Pretreatment Dysphagia Inventory and videofluorographic swallowing study as prognostic indicators of early survival outcomes in head and neck cancer

Abstract

BACKGROUND:The prognostic role of swallowing-related, pretreatment subjective and objective findings has not been investigated in detail. The authors evaluated the association between pretreatment MD Anderson Dysphagia Inventory (MDADI) or videofluorographic swallowing study (VFSS) results and standard outcomes, including early recurrence and survival, in patients with treatment-na€ ıve head and neck squamous cell carcinoma (HNSCC). METHODS: Patients with HNSCC (n 5 191) who received treatment at the authors' institution and were examined by self-administered MDADI questionnaires and VFSS were prospectively enrolled. MDADI and VFSS findings were analyzed in correlation with clinicopathologic variables, and factors that predicted 2-year disease-free survival (DFS) and overall survival (OS) were identified using a Cox proportional-hazards regression model. RESULTS: The 2-year OS and DFS rates were 80.1% and 77.5%, respectively. Clinical tumor (T) and lymph node (N) classifications, overall TNM stage, sex, tumor site, and educational level were significantly associated with specific MDADI subdomains, whereas Karnofsky performance score was significantly associated with all MDADI subdomains. After controlling for clinical factors, total scores, global assessment scores, and emotional and physical MDADI subscores were significantly predictive of 2-year OS and DFS (P <.05 for each). VFSS findings were not significantly associated with survival (P >.05). CONCLUSIONS: The current results provide evidence of the prognostic role of the MDADI in predicting early survival outcomes in patients with HNSCC.

An Introduction to a Head and Neck Cancer-Specific Frailty Index and Its Clinical Implications in Elderly Patients: A Prospective Observational Study Focusing on Respiratory and Swallowing Functions

“…The median value of the global assessment score of the MDADI was 74 in our current study patients.The same score was found in the HNC patient cohort that included all ages in our previous study [9]. Similarly, we found that an MDADI ,70 was related to a lower 2-year overall survival rate.…”

“…Older HNC patients have a relatively higher incidence of coexisting pulmonary diseases or degenerative neuromuscular disorders that can aggravate treatment-related complications and may lead to insufficient treatment or even treatment discontinuation [6]. Importantly, HNC itself and its associated aerodigestive complications during patient follow-up can lead to early death and noncancerous demises [7][8][9]. Therefore, pretreatment evaluation of the functional age of geriatric HNC patients should include assessment of swallowing and respiration abilities.…”

Long-Term, Prospective Performance of the MD Anderson Dysphagia Inventory in “Low-Intermediate Risk” Oropharyngeal Carcinoma After Intensity Modulated Radiation Therapy

“…Larger sample sizes are needed to power hypotheses regarding differences between staging subgroups. Evidence of associations between age, T stage, and site of disease with long-term swallowing outcomes in OPC cohorts is reported by many investigators and supports need for prospective identification of patients at higher risk for poorer swallowing outcomes [31–33]. …”

Impact of baseline patient‐reported dysphagia on acute gastrostomy placement in patients with head and neck squamous cell carcinoma undergoing definitive radiation

“…The deintensification regimens and dosimetric radiotherapy approaches designed to limit acute and chronic toxicity for patients with oropharyngeal cancer with biologically favorable tumor biology and with few dysphagia‐related symptoms at baseline may not benefit patients presenting with advanced disease and dysphagia before starting radiotherapy. Baseline patient‐reported dysphagia was shown to be an independent predictor of survival . Patients reporting dysphagia before radiation are also subject to chronic dysphagia after radiation, despite radiation dose reductions to swallowing structures .…”

“…Baseline patient-reported dysphagia was shown to be an independent predictor of survival. 3,4 Patients reporting dysphagia before radiation are also subject to chronic dysphagia after radiation, despite radiation dose reductions to swallowing structures. 2 Thus, patients with preexisting dysphagia are subject to both disability and death.…”