Rick Factors Associated with Aspiration in Patients with Head and Neck Cancer

Abstract

ObjectiveTo determine the major risk factors and abnormal videofluoroscopic swallowing study (VFSS) findings associated with aspiration in patients with head and neck cancer (HNC).MethodRisk factors associated with aspiration were investigated retrospectively in 241 patients with HNC using medical records and pre-recorded VFSS. Age, gender, lesion location and stage, treatment factors, and swallowing stage abnormalities were included.ResultsAspiration occurred in 50.2% of patients. A univariate analysis revealed that advanced age, increased duration from disease onset to VFSS, higher tumor stage, increased lymph node stage, increased American Joint Committee on Cancer (AJCC) stage, operation history, chemotherapy history, and radiotherapy history were significantly associated with aspiration (p<0.05). Among them, advanced age, increase AJCC stage, operation history, and chemotherapy history were significantly associated with aspiration in the multivariate analysis (p<0.05). Delayed swallowing reflex and reduced elevation of the larynx were significantly associated with aspiration in the multivariate analysis (p<0.05).ConclusionThe major risk factors associated with aspiration in patients with HNC were advanced age, higher AJCC stage, operation history, and chemotherapy history. A VFSS to evaluate aspiration is needed in patients with NHC who have these risk factors. Delayed swallowing reflex and reduced elevation of the larynx were major abnormal findings associated with aspiration. Dysphagia rehabilitation should focus on these results.

Association Between Pharyngeal Pooling and Aspiration Using Fiberoptic Endoscopic Evaluation of Swallowing in Head and Neck Cancer Patients with Dysphagia

“…Also the phenomena of pooling in both locations (pyriform sinuses and valleculae) probably indicate a more severe swallowing impairment with an increased risk of aspiration [27]. Previous studies by other authors demonstrated a significant association between vallecular pooling and aspiration [13,16,27]; however, most studies included mainly non-oncological patients [16,27]. Considerable heterogeneity exists across studies making comparisons difficult, especially regarding the methodology and study population, as the majority of patients showed neurogenic OD [16,27].…”

“…Previous studies demonstrated that postswallow pharyngeal pooling is associated with aspiration during FEES examination in patients with nasopharyngeal carcinoma treated with definitive radiotherapy [11,12]. However, these studies only included patients with nasopharyngeal carcinoma, and therefore their findings cannot be generalized to the overall HNC population, although, Jung et al found an association between the presence of vallecular pooling and aspiration in patients with HNC [13]. During their retrospective analysis, a different swallowing assessment tool (VFSS) without standardized bolus consistencies was used, and not all patients suffered from OD.…”

“…The visualization of aspiration during swallowing assessment in HNC patients has received much attention due to its potentially severe consequences, including aspiration pneumonia, sepsis, and death. Therefore, aspiration of food or liquids in patients with HNC is a major concern, with a reported incidence rate ranging from 36 to 94% [13]. Factors associated with aspiration are advanced age and tumor stage, previous history of head and neck surgery, and/or chemotherapy [13].…”

“…Therefore, aspiration of food or liquids in patients with HNC is a major concern, with a reported incidence rate ranging from 36 to 94% [13]. Factors associated with aspiration are advanced age and tumor stage, previous history of head and neck surgery, and/or chemotherapy [13]. As postswallow pharyngeal pooling is assumed to pose a risk for tracheal aspiration on the subsequent swallow, the detection of pooling during swallowing assessment is also becoming increasingly important [14].…”

Aspiration

“…1,19 Obesity and a smoking history have been demonstrated to be associated with increased gastroesophageal reflux, 20 therefore increasing this risk. 23 The risk of aspiration in other cancers, such as esophageal cancer or lung cancer, has not been explored. These factors combined with any accompanying upper airway injury or dysfunction that may have been associated with the procedure itself may put an already critically ill patient at higher risk for an aspiration episode.…”