Oral Cancer News

Source: Arch Otolaryngol Head Neck Surg. 2004;130:1100-1103
Authors: Bruce H. Campbell, MD et al.

Objective:
To determine associations between objective assessments (swallowing function and weight change) and subjective quality-of-life (QOL) measures.

Design:
Observational case series using clinical testing and questionnaires.

Setting:
University hospital-based tertiary clinical practice.

Patients:
Convenience sample of 5-year survivors of head and neck cancer (62 nonlaryngectomy survivors were studied).

Interventions:
Objective testing included examination, weight history, videofluoroscopic swallow studies (VFSS), and oropharyngeal swallowing efficiency (OPSE). Subjective testing included QOL questionnaires (University of Washington Quality-of-Life [UWQOL] Scale, Performance Status Scale for Head and Neck Cancer Patients [PSS-HN], Functional Assessment of Cancer Treatment–General [FACT-G] Scales, and Functional Assessment of Cancer Therapy–Head and Neck [FACT-H&N] Scale).

Main Outcome Measures:
Aspiration (identified by VFSS), weight change, and QOL measures.

Results:
Aspiration was associated with the decreased QOL scores in chewing, swallowing, normalcy of diet, and additional concerns of the FACT-H&N Scale. No association was found between aspiration and willingness to eat in public, subjective understandability, or any of the FACT-G scales. Of the nonlaryngectomy survivors, 27 (44%) demonstrated some degree of aspiration during VFSS. Associations were found between aspiration, primary tumor T stage, weight change, and OPSE. Aspirators lost a mean of 10.0 kg from precancer treatment weight, while nonaspirators gained a mean of 2.3 kg (P<.001). Mean OPSE scores were 69 for nonaspirators and 53 for aspirators (P = .01).

Conclusions:
Almost half of long-term nonlaryngectomy head and neck cancer survivors demonstrated at least some degree of aspiration. The presence of aspiration is associated with substantial weight loss, advanced initial tumor stage, diminished oropharyngeal swallowing efficiency, and lower scores on a variety of QOL scales.

Authors:
Bruce H. Campbell, MD; Kristine Spinelli, MD; Anne M. Marbella, MS; Katherine B. Myers, RN, BSN; Joan C. Kuhn, MS, CCC-SLP; Peter M. Layde, MD, MSc

Authors’ affiliations:
From the Departments of Otolaryngology & Communication Sciences (Dr Campbell and Mss Myers and Kuhn), Radiology (Dr Spinelli), and Family & Community Medicine (Ms Marbella and Dr Layde), and the MCW Cancer Center (Dr Layde), Medical College of Wisconsin, Milwaukee. The authors have no relevant financial interest in this article.