The course of swallowing problems in the first 2 years after diagnosis of head and neck cancer

Abstract

Introduction Head and neck cancer (HNC) and its treatment often negatively impact swallowing function. The aim was to investigate the course of patient-reported swallowing problems from diagnosis to 3, 6, 12, and 24 months after treatment, in relation to demographic, clinical, and lifestyle factors. Methods Data were used of the Netherlands Quality of Life and Biomedical Cohort Study in head and neck cancer research (NET-QUBIC). The primary outcome measures were the subscales of the Swallowing Quality of Life Questionnaire (SWAL-QOL). Linear mixed-effects models (LMM) were conducted to investigate changes over time and associations with patient, clinical, and lifestyle parameters as assessed at baseline. Results Data were available of 603 patients. There was a significant change over time on all subscales. Before treatment, 53% of patients reported swallowing problems. This number increased to 70% at M3 and decreased to 59% at M6, 50% at M12, and 48% at M24. Swallowing problems (i.e., longer eating duration) were more pronounced in the case of female, current smoking, weight loss prior to treatment, and stage III or IV tumor, and were more prevalent at 3 to 6 months after treatment. Especially patients with an oropharynx and oral cavity tumor, and patients receiving (C)RT following surgery or CRT only showed a longer eating duration after treatment, which did not return to baseline levels. Conclusion Half of the patients with HNC report swallowing problems before treatment. Eating duration was associated with sex, smoking, weight loss, tumor site and stage, and treatment modality, and was more pronounced 3 to 6 months after treatment.

The Change in Social Eating over Time in People with Head and Neck Cancer Treated with Primary (Chemo)Radiotherapy: The Role of Swallowing, Oral Function, and Nutritional Status

“…Associations were observed between more depressive and swallowing symptoms at baseline and more (worse) social eating problems in the early (3 months) and later phases (6-24 months). Considering that in similar HNC cohorts, high depressive and swallowing symptoms were described for up to 3-and 6-month follow-up [29,30], it may be hypothesized that worse social eating problems are observed as long as these symptoms persist. Older age was associated with increasing (worsening) social eating problems from 12-to 24-month follow-up.…”

A core outcome set for patient‐reported dysphagia for use in head and neck cancer clinical trials: An international multistakeholder Delphi study

“…1 Dysphagia, or swallowing difficulty, is one of the most prevalent and burdensome sequelae of HNC, affecting up to 70% of patients before, during or after treatment. [2][3][4][5][6] Dysphagia can lead to medical and psychosocial consequences. 7,8 Measuring patient-reported outcomes (PROs) related to dysphagia is important for assessing the benefit of treatment on patients' lives.…”

“…Head and neck cancer (HNC) represents the 7th most common malignancy worldwide 1 . Dysphagia, or swallowing difficulty, is one of the most prevalent and burdensome sequelae of HNC, affecting up to 70% of patients before, during or after treatment 2–6 . Dysphagia can lead to medical and psychosocial consequences 7,8 .…”

Patient‐reported outcome measures for dysphagia in head and neck cancer: A systematic review and appraisal of content validity and internal structure

“…5,6 Dysphagia (swallowing difficulty) is one of the most common sequelae of HNC, affecting up to 70% of patients before, during, or after treatment. [7][8][9][10][11] Dysphagia is reported by patients to be one of the primary concerns among HNC patients, 12 and can lead to several medical complications, 10,13,14 psychosocial distress, 15,16 and reduced quality of life (QOL). 17 Currently, numerous PROMs exist to evaluate dysphagia and its impact on people with HNC.…”

“…HNC is the seventh most prevalent cancer worldwide, accounting for more than 660 000 new cases and 325 000 deaths annually 5,6 . Dysphagia (swallowing difficulty) is one of the most common sequelae of HNC, affecting up to 70% of patients before, during, or after treatment 7–11 . Dysphagia is reported by patients to be one of the primary concerns among HNC patients, 12 and can lead to several medical complications, 10,13,14 psychosocial distress, 15,16 and reduced quality of life (QOL) 17 .…”