Swallowing disorders and mortality in adults with advanced cancer outside the head and neck and upper gastrointestinal tract: a systematic review

Abstract

BackgroundAlthough oncological palliative care is increasingly being offered by multidisciplinary teams, there is still a lack of data about some symptoms handled by these teams, such as dysphagia, in patients with advanced cancer outside swallow regions. This study aimed to estimate the occurrence of dysphagia in prognosis studies of adults with advanced cancer outside the head, neck, and upper gastrointestinal tract, and to determine if there is an association with mortality.MethodsA systematic review of studies that evaluated dysphagia and mortality was conducted (PROSPERO: CRD42021257172).Data sourcesBVS, PubMed, CINAHL, Web of Science, and Scopus. Data between 2011 and 2023 were selected.ResultsAmong the 608 articles screened, only 14 were included, which covered different types of cancer, primarily Lung, and Genitourinary, Skin, Hematological, and Central Nervous System as well. Dysphagia demonstrated a variable frequency, and almost half of the studies found a percentage of dysphagia above 60%, appearing most as a symptom that affects health-related quality of life and prove to be a toxicity of treatment. The association between dysphagia and mortality was only evaluated in three articles that studied advanced lung cancer, in which, after controlling for covariates, swallowing disorders were associated with worse survival, with prevalences of dysphagia and hazard ratios of 78.5% (1.12 [1.04–1.20]), 4% (1.34 [1.28–1.35]), and 3% (1.40 [1.07–1.81]), respectively.ConclusionsThe occurrence of dysphagia in advanced cancer outside the head, neck, and upper GI tract is common, and there seems to be an association with significantly decreased survival in patients with advanced lung cancer.