title: Pretreatment factors associated with functional oral intake and feeding tube use at 1 and 6 months post-radiotherapy (+/- chemotherapy) for head and neck cancer.
abstract: A proportion of patients with head and neck cancer (HNC) experience significant swallowing difficulty during and post-radiotherapy/chemoradiotherapy (RT/CRT). Identifying patients during the pretreatment period who are anticipated to have compromised oral intake would allow for early and accurate patient education, and prioritisation of their management. Ascertaining a clear set of pretreatment predictors from the literature is challenging due to heterogeneity in study designs and patient cohorts, with minimal prospective data available (especially at 1-month post-treatment). The objectives of this study were to investigate which pretreatment factors predicted compromised oral intake and feeding tube use at 1 and 6 months post-RT/CRT. Prospective data were collected on 80 consecutive HNC patients receiving RT/CRT from 2011 to 2014. The primary outcome was to identify predictors of a modified diet at 1 and 6 months post-RT/CRT. Secondary outcomes were to identify predictors of feeding tube use at these time intervals, and <6 vs. >6 week duration of feeding tube use. Multivariate analysis revealed bilateral neck radiotherapy treatment was a strong predictor of modified diets at 1 month (p < 0.001), and T-stages T3/T4 a predictor of modified diets at 6 months (p = 0.03). Patients treated with concurrent CRT (p = 0.02) and bilateral neck treatment (p = 0.02) predicted feeding tube use at 1 month, and concurrent CRT predicted feeding tube use for >6 weeks (p = 0.04). Therefore, patients receiving bilateral neck treatment and/or CRT are at greatest risk of requiring modified diets and feeding tube use early post-treatment, and should be prioritised for intervention and ongoing support.
authors: Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia. Molly.Barnhart@health.nsw.gov.au.|The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD, 4072, Australia. Molly.Barnhart@health.nsw.gov.au.
authors: Molly K
authors: http://orcid.org/0000-0001-6822-3276
authors: MK
authors: Barnhart
authors: The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD, 4072, Australia.|Centre for Functioning and Health Research, Queensland Health, Buranda, QLD, 4102, Australia.
authors: Elizabeth C
authors: EC
authors: Ward
authors: Centre for Functioning and Health Research, Queensland Health, Buranda, QLD, 4102, Australia.|Speech Pathology, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia.
authors: Bena
authors: B
authors: Cartmill
authors: Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia.
authors: Rachelle A
authors: RA
authors: Robinson
authors: Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia.
authors: Virginia A
authors: VA
authors: Simms
authors: Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia.
authors: Sophie J
authors: SJ
authors: Chandler
authors: Simba Analytics, Melbourne, VIC, 3000, Australia.
authors: Elea T
authors: ET
authors: Wurth
authors: Comprehensive Cancer Centre, POWH, Randwick, NSW, 2031, Australia.|The Clinical Teaching School, University New South Wales, Kensington, NSW, Australia.|Acting Dir, Radiation Oncology, Tamworth Base Hospital, Tamworth, NSW, 2340, Australia.
authors: Robert I
authors: RI
authors: Smee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D003680:Deglutition Disorders / Q000209:etiology* / Q000628:therapy*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000970:Antineoplastic Agents
keywords: Chemoradiotherapy; Dysphagia; Feeding tube; Oral intake; Predictors