title: Baseline health perceptions, dysphagia, and survival in patients with head and neck cancer.
abstract: BACKGROUND
  In head and neck cancer patients prior to treatment, dysphagia noted by patients is more common than aspiration on formal swallow studies. The authors hypothesized that patient-reported dysphagia impacts multiple domains of quality of life (QOL) and predicts disease recurrence and disease-related death.
  
  
  METHODS
  The Swal-QOL, a dysphagia-specific, swallowing-related, QOL measure, and the EuroQOL-5D-3L were administered to 159 patients before treatment with curative intent in this prospective cohort study. Logistic regression analysis evaluated associations among clinical and subjective measures. Multivariable competing risk regression tested the impact of clinical, tumor, and patient-reported measures on survival.
  
  
  RESULTS
  Baseline dysphagia, pain, and diminished patient-reported health state were found to be closely associated with weight loss before treatment and advanced T classification. However, only 58% of patients (23 of 40 patients) reporting dysphagia experienced > 5% weight loss. Dysphagia was found to be associated with pain and/or diminished patient-reported health state, independent of weight loss. Female patients were more likely to report pain and dysphagia, whereas male patients reported dysphagia alone. Dysphagia was found to be predictive of disease recurrence and disease-related death, adjusting for T and N classifications, ECOG performance status, smoking status, and weight loss, and accounting for competing risks of death (recurrence-free survival: hazards ratio, 3.8 [95% confidence interval, 1.7-8.4; P = .001] and disease-related death: hazards ratio, 4.2 [95% confidence interval, 1.04-5; P = .004]).
  
  
  CONCLUSIONS
  Baseline dysphagia affects multiple domains of QOL and general health perceptions in patients with head and neck cancer prior to treatment. A dysphagia measure captures the effort of maintaining nutrition, and identifies patients predisposed to disease recurrence and disease-related death.
authors.affiliation: Department of Surgical Oncology, Head and Neck Surgery Section, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania.
authors.forename: Miriam N
authors.initials: MN
authors.lastname: Lango
authors.forename: Brian
authors.initials: B
authors.lastname: Egleston
authors.forename: Carolyn
authors.initials: C
authors.lastname: Fang
authors.forename: Barbara
authors.initials: B
authors.lastname: Burtness
authors.forename: Thomas
authors.initials: T
authors.lastname: Galloway
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Liu
authors.forename: Ranee
authors.initials: R
authors.lastname: Mehra
authors.forename: Barbara
authors.initials: B
authors.lastname: Ebersole
authors.forename: Kathleen
authors.initials: K
authors.lastname: Moran
authors.forename: John A
authors.initials: JA
authors.lastname: Ridge
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000401:mortality* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009752:Nutritional Status; D010146:Pain / Q000209:etiology; D058748:Pain Perception; D010465:Perception; D011446:Prospective Studies; D011788:Quality of Life; D012306:Risk; D057566:Self Report; D013534:Survival; D015431:Weight Loss
keywords: baseline weight loss; dysphagia; head and neck cancer; health perceptions; survival