An exploratory study of the influence of clinico-demographic variables on swallowing and swallowing-related quality of life in a cohort of oral and oropharyngeal cancer patients treated with primary surgery

Abstract

There are insufficient data on swallowing and the consequences of its dysfunction in patients with cancers of the oral cavity (OC) and oropharynx (OP) that are treated with primary surgery. The study attempts to explore the effect of important clinico-demographic variables on post-treatment swallowing and related quality of life (QOL) in post-surgical OC and OP cancer patients. Sixty-two consecutive OC and OP cancer patients completed the MD Anderson Dysphagia Inventory (MDADI) questionnaire. Mean scores were computed. Comparison of scores based on mean ranks were performed using Mann-Whitney U test or Kruskal-Wallis test. Level of significance was set at P ≤ 0.02. Adjustments were made for multiple comparisons. Significantly worse mean (SD) QOL scores were observed in late T-stage (T3/T4) versus early T-stage (T1/T2) patients for global domain, physical domain, functional domain and emotional domains [44.4 (21.9) vs. 78.7 (22.7) (P < 0.001); 50.0 (9.4) vs. 75.9 (16.3), (P < 0.0001); 57.8 (20.6) vs. 84.1 (16.7), (P < 0.001) and 55.2 (18.0) vs. 78.5 (16.3), (P < 0.001)], respectively. Patients undergoing reconstruction versus without reconstruction had worse QOL scores; 58.8 (26.9) versus 79.5 (22.8), (P < 0.01); 61.2 (15.1) versus 76.4 (17.5), (P = 0.002); 65.4 (20.5) versus 86.3 (15.9), (P < 0.0001) and 63.3 (18.8) versus 79.8 (16.3), (P < 0.01), respectively, for global, physical, functional and emotional domains. Advanced T-stage, reconstruction, younger age and base of tongue tumours have a negative impact on post-treatment swallow function and related QOL in these patients.

Levels of scientific evidence of the quality of life in patients treated for oral cancer

“…Despite the heterogeneity of the designs, the results/conclusions are on the same line: a decrease in the HRQoL after treatment (14-22), which appears to parallel the magnitude of the tumor (2,4,23-31), and the use of radiotherapy (2,4,5,29,32-40). After a year, this declining trend turns around (15,16,18,20,22,41-47).…”

Tongue Strength as a Predictor of Functional Outcomes and Quality of Life after Tongue Cancer Surgery

“…55 Poorer speech, swallowing, and QOL have been found in surgically treated oral cancer patients who undergo postoperative radiotherapy as compared to those who undergo surgery alone. 2,3,8,9,11,18,27 In this study, the B A Fig 3. A) Relationship between tongue strength and Eating Assessment Tool (EAT-10) score (p < 0.05).…”

Functional Assessment and Rehabilitation

“…Current literature indicates that the percentage of oral tongue resection, type of reconstruction, contour of the free flap, and primary tumor stage affect postsurgical speech and swallowing outcomes. 5,10,26 Functional outcomes also vary depending on the schedule of radiation, radiotherapy dose distribution, and the use of concurrent chemotherapy. Finally, swallowing outcomes can be influenced by supportive care practices, including the timing and type of feeding tube placement and the provision of targeted preventive exercise in patients receiving radiotherapy or chemoradiation.…”

“…Some studies report significantly worse swallowing outcomes in patients who have reconstruction after oral cavity and oropharyngeal resections, 26 largely owing to the confounding effects of greater tumor burden and greater surgical defects in patients who require reconstruction rather than primary closure. Reconstructive factors that are associated with functional outcomes include sensory repair and the contour and volume of the flap.…”