Risk factors for recurrent pneumonia in post-irradiated patients with nasopharyngeal carcinoma

Wang, Jing-Jie; Jiang, Rong–San; Yen, Ting-Ting; Liang, Kai‐Li

doi:10.1016/j.jcma.2017.01.006

Cited by 15 publications

(13 citation statements)

References 23 publications

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“…The reason could be the high prevalence of nasogastric intubation and feeding gastrostomy rates in Taiwan 4 . Furthermore, our study that confirmed male gender, myocardial infarction, congestive heart failure, peripheral vascular disease and aneurysm, ischemic CVA, dementia, COPD, DM with or without organ damage, hemiplegia, CKD, metastatic solid tumor, and AIDS were independent predictors for AP events, consistent with the results of previous studies 5, 6, 7, 8, 9. All these systemic diseases will induce varying degrees of disability.…”

Section: Discussionsupporting

confidence: 91%

“…An association between dysphagia and AP has been reported in clinical observations. Poor swallowing function is known to be related to aging, head and neck irradiation, myopathies, stroke, and neuromuscular disease 5 , 6 , 12, 13, 14. Dysphagia is a major healthcare problem, as it increases the risk of malnutrition, dehydration, aspiration pneumonia, and death 11 .…”

Section: Discussionmentioning

confidence: 99%

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Dysphagia and risk of aspiration pneumonia: A nonrandomized, pair-matched cohort study

Leu

Yang

et al. 2019

Journal of Dental Sciences

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Background/purposeDysphagia was associated with increased prevalence of aspiration pneumonia (AP) in studies that were criticized for either their small sample size or lack of prospective design. Using a considerably larger nationwide, population-based database and a long-term prospective cohort design, our study aimed to explore the relationship between dysphagia and the subsequent development of AP.Materials and methodsFrom 2000 to 2009, we gathered a study cohort consisting of 6979 newly diagnosed cases of dysphagia from Taiwan's National Health Insurance Research Database. For the control group, another 20,937 individuals without dysphagia were matched for age, sex, and comorbidity. The two cohorts were followed-up to observe the occurrence of AP and correlated mortality.ResultsDuring an average of 3.88 ± 2.73 years of follow-up, we observed 315 cases of new AP [non-dysphagia (193, 0.92%) vs. dysphagia (122, 1.75%), p < 0.0001], and the incidence of AP was significant in the dysphagia group. After adjusting for age, sex, and comorbidity, dysphagia-related AP [hazard ratio (HR) 2.499; 95% confidence interval (CI), 2.089–2.99; p < 0.0001], dysphagia related mortality [HR 3.229; 95% CI, 3.052–3.417; p < 0.0001], and many other systemic diseases were independently associated with a diagnosis of AP.ConclusionDysphagia was highly associated with an increased risk of AP according to data derived from a large nationwide cohort database. Nonetheless, larger prospective studies or meta-analyses are recommended to confirm our findings.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Dysphagia and risk of aspiration pneumonia: A nonrandomized, pair-matched cohort study

Leu

Yang

et al. 2019

Journal of Dental Sciences

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“…Case series and cross-sectional data report alarmingly high rates of aspiration-related deaths (21–23). For example, the 30-day mortality rate in a series of nasopharyngeal cancer patients was 51% (24). It is crucial that we identify those at risk of developing aspiration pneumonia as early as possible.…”

Section: Dysphagiamentioning

confidence: 99%

Late Effects of Organ Preservation Treatment on Swallowing and Voice; Presentation, Assessment, and Screening

Patterson

2019

Front. Oncol.

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The prevalence of head and neck cancer (HNC) survivors is on the rise. Treatments for HNC can have a major deleterious impact on functions such as swallowing and voice. Poor functional outcomes are strongly correlated with distress, low quality of life, difficulties returning to work and socializing. Furthermore, dysphagia can have serious medical consequences such as malnutrition, dehydration, and pneumonia. A conservative estimate of the percentage of survivors living with dysphagia in the long-term is between 50 and 60%. Evidence is emerging that functions can worsen over time, sometimes several years following treatment due to radiation-associated fibrosis, neuropathy, intractable edema, and atrophy. Muscles lose their strength, pliability, stamina, and range, speed, precision, and initiation of movements necessary for swallowing and voice functions. Late treatment effects can go unrecognized, and may only be identified when there is a medical complication such as hospitalization for aspiration pneumonia. In the routine healthcare setting methods of evaluation include a detailed case history, a thorough clinical examination and instrumental assessments. Interventions for late treatment effects are limited and it is imperative that patients at risk are identified as early as possible. This paper considers the role of screening tests in monitoring swallowing and detecting aspiration in the long-term. Further work is indicated for addressing this pressing and increasingly common clinical problem.

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“…Due to increasing longevity, survivors are now suffering longer‐term side effects and complications of treatment such as dysphagia due to post‐irradiation sensory and motor neuropathies and soft tissue fibrosis 5–7 . This is an important cause of dysphagia in the south‐eastern Asian population 8–11 …”

Section: Introductionmentioning

confidence: 99%

Assessment of pharyngeal motor function using a novel velopharyngeal squeeze maneuver and a novel endoscopic pharyngeal contraction grade scale in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma

Vlantis

Hui

et al. 2021

Head & Neck

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Background To investigate a novel velopharyngeal squeeze maneuver (VPSM) and novel endoscopic pharyngeal contraction grade (EPCG) scale for the evaluation of pharyngeal motor function. Methods During endoscopic examination of 77 post‐irradiated nasopharyngeal carcinoma patients and control subjects, VPSM was rated and lateral pharyngeal wall movement graded with EPCG scale during swallowing. Pharyngeal constriction ratio (PCR) measured by videofluoroscopy was used for correlation. Results VPSM and EPCG scale showed almost perfect intra‐rater and inter‐rater reliability (Kappa: >0.90). VPSM was present in 61% of patients suggesting good pharyngeal motor function. VPSM was predictive of EPCG scale (Wald statistic = 29.99, p < 0.001). EPCG scale also correlated strongly with PCR (r: 0.812) and was predictive for aspiration (odds ratio: 22.14 [95% CI 5.01–97.89, p < 0.001]). Conclusions VPSM and EPCG scale are two novel tools to assess pharyngeal motor function, and both correlate well with pharyngeal contractility and aspiration.

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Risk factors for recurrent pneumonia in post-irradiated patients with nasopharyngeal carcinoma

Cited by 15 publications

References 23 publications

Dysphagia and risk of aspiration pneumonia: A nonrandomized, pair-matched cohort study

Dysphagia and risk of aspiration pneumonia: A nonrandomized, pair-matched cohort study

Late Effects of Organ Preservation Treatment on Swallowing and Voice; Presentation, Assessment, and Screening

Assessment of pharyngeal motor function using a novel velopharyngeal squeeze maneuver and a novel endoscopic pharyngeal contraction grade scale in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma

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