Aspiration, Weight Loss, and Quality of Life in Head and Neck Cancer Survivors

Abstract

To determine associations between objective assessments (swallowing function and weight change) and subjective quality-of-life (QOL) measures. Design: Observational case series using clinical testing and questionnaires. Setting: University hospital-based tertiary clinical practice. Patients: Convenience sample of 5-year survivors of head and neck cancer (62 nonlaryngectomy survivors were studied). Interventions: Objective testing included examination, weight history, videofluoroscopic swallow studies (VFSS), and oropharyngeal swallowing efficiency (OPSE). Subjective testing included QOL questionnaires (University of Washington Quality-of-Life [UWQOL] Scale, Performance Status Scale for Head and Neck Cancer Patients [PSS-HN], Functional Assessment of Cancer Treatment-General [FACT-G] Scales, and Functional Assessment of Cancer Therapy-Head and Neck [FACT-H&N] Scale). Main Outcome Measures: Aspiration (identified by VFSS), weight change, and QOL measures. Results: Aspiration was associated with the decreased QOL scores in chewing, swallowing, normalcy of diet, and additional concerns of the FACT-H&N Scale. No association was found between aspiration and willingness to eat in public, subjective understandability, or any of the FACT-G scales. Of the nonlaryngectomy survivors, 27 (44%) demonstrated some degree of aspiration during VFSS. Associations were found between aspiration, primary tumor T stage, weight change, and OPSE. Aspirators lost a mean of 10.0 kg from precancer treatment weight, while nonaspirators gained a mean of 2.3 kg (PϽ.001). Mean OPSE scores were 69 for nonaspirators and 53 for aspirators (P=.01). Conclusions: Almost half of long-term nonlaryngectomy head and neck cancer survivors demonstrated at least some degree of aspiration. The presence of aspiration is associated with substantial weight loss, advanced initial tumor stage, diminished oropharyngeal swallowing efficiency, and lower scores on a variety of QOL scales.

A Prospective Investigation of Swallowing, Nutrition, and Patient-rated Functional Impact Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

“…Specifically, significant improvement was found for physical and functional components of performing everyday activities, as reported by Epstein and colleagues 77 who found almost 60% of a heterogenous head and neck cancer population treated with surgery and/or radiotherapy reported no limitations at work or performing household jobs at 6-12 months post-treatment. As in the current study, negative outcomes at 6 months have been reported for the physical and head and neck specific concerns, largely reflecting the ongoing trouble with swallowing, social eating, dry mouth, sticky saliva, and mouth opening in the irradiated population 78,79 . In addition, weight loss of 10% or more in 6 months, as found in the current study, has been associated with increased morbidity such as impaired wound healing, reduced immune function, and increased mortality, and has also been shown to impact on quality of life and functional outcomes [80][81][82][83] .…”

Long-term Health-Related Quality of Life in Survivors of Head and Neck Cancer

“…In addition, poor swallowing function may exert more than a detrimental effect on HRQOL. 33 Unrecognized aspiration following chemoradiation to treat HNC may also contribute to mortality. Aspiration pneumonia may add substantially to the morbidity and mortality associated with HNC treatment, although this long-term adverse effect may not be easily identified as a result of cancer therapy.…”

Associação entre os achados do questionário de disfagia M. D. Anderson e a videofluoroscopia da deglutição após tratamento do câncer de cabeça e pescoço

“…In this sense, some studies indicate the need for assessing the quality of life of cancer patients for a good understanding of the degree of improvement and/or stabilization, or even worse, obtained with therapeutic procedures (2) . There are studies describing the association of dysphagia with the decline in quality of life during oncological treatment (3)(4)(5)(6)(7) . In head and neck cancer, this association has been studied through the application of symptom-specific quality of life questionnaires (8)(9)(10)(11)(12)(13) , considered effective in assessing the impact of the disease in affected individuals.…”