Posttherapeutic dysphagia in head and neck cancer patients – role of FEES for assessment in quality of life

Abstract

Head and neck cancer is associated with poor survival rates and significant functional limitations: pain, dysphagia, and dysphonia. These functional deficits are increasingly in focus. Assessment of swallowing function is often based on quality of life (QOL) questionnaires. In this context, the MDADI has been established as a primary endpoint of clinical trials, while the survey of objective findings has been omitted. However, the relationship between subjective QOL and objective functional impairment in head and neck cancer is discussed controversial. In the present study, patient characteristics, subjective QOL (n=384; EQ-5D-5L, MDADI), and fiberendoscopic evaluation of swallowing (FEES) scores (n=46) were compared. No significant correlation was found between QOL and FEES scores (p=0.21; p>0.05). Swallowing-related QOL was significantly decreased in advanced tumors, multimodal therapy, and PEG tube dependence. However, differences failed to reach clear clinical relevance (>10 points difference). Generic QOL was comparable in almost all groups. Additional FEES confirmed the clear association of aspiration/penetration with advanced tumors and PEG tube dependence (p<0.05). Thus, additional FEES provided a better differentiation than QOL questionnaires alone. The present work confirms the limited value of QOL in head and neck tumor patients as well as its reporting. Therefore, the assessment of QOL should always be supported by a FEES in clinical studies as well as in daily clinical practice.