Patient‐reported versus physiologic swallowing outcomes in patients with head and neck cancer after chemoradiation

Abstract

Objective The primary objective of this project was to retrospectively investigate the relationship between patient‐reported and physiologic swallowing measures after chemoradiation therapy for head neck cancer (HNC). Methods Adult patients who underwent chemoradiation therapy for HNC and presented for videofluoroscopic swallow study were reviewed retrospectively. Surgically treated patients were excluded. Patient perception of swallowing‐related outcomes was assessed via the MD Anderson Dysphagia Inventory (MDADI) on the same day that physiologic measures of swallow function were obtained. Using vidoefluoroscopic data, the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale yielded measures of safety (DIGEST‐S: penetration/aspiration) and efficiency (DIGEST‐E: residue). Statistical analysis for correlation coefficients was performed. Results Thirty patients met the inclusion criteria. The oropharynx was the most commonly affected site (70.0%), followed by the larynx (16.7%). The median radiation dose was 72 grays (Gy), and participants were assessed a mean of 4.6 (range 0–12) years following completion of treatment. There was no correlation between the MDADI and the DIGEST‐E score (Pearson rho = −0.045, P = 0.812), DIGEST‐S score (Pearson rho = 0.075, P = 0.695), or summary DIGEST grade (Pearson rho = 0.046, P = 0.810). MDADI scores did not change significantly with increasing time since radiation (P = 0.375), whereas the DIGEST‐E scores, DIGEST‐S score, and summary DIGEST grades worsened over time (P = 0.007, P = 0.002, and P = 0.0005, respectively). Conclusion Assessment of swallowing physiology showed that function worsened after chemoradiation therapy, but this did not correlate with patient‐reported quality‐of‐life measures. Reduced patient awareness of swallow dysfunction years after completion of chemoradiation has implications for management of dysphagia in the face of physiologic decline. Level of Evidence 4 Laryngoscope, 129:2059–2064, 2019

A visual analog scale for patient‐reported voice outcomes: The VAS voice

“…It is therefore incumbent upon clinicians to be quite thoughtful about the selection of survey instruments. As has been noted by many previous authors, PROMs currently used in laryngology are not necessarily optimal, either from a practical or psychometric perspective; they are not always correlated with objective measures and are designed to provide complementary information to standard clinical assessment . Furthermore, there are significant patient and physician factors that hinder the usefulness of PROMs, related to survey administration, impatience, and other underlying biases.…”

“…As has been noted by many previous authors, 8,9,42 PROMs currently used in laryngology are not necessarily optimal, either from a practical or psychometric perspective; they are not always correlated with objective measures and are designed to provide complementary information to standard clinical assessment. 48 which is a critical measure in development of such tools and was explicitly not studied herein, can be difficult to measure given the dynamic nature of voice complaints, which may vary over a short period of time. Clinicians using PROMs in all areas of otolaryngology, and medicine in general, are encouraged to consider the validity and reliability of this data prior to accepting and using a measure.…”

Very late xerostomia, dysphagia, and neck fibrosis after head and neck radiotherapy

“…[16][17][18] Also, dysphagia has been found to be one of the most commonly reported late side effects after radiotherapy, 16,18 with 45% of patients reporting it 2 years after IMRT. [19][20][21][22] Motz et al observed the highest incidence of dysphagia, airway obstruction, and pneumonia in the first year after treatment but without a significant decrease in the subsequent four years. 9 Limited studies have assessed toxicity >2 years after therapy.…”

“…9 Limited studies have assessed toxicity >2 years after therapy. 20 Furthermore, Patterson et al found that 71% of patients 6 years post-IMRT reported swallowing problems, of whom one-fifth suffered from aspiration. 22 The study by Kirsh et al assessed very late dysphagia (>3 years after IMRT) and saw that 23% of the patients still required a modified diet after a mean follow-up time of 4.55 years.…”

“…9 Limited studies have assessed toxicity >2 years after therapy. [19][20][21][22] Motz et al observed the highest incidence of dysphagia, airway obstruction, and pneumonia in the first year after treatment but without a significant decrease in the subsequent four years. 22 The study by Kirsh et al assessed very late dysphagia (>3 years after IMRT) and saw that 23% of the patients still required a modified diet after a mean follow-up time of 4.55 years.…”