Swallowing outcomes in oropharyngeal squamous cell carcinoma patients

Abstract

Background: Dysphagia, or impairment of swallowing function, is a consequence of oropharyngeal squamous cell carcinoma (OPSCC) treatments and often results in a devastating reduction in quality of life (QoL). The impacts of treatments on swallowing function makes this a critical area of study. Purpose: The research objective was to report swallowing outcomes in OPSCC patients using the Modified Barium Swallow Impairment Profile (MBSImP) PI scores and MD Anderson Dysphagia Inventory (MDADI) composite scores at four appointments: pre-treatment, one month post-, six months post-, and 12 months post-treatment. The secondary research objective was to study the relationship between these two types of measures at each appointment. Methods: This was a retrospective study design where data from January 2013 to December 2017 were collected from a tertiary health center for four appointments relative to cancer treatment. To address the primary objective, MBSImP PI scores and MDADI composite scores were reported for each appointment and stratified by treatment modality. To address the secondary objective, four Spearman tests were run between MBSImP PI and MDADI composite scores at each appointment. Results: 123 participants were included (81.9% male). Data were analyzed cross-sectionally, per appointment type. MBSImP PI scores worsened one month post-treatment and remained impaired at six and 12 months. At 12 months following treatment, organ preservation patients appeared to have the best clinician-driven swallowing outcomes, while patients who received both surgery and adjuvant (C)RT had the worst. For MDADI composite scores, patient reports worsened one month post-treatment and subsequently improved at six and 12 months. Patients who received surgery SWALLOWING OUTCOMES IN OPSCC PATIENTS 3 alone reported scores at 12 months that surpassed pre-treatment reports. Organ preservation patients reported MDADI composite scores that appeared to remain stable throughout the first year following treatment. Patients who received both surgery and (C)RT reported the greatest swallowing impairment and remained at a level of function at 12 months. MBSImP PI and MDADI composite scores were weakly negatively correlated (in agreement) at the pre- and 12 month post- treatment appointments. Conclusions: Swallowing outcomes in OPSCC patients have distinct yet predictable trends for both clinician-driven and patient-reported swallowing outcomes during the first year following cancer treatment. However, unlike previous findings, these two types of measures were in agreement at the pre-treatment and 12 month post-treatment appointment within the first year, highlighting the importance of considering data within this time period.