title: Impact of dysphagia on quality of life after treatment of head-and-neck cancer.
abstract: OBJECTIVE
  To evaluate the quality of life (QOL) associated with dysphagia after head-and-neck cancer treatment.
  
  
  METHODS
  Of a total population of 104, a retrospective analysis of 73 patients who complained of dysphagia after primary radiotherapy (RT), chemoradiotherapy, and postoperative RT for head-and-neck malignancies were evaluated. All patients underwent a modified barium swallow examination to assess the severity of dysphagia, graded on a scale of 1-7. QOL was evaluated by the University of Washington (UW) and Hospital Anxiety and Depression questionnaires. The QOL scores obtained were compared with those from the 31 patients who were free of dysphagia after treatment. The QOL scores were also graded according to the dysphagia severity.
  
  
  RESULTS
  The UW and Hospital Anxiety and Depression scores were reduced and elevated, respectively, in the dysphagia group compared with the no dysphagia group (p = 0.0005). The UW scores were also substantially lower among patients with moderate-to-severe (Grade 4-7) compared with no or mild (Grade 2-3) dysphagia (p = 0.0005). The corresponding Hospital Anxiety (p = 0.005) and Depression (p = 0.0001) scores were also greater for the moderate-to-severe group. The UW QOL subscale scores showed a statistically significant decrease for swallowing (p = 0.00005), speech (p = 0.0005), recreation/entertainment (p = 0.0005), disfigurement (p = 0.0006), activity (p = 0.005), eating (p = 0.002), shoulder disability (p = 0.006), and pain (p = 0.004).
  
  
  CONCLUSIONS
  Dysphagia is a significant morbidity of head-and-neck cancer treatment, and the severity of dysphagia correlated with a compromised QOL, anxiety, and depression. Patients with moderate-to-severe dysphagia require a team approach involving nutritional support, physical therapy, speech rehabilitation, pain management, and psychological counseling.
authors.affiliation: Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, and VA North Texas Health Care System, S. Lancaster Road, Dallas, TX 75216, USA. NamPhong.Nguyen@med.va.gov
authors.forename: Nam P
authors.initials: NP
authors.lastname: Nguyen
authors.forename: Cheryl
authors.initials: C
authors.lastname: Frank
authors.forename: Candace C
authors.initials: CC
authors.lastname: Moltz
authors.forename: Paul
authors.initials: P
authors.lastname: Vos
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Smith
authors.forename: Ulf
authors.initials: U
authors.lastname: Karlsson
authors.forename: Suresh
authors.initials: S
authors.lastname: Dutta
authors.forename: Allan
authors.initials: A
authors.lastname: Midyett
authors.forename: Jessica
authors.initials: J
authors.lastname: Barloon
authors.forename: Sabah
authors.initials: S
authors.lastname: Sallah
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011788:Quality of Life; D012189:Retrospective Studies