Northwest Clinic for Voice and Swallowing, Oregon Health and Science University, Portland
| | - Donna J Graville
- The Northwest Clinic for Voice and Swallowing, Oregon Health and Science University, Portland
| | - Tyler J Light
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Ryan Li
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Neil Gross
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston
| | - Peter E Andersen
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Daniel Clayburgh
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
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