Swallowing Function in Survivors of Oropharyngeal Cancer Is Associated With Advanced T Classification

Abstract

Objectives: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is rapidly increasing in the United States. The aim of this study was to characterize the functional status of OPSCC survivors to identify predictors of swallowing dysfunction in this patient population. Methods: OPSCC survivors (n = 81) treated at the Michael E. DeBakey Veterans Affairs Medical Center between 2005 and 2015 with at least 2 years of clinical follow-up were reviewed. Functional status was ascertained using (1) gastrostomy and tracheostomy placement and retention, (2) gastrostomy use at last follow-up, (3) patient-reported diet, and (4) modified barium swallow. Results: Median follow-up duration was 5.6 years; 67% of patients had ≥10-pack-year tobacco exposure; 96% of tumors for which p16 data were available were p16 positive. At last follow-up, 82% of patients reported a regular diet, and only 9 patients required gastrostomy use. Gastrostomy use at last follow-up was higher in patients with T3 and T4 tumors compared with those with T1 and T2 tumors ( P = .01). The relationship between T classification and gastrostomy use persisted even when the analysis was limited to p16+ tumors and p16+ tumors with ≥10-pack-year history of tobacco exposure. Conclusions: Advanced T classification at presentation is a critical predictor of gastrostomy use in long-term OPSCC survivors irrespective of p16 status or tobacco exposure history. Level of Evidence: 2b

Trends in Swallowing Outcomes Following Deintensified Treatment in Selected p16+ Oropharyngeal Carcinoma

“…[38], "Never heavy" 87.7% [50]; NAC+S+R: "Nonsmoker" 50.0% [5], "Never heavy" 70.0% [7]). The primary tumor site was evenly distributed between the base of tongue (BOT) and the tonsil in both groups (NAC+S: "BOT" 52.6% [30], "Tonsil" 47.4% [27]; NAC +S+R: "BOT" 40.0% [4], "Tonsil" 60.0% [6]).…”

“…Lastly, the nature of the patient‐reported subjective swallowing assessments may be vulnerable to biases and other validity issues, even though they have been widely accepted as reliable and validated. 5 , 22 …”

“…Lastly, the nature of the patient-reported subjective swallowing assessments may be vulnerable to biases and other validity issues, even though they have been widely accepted as reliable and validated. 5,22 We report several findings that can help establish expectations, guide patient education, and maximize longterm swallowing function in p16+ OPSCC patients:…”

“…With the advancement of treatment modality and favorable prognosis of OPSCC patients, quality of life has emerged as an important outcome measure in evaluating treatment success. 5 Among various domains of quality of life, swallowing function is reported to be a top concern among OPSCC patients. 6 NAC+S has been shown to improve 5‐year disease‐free survival with lower feeding dependence compared to stage‐matched patients undergoing concomitant chemoradiation.…”

“…With the advancement of treatment modality and favorable prognosis of OPSCC patients, quality of life has emerged as an important outcome measure in evaluating treatment success 5 . Among various domains of quality of life, swallowing function is reported to be a top concern among OPSCC patients 6 .…”