Dysphagia’s Effects on Quality of Life, Functional Disabilities, and Psychological Distress in Head and Neck Cancer Patients: Outcomes of Cancer Rehabilitation from an Observational Single-Centre Study

Abstract

Purpose Many patients with head and neck cancer (HNC) suffer from speech or swallowing disorders. We investigated the effects of dysphagia on health-related quality of life (HRQoL), functioning, and distress in HNC survivors, and the extent to which rehabilitation can alleviate these effects. Methods Cancer survivors undergoing inpatient cancer rehabilitation at an Austrian rehabilitation centre were asked to complete electronic patient-reported outcomes before admission (T0) and at discharge (T1). The EORTC QLQ-C30 questionnaire was assessing HRQoL, symptoms, and functioning, and the Hospital Anxiety and Depression Scale (HADS) to assess psychological distress. Results Of 63 HNC patients, 22 had dysphagia, 23 did not need speech therapy (control group C1), and 18 without dysphagia needed speech therapy (control group C2). Before rehabilitation, HRQoL, physical, social, and emotional functioning were significantly lower in dysphagia patients than in controls. Dysphagia patients suffered from more severe general symptoms, including fatigue, pain, sleep disturbances, nausea/vomiting, diarrhoea, and financial worries. In addition, emotional and social functioning of C2 patients who needed speech therapy but did not show dysphagia was significantly worse than of C1 patients. Social, emotional, and role functioning, fatigue, nausea/vomiting, insomnia, and appetite loss significantly improved by T1 in all HNC patients. Improvements in HRQoL were most noticeable in dysphagia patients. Psychooncological counselling reduced depression in dysphagia and in C2 patients to levels seen in the general population. Conclusion Dysphagia patients suffer severely from impaired functioning and systemic symptoms, but benefit substantially from cancer rehabilitation.