OP072: Analysis of swallowing pattern via modified barium swallow (MBS) test following treatment of head and neck cacner

Abstract

Purpose A wider range of treatment options for head and neck cancer (HNC) have increased adverse effects such as dysphagia. Long-term use of PEG for nutrition is reported as many as 30% of HNC patients. The purposes of our study were to evaluate patterns of dysphagia and to identify the factors affecting dysphagia in HNC patients. Material and methods A retrospective analysis was performed of 57 patients with various HNCs who underwent treatment since 2008. Patients who complained any dysphagia symptoms were evaluated via MBS test. 36 patients had DARS (dysphagia-aspiration related structures) primaries. About 70% of the patients had higher clinical stage diseases. Various treatment modalities were used and radiotherapy was performed in 71.9% of the patients. Results 20 patients were dependant on tube feeding at the initial visit. The characteristics of tube feeders were older age, DARS primaries, higher stage disease and underwent radiotherapy more frequently than the normal diet group. MBS findings of tube feeders were reduced BOT retraction, delayed laryngeal elevation, abnormal CP opening, aspiration and residue. However, only in 13 patients were at grade 7 swallowing performance scale (SPS) and needed tube feeding. The seven patients who did not know that they could eat by orally before having the test were able to eat orally with the help of diet modification and management. Higher aspiration rate and higher SPS were found in old age group significantly even with the same disease or treatment than younger age group. Reduced BOT retraction was relatively higher than other dysphagia findings and BOT retraction was affected by clinical stage and treatment including radiotherapy significantly. Conclusions Swallowing tests such as the MBS test is recommended in especially old HNC patients with an higher stage disease who has undergone radiotherapy to evaluate exact dysphagia patterns for proper rehabilitation, and to avoid unnecessary tube feeding.