title: Persistent dysphagia after head and neck radiotherapy: a common and under-reported complication with significant effect on non-cancer-related mortality.
abstract: OBJECTIVE
  Dysphagia is a well-recognised acute complication after radiotherapy. However, knowledge about the long-term prevalence and effect remains limited. The aims of this study were to determine the prevalence, severity, morbidity, time course and reporting patterns of dysphagia symptoms after head and neck radiotherapy.
  
  
  METHODS
  An observational cross-sectional study was conducted in a large consecutive series of head and neck cancer patients. All patients in the St George Hospital Cancer Care database who had received head and neck radiotherapy with curative intent 0.5-8 years previously and recorded as being alive were surveyed using the Sydney Swallow Questionnaire (SSQ). Case notes were reviewed to determine the level of awareness of swallowing dysfunction in all patients, as well as the causes of mortality in the 83 deceased patients.
  
  
  RESULTS
  The mean follow-up at the time of survey was 3 years after radiotherapy (range 0.5-8 years). Of the 116 patients surveyed by questionnaire, the response rate was 72% (83). Impaired swallowing (SSQ score > 234) was reported by 59% of patients. Dysphagia severity was not predicted by tumour site or stage, nor by the time since therapy, age, gender or adjuvant chemotherapy. Review of the hospital medical records and cancer database revealed that cancer accounted for 55% of deaths and aspiration pneumonia was responsible for 19% of non-cancer-related deaths. Of those with abnormal SSQ scores, only 47% reported dysphagia during follow-up clinic visits.
  
  
  CONCLUSIONS
  Persistent dysphagia is a prevalent, under-recognised and under-reported long-term complication of head and neck radiotherapy which currently cannot be predicted on the basis of patient, tumour or treatment characteristics. Aspiration pneumonia is an important contributor to non-cancer-related mortality in these patients. These data highlight the need for closer monitoring of swallow dysfunction and its sequelae in this population.
authors.affiliation: Department of Gastroenterology and Hepatology, St George Hospital, Sydney, NSW, Australia; St George Clinical School, University of New South Wales, Sydney, NSW, Australia. Electronic address: m.szczesniak@unsw.edu.au.
authors.forename: M M
authors.initials: MM
authors.lastname: Szczesniak
authors.affiliation: Speech Pathology Department, St George Hospital, Sydney, NSW, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Maclean
authors.affiliation: Department of Gastroenterology and Hepatology, St George Hospital, Sydney, NSW, Australia; St George Clinical School, University of New South Wales, Sydney, NSW, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Cancer Care Centre, St George Hospital, Sydney, NSW, Australia.
authors.forename: P H
authors.initials: PH
authors.lastname: Graham
authors.affiliation: Department of Gastroenterology and Hepatology, St George Hospital, Sydney, NSW, Australia; St George Clinical School, University of New South Wales, Sydney, NSW, Australia.
authors.forename: I J
authors.initials: IJ
authors.lastname: Cook
mesh_terms: D003430:Cross-Sectional Studies; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D011832:Radiation Injuries / Q000209:etiology / Q000401:mortality*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Dysphagia; head and neck; mortality; prevalence; radiotherapy