Contribution of long-term dysphagia monitoring to first line treatment of head and neck cancer patients

Authors

  • Marie Noëlle Falewee Department of Nutrition, Centre Antoine Lacassagne, Nice, France
  • Christophe Hebert Department of Nutrition, Centre Antoine Lacassagne, Nice, France
  • Karen Benezery Department of Radiation Therapy, Centre Antoine Lacassagne, Nice, France
  • Alexandre Bozec Department of ORL Surgery, Centre Antoine Lacassagne, Nice, France
  • Joël Guigay Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
  • Emmanuel Chamorey Department of Statistics, Centre Antoine Lacassagne, Nice, France
  • Cécile Michel Department of Clinical Research and Communication, Centre Antoine Lacassagne, Nice, France

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20184346

Keywords:

Dysphagia, Head-and-neck cancer, Deglutition handicap index, Longitudinal assessment, Deglutition disorders

Abstract

Background: Dysphagia is a serious sequel of head and neck cancer (HNC) and its treatment. This dysfunction is frequent and likely underreported by clinical exam. It seems necessary to assess its global burden during the pre, per and post treatment periods (up to 18 months), regardless of the treatment received.

Methods: This was a prospective cohort study assessing the rate of dysphagia in first-time treated HNC patients, using the deglutition handicap index questionnaire (DHI) and the clinician reporting. Time to occurrence, severity and length of the dysfunction were recorded. The benefit of an evaluation by the patient himself was investigated.  

Results: Of 134 evaluable patients: 22 were treated by surgery alone (16.4%), 16 by radiotherapy (RT) alone (11.9%), 3 by chemotherapy (CT) alone (2.2%), 28 by RTCT (20.9%), 31 by induction chemotherapy followed by RTCT (23.1%), 11 by surgery+RT (8.2%) and 23 by surgery+RTCT (17.2%). Patients completed 87.9% of the expected DHI. The dysphagia frequency reported was 92.2% by patient-reporting and 80.9% by clinicians-reporting, whatever the intensity. Self-perceived moderate to severe dysphagia was reported in 69.8% of patients.

Conclusions: Given the strong impact of dysphagia on the quality of life and prognosis of HNC patients, it appears essential to perform screening and systematic monitoring. Using a simple and well accepted questionnaire, such as DHI, which is also well correlated with clinical evaluation, we demonstrated a significant frequency of dysphagia. The use of real-time patient-reported outcomes for its early detection would be an asset, particularly during long-term follow-up.

Registered under ClinicalTrials.gov Identifier no. NCT03068559.

References

Nuyts S, Dirix P, Clement PM, Poorten VV, Delaere P, Schoenaers J, et al. Impact of adding concomitant chemotherapy to hyperfractionated accelerated radiotherapy for advanced head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2009;73:1088-95.

Raber-Durlacher JE, Brennan MT, Verdonck-de Leeuw IM, Gibson RJ, Eilers JG, Waltimo T, et al. Swallowing dysfunction in cancer patients. Support Care Cancer. 2012;20:433-43.

Kraaijenga SA, van der Molen L, van den Brekel MW, Hilgers FJ. Current assessment and treatment strategies of dysphagia in head and neck cancer patients: a systematic review of the 2012/13 literature. Curr Opin Support Palliat Care. 2014;8:152-63.

Hutcheson KA and Lewin JS. Functional outcomes after chemoradiotherapy of laryngeal and pharyngeal cancers. Curr Oncol Rep. 2012;14:158-65.

Schindler A, Denaro N, Russi EG, Pizzorni N, Bossi P, Merlotti A, et al. Dysphagia in head and neck cancer patients treated with radiotherapy and systemic therapies: Literature review and consensus. Crit Rev Oncol Hematol. 2015;96:372-84.

Silbergleit AK, Schultz L, Jacobson BH, Beardsley T, Johnson AF. The Dysphagia handicap index: development and validation. Dysphagia. 2012;27:46-52.

Woisard V, Andrieux MP, Puech M. Validation of a self-assessment questionnaire for swallowing disorders (Deglutition Handicap Index). Rev Laryngol Otol Rhinol (Bord). 2006;127(5):315-25.

National Cancer Institute. Fact sheet: NCI CTCAE v4.03, 2009. Available at: https://evs.nci.nih.gov/ ftp1/CTCAE/CTCAE_4.03_2010-06-14_Quick Reference_5x7.pdf. Accessed 14 June 2010.

Langendijk JA, Doornaert P, Rietveld DH, Verdonck-de Leeuw IM, Leemans CR, Slotman BJ. A predictive model for swallowing dysfunction after curative radiotherapy in head and neck cancer. Radiother Oncol. 2009;90:189-95.

O'Neil KH, Purdy M, Falk J, Gallo L. The Dysphagia Outcome and Severity Scale. Dysphagia. 1999;14:139-45.

Deutschmann MW, McDonough A, Dort JC, Dort E, Nakoneshny S, Matthews TW. Fiber-optic endoscopic evaluation of swallowing (FEES): predictor of swallowing-related complications in the head and neck cancer population. Head Neck. 2013;35:974-9

Nguyen NP, Vos P, Moltz CC, Frank C, Millar C, Smith HJ, et al. Analysis of the factors influencing dysphagia severity upon diagnosis of head and neck cancer. Br J Radiol. 2008;81:706-10.

Pauloski BR, Rademaker AW, Logemann JA, Lazarus CL, Newman L, Hamner A, et al. Swallow function and perception of dysphagia in patients with head and neck cancer. Head Neck. 2002;24:555-65.

