OP074: Swallowing outcomes in lip and oral cavity cancers: The dysphagia outcome and severity scale

Abstract

Functional outcomes following the treatment of lip and oral cavity cancers are important determinants of quality of life. The Dysphagia Outcome and Severity Scale (DOSS) is a validated seven point scale which systematically rates the severity of dysphagia. The scale uses objective findings to develop recommendations regarding the safety of oral intake, dietary restrictions, and the need for cueing of compensatory strategies with swallowing. The scale is based on three primary functions: oral stage bolus transfer, pharyngeal stage transfer, and airway protection. This study reports the results of the DOSS obtained in patients treated for lip and oral cavity cancer. Methods From 2004 to 2010, 504 lip and oral cavity cancers were treated in the Department of otolaryngology. 130 patients with previously untreated cancers and 62 patients with recurrent cancers were evaluated with a video swallow with speech pathologist participation and a DOSS assigned. Results Increasing Tstage was associated with increasing dysfunction documented by the DOSS for previously untreated lip and oral cavity cancers. 51% of previously untreated patients with T1 and T2 lesions were able to meet all nutrition and hydration needs orally. 49% required at least some alteration of the diet. Only a single patient treated for recurrent lip and oral cavity cancer demonstrated safe and efficient swallowing for all consistencies, the ability to eat independently unlimited by swallow function, and effectively use compensatory strategies when needed. The majority of recurrent cancers, 68%, required alternate methods of feeding or supplements. This level of dysfunction was consistent for recurrent T1, T2, T3, and T4 tumors. Conclusions Patients treated for recurrent lip and oral cavity cancer are significantly limited in the ability to maintain oral intake. Among patients with previously untreated lip and oral cancers who underwent a videoswallow with a speech pathologist, a variable outcome is documented with the majority maintaining all nutrition and hydration orally.