Study of Dysphagia in Patients with Advanced Oropharyngeal Cancer Subjected to an Organ Preservation Protocol Based on Concomitant Radiotherapy and Chemotherapy

Document Type: Research Articles

Authors

1 Post-Graduate Program, Barretos Cancer Hospital, Barretos – SP, Brazil.

2 Speech Language Pathology Department, Barretos Cancer Hospital, Barretos – SP, Brazil

3 Epidemiology and Biostatistics Group, Barretos Cancer Hospital, Barretos – SP, Brazil.

4 Center for Research Support, Barretos Cancer Hospital, Barretos – SP, Brazil.

5 Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos – SP, Brazil.

6 Head and Neck Surgery Department, Barretos Cancer Hospital, Barretos – SP, Brazil.

Abstract

Introduction: Organ preservation protocol (based on chemo-radiotherapy) for oropharyngeal tumors include
dysphagia as a possible sequel leading to function impairment and changes in patient’s quality of life. Objectives:
The aim of this study is to assess dysphagia severity after treatment in advanced oropharyngeal cancer patients treated
with concurrent chemo-radiation. Methods: This prospective cross-sectional study included 64 participants who
had been disease free for at least six months after primary treatment. Dysphagia severity was assessed by fibre-optic
endoscopic evaluation of swallowing (FEES) and the Dysphagia Outcome and Severity Scale (DOSS); the occurrence
of penetration/aspiration during swallowing was also investigated. All participants also completed the M. D. Anderson
Dysphagia Inventory (MDADI). The correlation of FEES results with clinical-demographic variables and MDADI
scores was assessed. Descriptive analysis was performed, and qualitative variables were compared using either the
chi-square or Fisher’s exact test. Results: FEES revealed silent aspiration in 18.8% of the patients. Approximately 6.3%
of the patients exhibited severe dysphagia (scores 1-2 in DOSS). Dysphagia severity was significantly associated with
the MDADI physical domain scores. The participants with scores 5-7 in DOSS (no or mild dysphagia) exhibited less
limitations in the MDADI physical domain (p=0.015). Conclusions: Silent aspiration was detected in one of every five
patients treated with concurrent chemo-radiotherapy; almost half of the patients exhibit at least moderate dysphagia.
Assessment of the participant’s quality of life via the MDADI revealed an association between the physical domain
scores and dysphagia severity.

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