Basch E, Iasonos A, McDonough T, Barz A, Culkin A, Kris MG, et al. Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for Adverse Events: results of a questionnaire-based study. Lancet Oncol. 2006;7:903-9.

Gluck I, Feng FY, Lyden T, Haxer M, Worden F, Chepeha DB, et al. Evaluating and reporting dysphagia in trials of chemoirradiation for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2010;77:727-33.

Jensen K, Bonde Jensen A, Grau C. The relationship between observer-based toxicity scoring and patient assessed symptom severity after treatment for head and neck cancer. A correlative cross sectional study of the DAHANCA toxicity scoring system and the EORTC quality of life questionnaires. Radiother Oncol. 2006;78:298-305.

Caudell JJ, Schaner PE, Meredith RF, Locher JL, Nabell LM, Carroll WR, et al. Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2009;73:410-5.

Machtay M, Moughan J, Trotti A, Garden AS, Weber RS, Cooper JS, et al. Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol. 2008;26:3582-9.

Russi EG, Corvo R, Merlotti A, Alterio D, Franco P, Pergolizzi S, et al. Swallowing dysfunction in head and neck cancer patients treated by radiotherapy: review and recommendations of the supportive task group of the Italian Association of Radiation Oncology. Cancer Treat Rev. 2012;38:1033-49.

Francis DO, Weymuller EA, Jr., Parvathaneni U, Merati AL, Yueh B. Dysphagia, stricture, and pneumonia in head and neck cancer patients: does treatment modality matter? Ann Otol Rhinol Laryngol. 2010;119:391-7.

Dirix P, Abbeel S, Vanstraelen B, Hermans R, Nuyts S. Dysphagia after chemoradiotherapy for head-and-neck squamous cell carcinoma: dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys. 2009;75:385-92.

Lewin JS. Dysphagia after chemoradiation: prevention and treatment. Int J Radiat Oncol Biol Phys. 2007;69:S86-7.

Schoen PJ, Raghoebar GM, Bouma J, Reintsema H, Burlage FR, Roodenburg JL, et al. Prosthodontic rehabilitation of oral function in head-neck cancer patients with dental implants placed simultaneously during ablative tumour surgery: an assessment of treatment outcomes and quality of life. Int J Oral Maxillofac Surg. 2008;37:8-16.

Zuydam AC, Lowe D, Brown JS, Vaughan ED, Rogers SN. Predictors of speech and swallowing function following primary surgery for oral and oropharyngeal cancer. Clin Otolaryngol. 2005;30:428-37.

Pauloski BR, Rademaker AW, Logemann JA, Stein D, Beery Q, Newman L, et al. Pretreatment swallowing function in patients with head and neck cancer. Head Neck. 2000;22:474-82.

van der Molen L, van Rossum MA, Ackerstaff AH, Smeele LE, Rasch CR, Hilgers FJ. Pretreatment organ function in patients with advanced head and neck cancer: clinical outcome measures and patients' views. BMC Ear Nose Throat Disord. 2009;9:10.

Ellabban MA, Shoaib T, Devine J, McMahon J, Morley S, Adly OA, et al. The functional intraoral Glasgow scale in floor of mouth carcinoma: longitudinal assessment of 62 consecutive patients. Eur Arch Otorhinolaryngol. 2013;270:1055-66.

Rogers SN, Scott J, Chakrabati A, Lowe D. The patients' account of outcome following primary surgery for oral and oropharyngeal cancer using a 'quality of life' questionnaire. Eur J Cancer Care (Engl). 2008;17:182-8.

Cartmill B, Cornwell P, Ward E, Davidson W, Nund R, Bettington C, et al. Emerging understanding of dosimetric factors impacting on dysphagia and nutrition following radiotherapy for oropharyngeal cancer. Head Neck. 2013;35:1211-9.

Roe JW, Carding PN, Dwivedi RC, Kazi RA, Rhys-Evans PH, Harrington KJ, et al. Swallowing outcomes following Intensity Modulated Radiation Therapy (IMRT) for head & neck cancer - a systematic review. Oral Oncol. 2010;46:727-33.

Jiang N, Zhang LJ, Li LY, Zhao Y and Eisele DW. Risk factors for late dysphagia after (chemo) radiotherapy for head and neck cancer: A systematic methodological review. Head Neck. 2016;38:792-800.

Eisbruch A, Lyden T, Bradford CR, Dawson LA, Haxer MJ, Miller AE, et al. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2002;53:23-8.

Rosenthal DI, Lewin JS, Eisbruch A. Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol. 2006;24:2636-43.

Wilson JA, Carding PN, Patterson JM. Dysphagia after nonsurgical head and neck cancer treatment: patients' perspectives. Otolaryngol Head Neck Surg. 2011;145:767-71.

Kreeft AM, van der Molen L, Hilgers FJ, Balm AJ. Speech and swallowing after surgical treatment of advanced oral and oropharyngeal carcinoma: a systematic review of the literature. Eur Arch Otorhinolaryngol. 2009;266:1687-98.

Feng FY, Kim HM, Lyden TH, Haxer MJ, Worden FP, Feng M, et al. Intensity-modulated chemoradiotherapy aiming to reduce dysphagia in patients with oropharyngeal cancer: clinical and functional results. J Clin Oncol. 2010;28:2732-8.

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Published

2018-10-24

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Original Research Articles