Dysphagia, stricture, and pneumonia in head and neck cancer patients: does treatment modality matter?
OBJECTIVE
Dysphagia-related sequelae are common after head and neck cancer treatment. Our aims were 1) to document overall and site-specific dysphagia, stricture, and pneumonia rates in a Medicare population, 2) to calculate treatment-specific rates and adjusted odds of developing these complications, and 3) to track changes in rates between 1992 and 1999.


METHODS
Head and neck cancer patients between 1992 and 1999 were identified in combined Surveillance Epidemiology and End Results (SEER) registry and Medicare databases. Multivariate analyses determined odds of dysphagia, stricture, and pneumonia based on modality.


RESULTS
Of 8,002 patients, 40% of experienced dysphagia, 7% stricture, and 10% pneumonia within 3 years of treatment. In adjusted analyses, patients treated with chemoradiation had more than 2.5-times-greater odds of dysphagia than did those treated with surgery alone. Combined therapy was associated with increased odds of stricture (p<0.05). The odds of pneumonia were increased in patients treated with radiation with or without chemotherapy. Temporally, the dysphagia rates increased 10% during this period (p<0.05).


CONCLUSIONS
Sequelae of head and neck cancer treatment are common and differ by treatment regimen. Those treated with chemoradiation had higher odds of experiencing dysphagia and pneumonia, whereas patients treated with any combined therapy more commonly experienced stricture. These sequelae represent major sources of morbidity and mortality in this population.
Francis
David O
DO
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
Weymuller
Ernest A
EA
Parvathaneni
Upendra
U
Merati
Albert L
AL
Yueh
Bevan
B
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000453:epidemiology*; D004940:Esophageal Stenosis / Q000453:epidemiology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000628:therapy; D007822:Laryngeal Neoplasms / Q000628:therapy; D008297:Male; D011014:Pneumonia / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*