title: Patient-reported outcomes following parotid-sparing intensity-modulated radiotherapy for head and neck cancer. How important is dysphagia?
abstract: OBJECTIVE
  Swallowing can be significantly affected during and following radiotherapy for head and neck cancer (HNC). The purpose of this study was to understand: (1) the trajectory of swallowing recovery following parotid-sparing intensity-modulated radiotherapy (IMRT) and (2) overall physical and social-emotional wellbeing and how patients prioritise swallowing following treatment.
  
  
  METHODS
  Sixty-one HNC patients completed questionnaires as part of a prospective study exploring patient-reported swallowing outcomes following parotid-sparing IMRT. Participants were asked to complete the M.D. Anderson Dysphagia Inventory (MDADI) and University of Washington Quality of Life Questionnaire (UW-QoL) v.04 before treatment and 3, 6 and 12months after treatment. Given the rise in human papilloma virus (HPV) and associated oropharyngeal cancers, we completed a sub analysis of the data in those participants.
  
  
  RESULTS
  There was a significant reduction in the MDADI composite scores 3months after completion of treatment. Improvements were observed by 12months, however, scores did not recover to baseline. The recovery in physical function was limited in comparison to social-emotional recovery at 12months. When oropharyngeal cancer scores were analysed, there was not a substantial difference to the whole group results. There was a shift in priorities following treatment. Swallowing was highlighted as a concern by 44% of HNC patients up to 12months after treatment with swallowing-related factors (saliva, taste and chewing) rated highly.
  
  
  CONCLUSIONS
  Patient reported swallowing outcomes were significantly affected from baseline to all follow-up time points and remained a priority concern at 12months following treatment. Overall social-emotional functioning does improve, suggesting that patients have the potential to adapt to their "new normal" following IMRT for HNC.
authors.affiliation: Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, United Kingdom; The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom. Electronic address: Justin.roe@nhs.net.
authors.forename: Justin W G
authors.initials: JW
authors.lastname: Roe
authors.affiliation: Institute of Cellular Medicine, University of Newcastle upon Tyne, NE1 7RU, United Kingdom. Electronic address: m.j.drinnan@ncl.ac.uk.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Drinnan
authors.affiliation: School of Allied and Public Health, Australian Catholic University, Brisbane Campus, 1100 Nudgee Road, Banyo, Queensland, 4014, Australia. Electronic address: paul.carding@acu.edu.au.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Carding
authors.affiliation: Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, United Kingdom; The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom. Electronic address: kevin.harrington@icr.ac.uk.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Harrington
authors.affiliation: Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, United Kingdom; The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom. Electronic address: chris.nutting@rmh.nhs.uk.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Nutting
mesh_terms: D000328:Adult; D000368:Aged; D003679:Deglutition / Q000528:radiation effects*; D003680:Deglutition Disorders / Q000209:etiology / Q000523:psychology; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications; D010306:Parotid Gland; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D011788:Quality of Life; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Head and neck cancer; Intensity-modulated radiotherapy; Oropharyngeal cancer; Quality of life; Survivorship; Swallowing