Gastrostomy Utilization by Oropharyngeal Cancer Patients Is Partially Driven by Swallowing Function

Abstract

ObjectiveOropharyngeal 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.MethodsForty‐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).ResultsPatients 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.ConclusionPre‐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 Evidence4 Laryngoscope, 130:2153–2159, 2020

Functional Outcomes in Patients with Human Papillomavirus‐Associated Oropharyngeal Squamous Cell Cancer Treated with Trimodality Therapy

“…However, objectively measured swallow function was not associated with PEG utilization. Development of PEG placement algorithms (reactive vs. prophylactic) therefore require additional inputs/metrics 40 . Long‐term gastrostomy tube dependence following TORS is rare, particularly in patients that receive surgery alone 41 .…”

Preliminary development and validation of a measure of fear of swallowing and swallowing‐related movement injury in head and neck cancer: Swallowing Kinesiophobia Scale

“…Although HNC accounts for only 4% of all cancer it suffers the highest treatment‐related morbidity 3,22,23 . Consequently, the experience of having been diagnosed with HNC produces reactions that can impact critical activities such as swallowing, feeding and overall quality of life 3 .…”

“…Although HNC accounts for only 4% of all cancer it suffers the highest treatment‐related morbidity 3,22,23 . Consequently, the experience of having been diagnosed with HNC produces reactions that can impact critical activities such as swallowing, feeding and overall quality of life 3 . One method of ameliorating the effects of ablative HNC treatment is early swallow exercise aimed at promoting movement of the swallowing musculature and maintaining oral intake 4 .…”

“…Nearly all head and neck cancer (HNC) patients treated with radiotherapy (with or without chemotherapy) (C/RT) experience co‐morbidities and treatment‐related concern or worry prior to, or during their cancer treatment 1,2 . A significant HNC treatment‐related co‐morbidity is swallowing difficulty 3 . Swallowing changes during and after treatment are highly prevalent, and often result in a profile characterized by reduced feeding efficiency facilitating severe limits in oral intake of food/liquid 4 .…”

Refining measurement of swallowing safety in the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) criteria: Validation of DIGEST version 2

“…DIGEST is a simple but robust tool with evidence of uptake in clinical and research practice. [6][7][8][9][10][11] Since its implementation began in 2016, clinical and research speechlanguage pathology users of DIGEST have identified areas for refinement specifically related to the grading of mild safety impairments. The objective of this work was, therefore, to assess the performance of refined DIGEST safety grading criteria in DIGEST version 2 (DIGEST v2 ) and the structural validity of DIGEST v2 .…”