Mastication, swallowing, and salivary flow in patients with head and neck cancer: objective tests versus patient-reported outcomes

Jorine A Vermaire,Caroline M Speksnijder,Cornelis P J Raaijmakers,C René Leemans,Chris H J Terhaard,Irma M Verdonck-De Leeuw,Femke Jansen

doi:10.1007/s00520-021-06368-6

Abstract

PurposeBefore and after treatment for head and neck cancer (HNC), many patients have problems with mastication, swallowing, and salivary flow. The aim of this study was to investigate the association between objective test outcomes of mastication, swallowing, and salivary flow versus patient-reported outcomes (PROs) measuring mastication-, swallowing-, and salivary flow–related quality of life.MethodsData of the prospective cohort “Netherlands Quality of Life and Biomedical Cohort Study” was used as collected before treatment, and 3 and 6 months after treatment. Spearman’s rho was used to test the association between objective test outcomes of the mixing ability test (MAT) for masticatory performance, the water-swallowing test (WST) for swallowing performance, and the salivary flow test versus PROs (subscales of the EORTC QLQ-H&N35, Swallow Quality of Life questionnaire (SWAL-QoL-NL) and Groningen Radiation-Induced Xerostomia (GRIX)).ResultsData of 142 patients were used, and in total, 285 measurements were performed. No significant correlations were found between the MAT or WST and subscales of the EORTC QLQ-H&N35. Significant but weak correlations were found between the MAT or WST and 4 subscales of the SWAL-QoL-NL. Weak to moderate correlations were found between the salivary flow test and GRIX at 3 and 6 months after treatment, with the highest correlation between salivary flow and xerostomia during the day (Spearman’s rho = − 0.441, p = 0.001).ConclusionThe association between objective test outcomes and PROs is weak, indicating that these outcome measures provide different information about masticatory performance, swallowing, and salivary flow in patients with HNC.

Highlights

Head and neck cancer (HNC) is the seventh most common cancer worldwide, most often caused by alcohol and tobacco use, or the human papilloma virus (HPV) [1]
The study population consisted of patients with data on mixing ability test (MAT), water-swallowing test (WST), and salivary flow test
The study cohort consisted of 142 patients out of the total Net-Qubic cohort in the UMCU (N = 154), of which 64 patients had repeated measurements for the MAT and WST at M0, M3, and M6

Summary

Introduction

Head and neck cancer (HNC) is the seventh most common cancer worldwide, most often caused by alcohol and tobacco use, or the human papilloma virus (HPV) [1]. Treatment options for HNC (e.g., oral, pharyngeal, or laryngeal cancer) include surgery, radiation therapy (RT), and chemoradiation therapy (CRT). Patients may suffer from tissue fibrosis, osteoradionecrosis, xerostomia, or dysphagia. Deterioration in oral functioning (such as mastication, swallowing, saliva production, taste, dental condition, and speech) can result in complications such as malnutrition, dehydration, aspiration, and subsequent pneumonia. Within the first year after radiotherapy, approximately half of the HNC survivors experience difficulties with oral functioning, and unmet survivorship needs are common [2].

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