Patient-reported versus physiologic swallowing outcomes in patients with head and neck cancer after chemoradiation
Patient-reported versus physiologic swallowing outcomes in patients with head and neck cancer after chemoradiation
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DOI：
10.1002/lary.27610
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发表时间：
2019-09-01
期刊：
影响因子：
2.6
通讯作者：
Goldsmith, Tessa
中科院分区：
文献类型：
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作者：
Kirsh, Elliana;Naunheim, Matthew;Goldsmith, Tessa
目的 该项目的主要目的是回顾性研究头颈癌 (HNC) 放化疗后患者报告的吞咽测量与生理吞咽测量之间的关系。方法对因 HNC 接受放化疗并进行电视荧光镜吞咽研究的成年患者进行回顾性分析。接受手术治疗的患者被排除在外。在获得吞咽功能生理测量的同一天，通过 MD 安德森吞咽困难量表 (MDADI) 评估患者对吞咽相关结果的感知。使用视频荧光镜数据，吞咽毒性动态成像等级 (DIGEST) 量表得出了安全性（DIGEST-S：穿透/吸入）和效率（DIGEST-E：残留）的测量值。对相关系数进行统计分析。结果 30例患者符合纳入标准。口咽部是最常受影响的部位（70.0%），其次是喉部（16.7%）。中位辐射剂量为 72 戈瑞 (Gy)，参与者在治疗完成后平均 4.6 年（范围 0-12）接受评估。 MDADI 与 DIGEST-E 评分（Pearson rho = -0.045，P = 0.812）、DIGEST-S 评分（Pearson rho = 0.075，P = 0.695）或摘要 DIGEST 评分（Pearson rho = 0.046，P = 0.810）之间不存在相关性。 MDADI 评分并没有随着辐射后时间的增加而发生显着变化（P = 0.375），而 DIGEST-E 评分、DIGEST-S 评分和摘要 DIGEST 评分则随着时间的推移而恶化（分别为 P = 0.007、P = 0.002 和 P = 0.0005）。结论 吞咽生理学评估显示放化疗后吞咽功能恶化，但这与患者报告的生活质量指标无关。放化疗完成数年后，患者对吞咽功能障碍的认识降低，这对于面对生理衰退时吞咽困难的治疗具有重要意义。证据水平 4 喉镜，129：2059-2064，2019
Objective The primary objective of this project was to retrospectively investigate the relationship between patient-reported and physiologic swallowing measures after chemoradiation therapy for head neck cancer (HNC). Methods Adult patients who underwent chemoradiation therapy for HNC and presented for videofluoroscopic swallow study were reviewed retrospectively. Surgically treated patients were excluded. Patient perception of swallowing-related outcomes was assessed via the MD Anderson Dysphagia Inventory (MDADI) on the same day that physiologic measures of swallow function were obtained. Using vidoefluoroscopic data, the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale yielded measures of safety (DIGEST-S: penetration/aspiration) and efficiency (DIGEST-E: residue). Statistical analysis for correlation coefficients was performed. Results Thirty patients met the inclusion criteria. The oropharynx was the most commonly affected site (70.0%), followed by the larynx (16.7%). The median radiation dose was 72 grays (Gy), and participants were assessed a mean of 4.6 (range 0-12) years following completion of treatment. There was no correlation between the MDADI and the DIGEST-E score (Pearson rho = -0.045, P = 0.812), DIGEST-S score (Pearson rho = 0.075, P = 0.695), or summary DIGEST grade (Pearson rho = 0.046, P = 0.810). MDADI scores did not change significantly with increasing time since radiation (P = 0.375), whereas the DIGEST-E scores, DIGEST-S score, and summary DIGEST grades worsened over time (P = 0.007, P = 0.002, and P = 0.0005, respectively). Conclusion Assessment of swallowing physiology showed that function worsened after chemoradiation therapy, but this did not correlate with patient-reported quality-of-life measures. Reduced patient awareness of swallow dysfunction years after completion of chemoradiation has implications for management of dysphagia in the face of physiologic decline. Level of Evidence 4 Laryngoscope, 129:2059-2064, 2019