Baseline health perceptions, dysphagia, and survival in patients with head and neck cancer

Abstract

Introduction Baseline dysphagia, more common than abnormalities on formal swallowing testing, is believed to predict survival in untreated head and neck cancer patients. We hypothesized that patient-reported dysphagia impacts multiple domains of quality of life and predicts disease recurrence and disease-related death. Methods The Swal-QOL, a dysphagia-specific measure, and the EuroQOL were administered to 159 patients prior to treatment with curative intent, in this prospective cross-sectional cohort study. Logistic regression evaluated associations among clinical and subjective measures. Multivariable competing risk regression tested the impact of clinical, tumor and patient-reported measures on survival. Results Baseline dysphagia, pain and diminished patient-reported health state (PRHS) were more closely associated with weight loss prior to treatment and advanced T-classification, than any other clinical feature. However, only 56% (23/40) of patients reporting dysphagia had >5% weight loss. Dysphagia was associated with pain and/or diminished PRHS, independent of weight loss. Female patients were more likely to report pain and dysphagia, while males reported dysphagia alone. Dysphagia predicted recurrence and disease related death, adjusting for T and N classification, performance status, smoking and weight loss, and accounting for competing risks of death (RFS: HR 3.8 (95%CI 1.7–8.4), p=.001; DOD HR 4.2 (95%CI 1.04–5), p=.004). Conclusion Baseline dysphagia affects multiple domains of quality of life and general health perceptions in untreated head and neck cancer patients. A dysphagia measure captures the effort of maintaining nutrition with cancer, identifying patients with or at risk for weight loss, and predisposed to disease recurrence and disease-related death.

The impact of developing a speech and swallow rehab program: Improving patient satisfaction and multidisciplinary care

“…Long‐term quality of life is intimately related to speech and swallowing function. Furthermore, swallowing outcomes have been not only linked to quality of life, but also to health‐related outcomes and mortality . SLPs are uniquely equipped to address these functional issues, and evidence shows that early integration of SLP care leads to better treatment adherence and functional outcomes .…”

Qualidade De Vida Em Deglutição E Câncer De Cabeça E Pescoço: Revisão De Literatura

“…A adição da disfagia, percepção do estado de saúde e dor contribuíram substancialmente para a perda de peso pré-tratamento, assim como o estágio avançado do tumor, como constatado por Lango e cols. (2014) 28 .…”

“…Dos 159 pacientes avaliados, 58% teve perda de peso, atribuindo sua ingestão diminuída e perda de apetite principalmente a disfagia 28 .…”

Impact of Pain and Evaluation of Education and Self-Care in Patients with Head and Neck Cancer

“…Similarly, one study of 133 patients with HNC found lower QoL compared with the general population, both prior to start of RT and one month later [71]. To date, general HR-QoL and health among patients with HNC has been sparsely studied [179] for which reason they were investigated in Paper III. The points at which time measurements were taken, along with differences in the HR-QoL questionnaires used in the studies above, make comparisons difficult.…”

“…A systematic review [205] found that good HRQoL was an indicator of better survival and one study [179] showed that pain prior to treatment had a significant association with lower survival.…”