Evaluation of Objective and Subjective Swallowing Outcomes in Patients with Dysphagia Treated for Head and Neck Cancer

Abstract

We evaluated objective and subjective swallowing function outcomes in patients with dysphagia treated for head and neck cancer (HNC) and identified risk factors for poor swallowing outcomes. Patients undergoing videofluoroscopic swallowing studies (VFSS) between January 2016 and March 2021 were divided into four groups according to primary tumor sites; post-treatment dysphagia was assessed. The penetration–aspiration scale (PAS) and bolus residue scale (BRS) were used to objectively assess swallowing function through VFSS. The Functional Oral Intake Scale (FOIS) was used for subjective analyses of swallowing statuses. To account for potential confounding, important covariates were adjusted for in logistic regression models. Oropharyngeal tumors were significantly more likely to have poor PAS and BRS scores than oral cavity tumors, and the patients with nasopharyngeal tumors were significantly less likely to have poor FOIS scores. Old age, having multiple HNCs, and a history of radiotherapy were associated with an increased odds of poor PAS scores (for all types of swallows), poor BRS scores (for semiliquid and solid swallows), and poor FOIS scores, respectively. This indicates using only subjective assessments may not allow for accurate evaluations of swallowing function in patients treated for HNC. Using both objective and subjective assessments may allow for comprehensive evaluations.

Transoral robotic surgery with free flap reconstruction: Functional outcomes of 241 patients at a single institution

“…Univariate logistic regression identified factors that increase aspiration risk. Age >70 years increased the risk of aspiration, similar to findings by Liou et al, of older H&N patients who have poorer penetration‐aspiration scores 30 . Consistent with studies of H&N patients receiving primary RT, smoking history also increased aspiration risk 31 .…”

“…Age >70 years increased the risk of aspiration, similar to findings by Liou et al, of older H&N patients who have poorer penetration-aspiration scores. 30 Consistent with studies of H&N patients receiving primary RT, smoking history also increased aspiration risk. 31 Notably, hypoglossal nerve (CN XII) resection increased aspiration risk by an odds ratio of 10.86.…”

Head and Neck Cancer: A Study on the Complex Relationship between QoL and Swallowing Function

“…Previous research on the correlation between objective findings and QoL is highly controversial. In head and neck cancer patients, this limited correlation was observed when comparing multiple questionnaires alongside different accurate diagnostic methods in heterogeneous patient cohorts [18][19][20][21][22][23][24][25][26][27][28][29]49,50]. Standardized objective diagnostics, such as FEES [17,[20][21][22][23][24] or VFSS [18,19,22,[25][26][27][28][29], were commonly utilized, primarily focusing on measuring penetration and aspiration during swallowing.…”

“…In head and neck cancer patients, this limited correlation was observed when comparing multiple questionnaires alongside different accurate diagnostic methods in heterogeneous patient cohorts [18][19][20][21][22][23][24][25][26][27][28][29]49,50]. Standardized objective diagnostics, such as FEES [17,[20][21][22][23][24] or VFSS [18,19,22,[25][26][27][28][29], were commonly utilized, primarily focusing on measuring penetration and aspiration during swallowing. Among the questionnaires employed, the MD Anderson Dysphagia Inventory (MDADI) emerged as the most frequently used [17,19,20,22,23,26,27,34].…”

“…However, the validity of PROs in evaluating swallowing function in HNSCC is controversial: Some studies indicate significant correlations between subjective swallowing difficulties and objective parameters such as oropharyngeal swallowing efficiency, bolus transport time, residue, and aspiration [14][15][16][17]. Nevertheless, most research suggests a tenuous relationship between these measures, particularly concerning penetration and aspiration [18][19][20][21][22][23][24][25][26][27][28][29]. The present study aimed to determine if central European patients with tumors primarily attributable to smoking and/or alcohol can accurately assess their physiologic swallowing functioning using the most widely employed questionnaire, MDADI [12,[30][31][32].…”