Swallowing-related quality of life after head and neck cancer treatment.
OBJECTIVE
To determine the role of treatment modality in swallowing outcome after head and neck cancer treatment and to identify potential risk factors for posttreatment dysphagia.


METHODS
Cross-sectional survey of patients with no evidence of disease 12 months or more after the treatment of a stage III or IV squamous cell carcinoma of the oropharynx, larynx, or hypopharynx.


METHODS
Potential subjects were stratified by tumor site and tumor T-stage to achieve a balanced comparison between chemoradiation (n = 18) and surgery/radiation (n = 22) groups. Outcome measures included a dysphagia risk factor survey, the MD Anderson Dysphagia Inventory (MDADI), and the Short-Form 36 (SF-36).


RESULTS
Patients who received chemoradiation for oropharyngeal primaries demonstrated significantly better scores on the emotional (P =.03) and functional (P =.02) subscales of the MDADI than did patients who underwent surgery followed by radiation. There were no significant differences between chemoradiation and surgery/radiation groups for laryngeal and hypopharyngeal primaries. Additional risk factors for posttreatment dysphagia include prolonged (>2 weeks) nothing by mouth (NPO) status (P =.002) and low SF-36 Mental Health Subscale score (P =.002).


CONCLUSIONS
The study suggests that chemoradiation may provide superior swallowing outcome to surgery/radiation in patients with oropharyngeal primary. Patients with depressed mental health and prolonged feeding tubes may be at higher risk of long-term dysphagia.
Department of Otolaryngology--Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA. gillesmb@musc.edu
M Boyd
MB
Gillespie
Martin B
MB
Brodsky
Terry A
TA
Day
Fu-Shing
FS
Lee
Bonnie
B
Martin-Harris
D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000628:therapy*; D007822:Laryngeal Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000628:therapy*; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires