Correlation between swallowing-related quality of life and videofluoroscopy after head and neck cancer treatment

Acute Swallowing Outcomes After Surgical Resection of Oral Cavity and Oropharyngeal Cancers With the Mandibular Lingual Release Approach

OBJECTIVE

To investigate the incidence, nature, severity, and recovery of early dysphagia in patients following surgical resection of oral and/or oropharyngeal squamous cell carcinoma with a mandibular lingual release approach (MLRA).

STUDY DESIGN

Retrospective cohort study.

SETTING

Tertiary head and neck cancer center.

METHODS

Inclusion of patients' after surgical resection of oral cavity and/or oropharyngeal squamous cell carcinoma via an MLRA between 2012 and 2017. Data collection included acute medical care, enteral feeding, and swallowing outcomes derived from clinical swallow examination and videofluoroscopic swallowing study assessments at baseline, after surgery, and prior to discharge.

RESULTS

Twenty-eight patients were eligible for participation (23 males; mean age, 63 years). Baseline clinical swallow examination findings revealed that 32% (n = 9) were tolerating normal diet and fluids preoperatively (Functional Oral Intake Scale [FOIS] = 7). Following surgery, the majority (n = 21, 75%) experienced severe dysphagia (FOIS ≤4), of which 15 were nil by mouth. Twelve patients received a postoperative videofluoroscopic swallowing study, with silent aspiration observed in 9 cases. At discharge, 12 (43%) patients had persistent severe functional dysphagia (FOIS ≤4) with ongoing enteral feeding requirements, of which 7 were nil by mouth. Eleven (39%) were managing diets of modified fluid/diet consistencies (FOIS = 5), and 5 (18%) had mild dysphagia (FOIS ≥6) at discharge. None were able to manage a normal diet. The average length of hospital stay was 27.9 days.

CONCLUSIONS

Early dysphagia post-MLRA is a common and often severe complication of surgery. Patients require extended hospital admission with prolonged enteral feeding, which may persist postdischarge. This cohort requires early intervention by speech-language pathology services to aid swallow rehabilitation.

Predictors of severe dysphagia following radiotherapy for head and neck cancer

OBJECTIVE

To investigate if severe dysphagia following radiotherapy for head and neck cancer (HNC) could be predicted by patient and tumor characteristics, feeding tube use, weight factors, jaw opening function, and saliva secretion.

METHODS

Data was collected from 94 HNC patients 6 to 36 months post radiotherapy. Swallowing function was assessed by videofluroscopy (VFS). Severe dysphagia was defined by Penetration Aspiration Scale (PAS) as PAS≥5 or a total score ≤60 on the M. D. Anderson Dysphagia Inventory (MDADI).

RESULTS

Thirty-three patients (35%) had PAS ≥5 and 19 (20%) a MDADI ≤60, that is, presented with severe dysphagia. Univariable logistic regression analysis (UVA) gave that tumor of the tonsil, overweight at time of VFS and each unit increase in Body Mass Index (BMI) predicted less risk of PAS ≥5. Dependency of feeding tube at time of VFS and each month's continued use and weight loss ≥7.5% since treatment to time of VFS predicted increased risk of PAS ≥5. Predictive variables from the UVA of PAS ≥5 (tumor of the tonsil, overweight, and total duration of feeding tube), were analyzed by multivariate logistic regression analysis. All retained power as independent predictors. UVA for MDADI showed that use of feeding tube at time of VFS predicted MDADI ≤60 with the risk increasing each month. Each increasing unit of BMI decreased risk of MDADI ≤60.

CONCLUSION

Long time users of feeding tube and higher weight-loss are at risk of severe dysphagia. This makes collaboration between professionals working with dysphagia an important step in detecting severe dysphagia.Level of Evidence: 3.

Dysphagia and its impact on the quality of life of head and neck cancer patients: institution-based cross-sectional study

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.

Prediction of aspiration in dysphagia using logistic regression: oral intake and self-evaluation

OBJECTIVES

Oropharyngeal dysphagia (OD) has a major influence on health in general and health-related quality of life (HR-QoL) in particular. The gold standard assessments for OD, especially for aspiration in OD, are fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopy (VFSS), but not all patients have access to such procedures. Therefore, the current study built a prediction model to forecast aspiration in patients with OD on the basis of common self-evaluation questionnaires and oral intake status.

METHODS

A consecutive series of 111 patients with confirmed diagnosis of OD was measured according to a standardised protocol using the following tools: the Swallowing Quality of Life Questionnaire (SWAL-QOL), the Dysphagia Handicap Index (DHI), two self-report visual analogue scales which measure the Severity and the Impairment of the swallowing problem on everyday social life as experienced by the patient, the Eating Assessment Tool 10 (EAT-10), the Functional Oral Intake Scale (FOIS) and subsequently FEES (the gold standard). Penalised logistic regression was carried out to predict aspiration. The performance of the resulting models was evaluated by constructing receiver operating characteristics (ROC) curves and computing areas under the curve (AUC).

RESULTS

The final model showed an AUC of 0.92, indicating excellent performance.

CONCLUSION

This study shows that it may be possible to accurately predict aspiration in oropharyngeal dysphagia by a non-invasive and non-instrumental assessment protocol including oral intake status and self-report questionnaires on functional health status and HR-QoL.