FraMaDySc: dysphagia screening for patients after surgery for head and neck cancer

Abstract

Purpose Oropharyngeal dysphagia is one of the most common postoperative consequences in head and neck cancer patients. Above all, these patients often suffer from aspiration and limitations of oral intake. However, no reliable dysphagia screening is available for this target group. This study aimed to develop and validate a screening, FraMaDySc, based on a water swallow test (WST) for the identification of postsurgical patients with a risk of aspiration, limitations of oral intake, and, as their derivate, a relevant oropharyngeal dysphagia in general (OD) that constituted the main reference standard. Methods A total of 184 postsurgical head and neck cancer patients were tested with a WST. The patients were, on average, 62 years old and predominantly male (71%). After WST, they underwent Fiberoptic Endoscopic Evaluation of Swallowing (FEES®). FEES® results were dichotomized by Penetration aspiration scale and Functional oral intake scale. Patients with a “fail” result on one of these two scales were classified as having OD. Quality criteria of WST were quantified by means of cross-tabulation with FEES® results. Results OD was found in 65% of patients, aspiration in 44%, limitations of oral intake in 56%. WST delivered a “fail” result in 65% of patients. WST showed sensitivity 91% and specificity 88% for OD. Quality criteria for aspiration (sensitivity 64%, specificity 93%) and limitations of oral intake (sensitivity 80%, specificity 87%) were lower. Conclusion FraMaDySc is a standardized, quick, and valid WST and therefore an excellent screening tool for the identification of OD in postoperative head and neck cancer patients.

Diagnostic value of water swallow test for dysphagia in patients with head and neck cancer: A systematic review and meta‐analysis

“…Therefore, we determined their eligibility for inclusion in the study through calculations. Horii et al 19 and Hey et al 10 reported sensitivity, specificity, positive LR, and negative LR, while Patterson et al 13 provided information on sensitivity, specificity, TP, actual positive cases, TN, and actual negative cases. We calculated the values for the 2 × 2 contingency tables using the Revman 5.3 calculator.…”

“…This may be attributed to the standardization of testing performance and failure criteria in the modified WST, thereby minimizing subjectivity. 10 Furthermore, whether it is the incremental WST or the 100 mL WST, increasing water volume can reduce the risk of aspiration, and the use of failure criteria (wet sounds and coughing) can ensure patient safety. 10,12 Hence, future investigations can explore the application of the modified WST in HNC patients with diverse tumor sites and treatment to further assess its reliability in screening.…”

“…Concerning the "Reference standard," it was challenging to ascertain whether the assessors' interpretations of the reference standard were conducted without knowledge of the WST screening results in five studies. 10,[20][21][22][23] In terms of "Case Flow and Timing," two studies explicitly indicated that FEES examination was conducted by a speech therapist 1 h after completing the WST. 10,21 The remaining studies did not specify whether an appropriate time interval existed between the WST and the reference standard.…”

“…10,[20][21][22][23] In terms of "Case Flow and Timing," two studies explicitly indicated that FEES examination was conducted by a speech therapist 1 h after completing the WST. 10,21 The remaining studies did not specify whether an appropriate time interval existed between the WST and the reference standard. In one study, not all cases were included in the analysis due to instances of patient mortality and loss to follow-up.…”

“…Swallowing function was categorized into five levels, with Level III and above indicating abnormalities. Currently, several scholars have proposed various modified versions of the WST 10–12 . One approach involves incremental water trial volumes (2, 5, 10, 20 mL) for the water swallow screening to identify oropharyngeal dysphagia, risk of aspiration, and restricted oral intake 10,11 .…”