Clinico-demographic Risk Factors of Patient-Reported Dysphagia Among Long-term Oropharyngeal Cancer Survivors

Presentation: A109
Topic: Oropharynx / HPV Related Disease
Type: Poster
Authors: Camille R Charles, OMSII, BS1; Puja Aggarwal, PhD, BDS, MPH1; Adam S Garden, MD2; Frank E Mott, MD, FACP3; Charles Lu, MD, SM3; Ryan P Goepfert, MD4; Mayur Patel, BSA, MS, IV5; Clifton D Fuller, MD, PhD2; Stephen Y Lai, MD, PhD4; G. Brandon Gunn, MD2; Mark S Chambers, DMD, MS4; Erich M Sturgis, MD, MPH6; Ehab Y Hanna, MD4; Sanjay Shete, PhD1,7,8; Katherine A Hutcheson, PhD2,4
Institution(s): 1Department of Epidemiology, The University of Texas MD Anderson Cancer Center; 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center; 3Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center; 4Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center; 5The University of Texas Health Science Center at Houston, McGovern Medical School; 6Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine; 7Department of Biostatistics, The University of Texas MD Anderson Cancer Center; 8Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center

Dysphagia, or difficulty swallowing, is a commonly reported side effect of oropharyngeal cancer (OPC) after surgery, radiation therapy (RT) or chemoradiotherapy and can contribute to poor health and quality of life. Morbidities of dysphagia include dehydration, malnutrition, and depression among others. The aim of this study was to investigate the association of clinical and demographic risk factors with moderate to severe patient-reported dysphagia symptoms in long-term survivors.

Methods: A cross-sectional survey included OPC survivors treated at MD Anderson between January 2000 to December 2013. Dysphagia was rated using the MD Anderson Symptom Inventory Head and Neck Cancer Module (MDASI-HN). Single item MDASI-HN dysphagia symptoms were defined as none to mild (score:0-5) versus moderate to severe (score:6-10). Descriptive statistics were conducted, and multivariable logistic regression analysis was used to identify risk factors associated with moderate to severe dysphagia.

Results: A total of 880 responded to the MDASI-HN difficulty swallowing symptom question, of which and 153 (17.4%) reported moderate to severe dysphagia and 727 (82.6%) reported none to mild dysphagia. The median age at diagnosis of survey respondents was 56 (range: 32-84) years and median survival from time of diagnosis was 6 (range:1-16) years. In multivariable analyses, patients with advanced T4 staging (OR, 2.21; 95% CI, 1.08-4.56; p=0.031), those treated with multimodality treatment (OR, 1.82; 95% CI, 1.02-3.26; p=0.043), those with late lower cranial neuropathy (LCNP) (OR, 3.56; 95% CI, 1.59-7.97; p=0.002) and patients that were current smokers at the time of survey (OR, 2.77; 95% CI, 1.20-6.42; p=0.017) had significantly higher odds of moderate to severe dysphagia. Additionally, patients with greater than high school education (OR, 0.60; 95% CI, 0.38-0.97; p=0.037), those with N2b and N3 tumors (OR, 0.45; 95% CI, 0.22-0.94; p=0.033), and those who underwent bilateral intensity-modulated radiation therapy (IMRT) (bilateral IMRT OR, 0.23; 95% CI, 0.10-0.54; p=0.001, and unilateral IMRT OR, 0.13; 95% CI, 0.04-0.43; p=0.001) had lower odds of moderate to severe dysphagia.

Conclusion: This large survey study identified 1 of 6 OPC survivors who reported moderate to severe dysphagia on long-term follow-up. Several key factors associated with dysphagia were identified. These results reflect survivor groups who may require additional swallowing support and continue to emphasize the need for prolonged surveillance for and supportive treatment of dysphagia years after oncologic cure.