Baseline health perceptions, dysphagia, and survival in patients with head and neck cancer

Authors

  • Miriam N. Lango MD,

    Corresponding author
    1. Department of Surgical Oncology, Head and Neck Surgery Section, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
    • Corresponding author: Miriam N. Lango, MD, Department of Surgical Oncology, Head and Neck Surgery Section, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111; Fax: (215) 214-4222; Miriam.Lango@fccc.edu

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  • Brian Egleston PhD,

    1. Department of Biostatistics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
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  • Carolyn Fang PhD,

    1. Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
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  • Barbara Burtness MD,

    1. Department of Medical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
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  • Thomas Galloway MD,

    1. Department of Radiation Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
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  • Jeffrey Liu MD,

    1. Department of Surgical Oncology, Head and Neck Surgery Section, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
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  • Ranee Mehra MD,

    1. Department of Medical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
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  • Barbara Ebersole CCCP,

    1. Department of Rehabilitation, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania.
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  • Kathleen Moran CCCP,

    1. Department of Rehabilitation, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania.
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  • John A. Ridge MD, PhD

    1. Department of Surgical Oncology, Head and Neck Surgery Section, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
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  • We would like to thank Sandy Schwartz, MS, SLP, for assistance in the initial implementation of this study, and Olga Tchuvatkina, MS, and Suresh Yalamanchi for database support.

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. Cancer 2014;120:840–847. © 2013 American Cancer Society.

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