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.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Oto-rhino-laryngologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Otorhinolaryngology (hsv//eng)

Keyword

deglutition disorders

head and neck neoplasms

saliva secretions

trismus

weight loss

quality-of-life

modulated radiation-therapy

long-term

concurrent

chemoradiotherapy

chemo-imrt

aspiration

trismus

impact

chemotherapy

prevalence

Otorhinolaryngology

Publication and Content Type

ref (subject category)

art (subject category)