title: Swallowing outcome measures in head and neck cancer--How do they compare?
abstract: OBJECTIVE
  Dysphagia is a common and debilitating side effect of chemoradiotherapy. Assessment is difficult; swallowing is multifactorial and studies choose from a range of dysphagia assessments. This study intended to investigate the relationship between swallowing assessments of dysphagia in a cohort of patients and to evaluate whether clinical swallowing measures can predict patient reported swallowing outcomes.
  
  
  METHODS
  One hundred and seventy-three head and neck cancer patients from two teaching hospitals were recruited prospectively over 25 months. At three months follow-up patients were assessed using Rosenbeck's Penetration-Aspiration Scale (PAS), The 100 ml Water Swallow Test (WST), The Performance Status Scale: Normalcy of Diet and the MD Anderson Dysphagia Inventory (MDADI).
  
  
  RESULTS
  The highest correlation was observed between the MDADI and Normalcy of Diet (rho 0.68) and the lowest between the MDADI and the PAS (rho 0.34). Using multiple regression the PAS and WST accounted for 44% of the variance in the MDADI scores (R2 = 0.44, F = 37.8, p < 0.001). On stepwise regression, the model only retained the Normalcy of Diet scores (R2 = 0.42, F=107.9, p < 0.001). Separating the PAS into subgroups, those with no penetration or aspiration on the PAS scored significantly higher on the MDADI (p = <0.001).
  
  
  CONCLUSIONS
  Patient reported swallowing outcomes were strongly aligned with diet restrictions but poorly aligned with clinical assessment. The WST, however, was more correlated than the PAS score, representing a more functional assessment. Clinical dysphagia, associated with significant morbidity, and patient reported dysphagia related to quality of life are not interchangeable and must be measured separately.
authors.affiliation: Department of Ear, Nose and Throat Surgery, Freeman Hospital, Newcastle upon Tyne, UK. Electronic address: ami.pedersen@doctors.org.uk.
authors.forename: A
authors.initials: A
authors.lastname: Pedersen
authors.affiliation: Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Wilson
authors.affiliation: Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Elaine
authors.initials: E
authors.lastname: McColl
authors.affiliation: Speech Pathology, Faculty of Health Sciences, Australian National Catholic University, Brisbane Campus, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Carding
authors.affiliation: Speech & Language Therapy Department, Sunderland Royal Hospital, Sunderland, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Patterson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000009:adverse effects*; D003679:Deglutition / Q000187:drug effects / Q000528:radiation effects; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Chemoradiotherapy; Deglutition disorders; Head and neck cancer; Outcome assessment (healthcare)