Risk factors for late dysphagia after (chemo)radiotherapy for head and neck cancer: A systematic methodological review

Jiang, Nan; Zhang, Lijuan; Li, Liya; Zhao, Yue; Eisele, David W.

doi:10.1002/hed.23963

Cited by 32 publications

(30 citation statements)

References 65 publications

(75 reference statements)

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“…Threepoint ordinal scales (range 0-2) were used to capture pooling severity. The categorical rating scale comprises three levels of pooling severity: no pooling (0), mild-to-moderate pooling (1), and severe pooling (2). The description of each ordinal level of the severity of pooling is based on the perceptual judgment of the amount of bolus in relation to the size of the valleculae and/or pyriform sinuses.…”

Section: Fees Outcome Variablesmentioning

confidence: 99%

“…Treatment-induced alterations that contribute to OD include xerostomia, lymphedema, fibrosis, and damage to neuromuscular structures. Furthermore, chemoradiotherapy and the presence of hypopharyngeal carcinoma are associated with an increased risk for late OD [2]. Common symptoms of swallowing impairment in HNC patients while eating include complaints of food 'sticking' in the throat, nasal regurgitation, coughing, or choking [3].…”

Section: Introductionmentioning

confidence: 99%

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Association Between Pharyngeal Pooling and Aspiration Using Fiberoptic Endoscopic Evaluation of Swallowing in Head and Neck Cancer Patients with Dysphagia

et al. 2019

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Postswallow pharyngeal pooling may be a risk factor for tracheal aspiration. However, limited literature shows the potential association between pharyngeal pooling and aspiration in head and neck cancer (HNC) patients. This study investigates the relationship between postswallow pharyngeal pooling and aspiration in HNC patients with oropharyngeal dysphagia. Furthermore, the effects of tumor stage, tumor location, and cancer treatment on aspiration were examined. Ninety dysphagic HNC patients underwent a standardized fiberoptic endoscopic evaluation of swallowing (FEES) using thin and thick liquid boluses. For each swallow, three visuoperceptual ordinal variables were scored: postswallow vallecular pooling, postswallow pyriform sinus pooling, and aspiration. Logistic regression analyses with correction for the location of pooling, tumor stage, tumor location, and cancer treatment were performed to explore the association between pooling and aspiration. No significant association was found between postswallow vallecular pooling and aspiration for thin liquid. However, severe versus mild-to-moderate postswallow vallecular pooling of thick liquid was significantly associated to aspiration. Similar results were seen after correction for the presence of pyriform sinus pooling, tumor stage, tumor location, or type of cancer treatment. This study showed a significant association between severe postswallow pyriform sinus pooling of thick liquid and aspiration, independent of the presence of vallecular pooling, tumor stage, tumor location, or cancer treatment. Concluding, location (valleculae versus pyriform sinuses), liquid bolus consistency (thin versus thick liquid), and amount of postswallow pharyngeal pooling (no pooling, mild/moderate pooling, severe pooling) have an influence on the probability of aspiration in dysphagic HNC patients, and they should be carefully considered during FEES, even in the absence of aspiration during the examination.

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Section: Fees Outcome Variablesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association Between Pharyngeal Pooling and Aspiration Using Fiberoptic Endoscopic Evaluation of Swallowing in Head and Neck Cancer Patients with Dysphagia

et al. 2019

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“…19 Jiang et al have demonstrated that a hypopharyngeal tumor site and the existence of pretreatment dysphagia, are factors of late dysphagia worsening. 31 Moreover, Gluck et al has stressed the importance of considering the toxicities of lower grade (NCI-CTCAE Grades 1 and 2) to have an adequate estimation of the dysphagia burden. 15 In previous papers, the estimated prevalence of dysphagia during and after chemoradiotherapy/radiotherapy varies from 43% to 64% by instrumental measure.…”

Section: Discussionmentioning

confidence: 99%

Contribution of long-term dysphagia monitoring to first line treatment of head and neck cancer patients

