What are the patient variables associated with swallowing dysfunction in head and neck cancer (HNCa) patients prior to intervention?
Background: Recent studies have shown that pretreatment deficits are common in HNCa patients, particularly those with advanced stage disease. Further, the research has shown poor correlation between measurable deficits and patients’ perceptions of these deficits. Determining aspiration risk prior to treatment may assist in ensuring optimal intervention by the speech language pathologist through application of compensatory maneuvers, dietary modifications and rehabilitative interventions. Understanding pretreatment organ function may also influence the oncologic treatment approach.
Study Design: Prospective, multi-institutional cohort study.
Setting: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins medical institutions, Baltimore, Md.; Department of Otolaryngology, MCG Center for Voice and Swallowing Disorders, Medical College of Georgia, Augusta.
Synopsis: Researchers studied 204 consecutive individuals with newly diagnosed HNCa. Pretreatment penetration aspiration scale (PAS) scores were analyzed by primary tumor site, tumor stage and standard demographic variables. Patients with advanced primary tumor stage laryngeal/hypopharyngeal tumors had higher mean PAS scores (5.18) in contrast to early stage larynx/hypopharynx (1.93), advanced stage oral cavity/oropharynx (2.24) and early stage oral cavity/oropharynx (1.54), indicative of poorer function. Age, race and gender were not associated with PAS scores. Multivariate logistic regression revealed significantly poorer PAS scores in patients with advanced primary tumors and laryngeal/hypopharyngeal primary site disease. However, even in the lower risk groups, abnormal PAS scores were identified.
The authors suggested that instrumental swallowing evaluation can be accomplished through fiberoptic endoscopic evaluation of swallowing (FEES) or videofluoroscopic swallowing study (VFSS). The assessments allow for identification of individuals in need of intensive rehabilitation efforts prior to, during or after oncologic management.
Bottom Line: Swallowing dysfunction in high-risk patients may be present in the pretreatment state and should be considered when determining candidacy for organ preservation modalities.
Citation: Starmer H, Gurin C, Lua LL, et al. Pretreatment swallowing assessment in head and neck cancer patients. Laryngoscope. 2011;121:1208-1211.
—Reviewed by Sue Pondrom