title: Pretreatment swallowing assessment in head and neck cancer patients.
abstract: OBJECTIVE
  To discuss patient variables associated with swallowing dysfunction in head and neck cancer (HNCA) patients prior to intervention.
  
  
  METHODS
  Prospective, multi-institutional cohort study.
  
  
  METHODS
  All patients included had newly diagnosed head and neck malignancies. Patients undergoing instrumental swallowing evaluations prior to oncologic management were included for analysis. Pretreatment Penetration Aspiration Scores (PAS) were analyzed by primary tumor site, tumor stage, and standard demographic variables.
  
  
  RESULTS
  The final study sample was comprised of 204 consecutive individuals with newly diagnosed HNCA. Patients with advanced primary tumor (T) stage laryngeal/hypopharyngeal tumors had higher mean PAS scores (5.18) in contrast to early stage larynx/hypopharynx (1.93), advanced stage oral cavity/oropharynx (2.24), and early stage oral cavity/oropharynx (1.54, P < .0001), indicative of poorer function. Age, race, and sex were not associated with PAS scores. Multivariate logistic regression revealed significantly poorer PAS scores in patients with advanced primary tumors (odds ration [OR] = 3.83, 95% confidence interval [CI], 1.84-8.00, P < .0001) and laryngeal/hypopharyngeal primary site disease (OR = 3.04, 95% CI, 1.41-6.54, P = .004), after controlling for all other variables.
  
  
  CONCLUSIONS
  This series demonstrates that swallowing dysfunction in high-risk patients may be present in the pretreatment state and should be considered when determining candidacy for organ preservation modalities. These data highlight the importance of instrumental swallowing evaluations prior to intervention, particularly for those individuals with advanced stage and/or laryngeal/hypopharyngeal tumors.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. hstarme1@jhmi.edu
authors.forename: Heather
authors.initials: H
authors.lastname: Starmer
authors.forename: Christine
authors.initials: C
authors.lastname: Gourin
authors.forename: Lannah L
authors.initials: LL
authors.lastname: Lua
authors.forename: Lori
authors.initials: L
authors.lastname: Burkhead
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007822:Laryngeal Neoplasms / Q000150:complications / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000150:complications / Q000503:physiopathology; D015337:Multicenter Studies as Topic; D009959:Oropharyngeal Neoplasms / Q000150:complications / Q000503:physiopathology; D055815:Young Adult