Falewee

Hébert

Bénézery

et al. 2018

Int J Otorhinolaryngol Head Neck Surg

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Background: Dysphagia is a serious sequel of head and neck cancer (HNC) and its treatment. This dysfunction is frequent and likely underreported by clinical exam. It seems necessary to assess its global burden during the pre, per and post treatment periods (up to 18 months), regardless of the treatment received.Methods: This was a prospective cohort study assessing the rate of dysphagia in first-time treated HNC patients, using the deglutition handicap index questionnaire (DHI) and the clinician reporting. Time to occurrence, severity and length of the dysfunction were recorded. The benefit of an evaluation by the patient himself was investigated. Results: Of 134 evaluable patients: 22 were treated by surgery alone (16.4%), 16 by radiotherapy (RT) alone (11.9%), 3 by chemotherapy (CT) alone (2.2%), 28 by RTCT (20.9%), 31 by induction chemotherapy followed by RTCT (23.1%), 11 by surgery+RT (8.2%) and 23 by surgery+RTCT (17.2%). Patients completed 87.9% of the expected DHI. The dysphagia frequency reported was 92.2% by patient-reporting and 80.9% by clinicians-reporting, whatever the intensity. Self-perceived moderate to severe dysphagia was reported in 69.8% of patients.Conclusions: Given the strong impact of dysphagia on the quality of life and prognosis of HNC patients, it appears essential to perform screening and systematic monitoring. Using a simple and well accepted questionnaire, such as DHI, which is also well correlated with clinical evaluation, we demonstrated a significant frequency of dysphagia. The use of real-time patient-reported outcomes for its early detection would be an asset, particularly during long-term follow-up.Registered under ClinicalTrials.gov Identifier no. NCT03068559.

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“…A few studies have associated more advanced tumor classification with worse swallowing scores and higher rates of gastrostomy tube placement . Radiation therapy and combined chemoradiation have been associated with higher rates of dysphagia, stricture, pneumonia, and prolonged gastrostomy tube dependence, along with a lower likelihood of eating a normal diet . Poor swallowing function prior to HNC has been associated with worse swallowing function after treatment .…”

Section: Introductionmentioning

confidence: 99%

Individualized prediction of late‐onset dysphagia in head and neck cancer survivors

et al. 2020

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Background Limited data exist regarding which head and head and neck cancer (HNC) survivors will suffer from long‐term dysphagia. Methods From a population‐based cohort of 1901 Utah residents with HNC and ≥3 years follow‐up, we determined hazard ratio for dysphagia, aspiration pneumonia, or gastrostomy associated with various risk factors. We tested prediction models with combinations of factors and then assessed discrimination of our final model. Results Cancer site in the hypopharynx, advanced tumor classification, chemoradiation, preexisting dysphagia, stroke, dementia, esophagitis, esophageal spasm, esophageal stricture, gastroesophageal reflux, thrush, or chronic obstructive pulmonary disease were associated with increased risk of long‐term dysphagia. Our final prediction tool gives personalized risk calculation for diagnosis of dysphagia, aspiration pneumonia, or gastrostomy tube placement at 5, 10, and 15 years after HNC based on 18 factors. Conclusion We developed a clinically useful risk prediction tool to identify HNC survivors most at risk for dysphagia.

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Risk factors for late dysphagia after (chemo)radiotherapy for head and neck cancer: A systematic methodological review

Abstract: Although there is no conclusive evidence for dysphagia in patients with head and neck cancer after (chemo)radiotherapy, these data provide evidence to guide clinicians in patients who will have late dysphagia and to choose an optimal prophylactic strategy.

Cited by 32 publications

References 65 publications

Association Between Pharyngeal Pooling and Aspiration Using Fiberoptic Endoscopic Evaluation of Swallowing in Head and Neck Cancer Patients with Dysphagia

Association Between Pharyngeal Pooling and Aspiration Using Fiberoptic Endoscopic Evaluation of Swallowing in Head and Neck Cancer Patients with Dysphagia

Contribution of long-term dysphagia monitoring to first line treatment of head and neck cancer patients

Individualized prediction of late‐onset dysphagia in head and neck cancer survivors

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