Two-Year Prevalence of Dysphagia and Related Outcomes in Head and Neck Cancer Survivors: An Updated SEER-Medicare Analysis

Abstract

Using a national database, we aimed to examine prevalence of dysphagia at the population level in head and neck cancer (HNC) survivors. Surveillance, Epidemiology, and End Results (SEER)-Medicare data were retrospectively analyzed among 16,194 eligible HNC patients treated between 2002 and 2011. Claims were used to estimate prevalence of 3 swallowing-related endpoints within 2 years of treatment: dysphagia, stricture, and aspiration pneumonia and derive treatment- and site-specific estimates. Multiple logistic regression was conducted with stepwise backward selection. Dysphagia, stricture, and aspiration pneumonia were prevalent, occurring among 45.3% (95% CI: 44.5-46.1), 10.2% (95% CI: 9.7-10.7), and 8.7% (95% CI: 8.2-9.1) of all patients, respectively. Prevalence of aspiration pneumonia and stricture remained stable over the decade, but dysphagia increased by 11.7%. Prevalence of all swallowing-related endpoints was highest among those treated with chemoradiation. Relative to single modality surgery, single modality radiation was associated with 2.1 (95% CI: 1.8-2.4), 1.3 (95% CI: 0.97-1.6), and 1.4 (95% CI: 1.1-1.8) greater odds of dysphagia, stricture, and aspiration pneumonia respectively. Relative to single modality RT, multimodality surgery+RT or CRT was associated with 1.5 (95% CI: 1.3-1.7), 1.7 (95% CI: 1.4-2.1), and 1.2 (95% CI: 0.95-1.5) or 2.9 (95% CI: 2.5-3.3), 2.3 (95% CI: 1.9-2.8), and 1.6 (95% CI: 1.3-2.0) greater odds of dysphagia, stricture, and aspiration pneumonia, respectively. Relative to multimodality surgery+RT, CRT was associated with 1.9 (95% CI: 1.7-2.2), 1.3 (95% CI: 1.1-1.5), and 1.3 (95% CI: 1.1-1.6) greater odds of dysphagia, stricture, and aspiration pneumonia respectively. Prevalence of dysphagia, stricture, and aspiration pneumonia were similar in the decade studied (2002 to 2011) when comparing to published rates using similar methodology in an earlier decade (1992-1999), suggesting persistence of this morbidity in the decade in which IMRT was popularized.