Two-Year Prospective Patient Reported Outcomes Related to Dysphagia After Intensity Modulated Proton Therapy for Oropharyngeal Cancer

Abstract

Characterize longitudinal change in swallowing related quality of life during and after intensity modulated proton therapy (IMPT) for oropharyngeal cancer. The MD Anderson Dysphagia Inventory (MDADI) was administered prospectively at baseline, end of IMPT, and 10 weeks, and 6 , 12, and 24 months after IMPT as part of a prospective proton therapy registry. MDADI 19-item composite and subscale scores were plotted longitudinally. Pairwise tests were Bonferroni corrected for multiple comparisons (P<.003). Sixty-six patients with a mean age of 62 were included. Almost all had stage III/IV disease (96%) and 71% were treated with concurrent chemotherapy. A majority had T1-T2 primary tumors (80%); 84% had p16 positive disease and 41% were never smokers. Mean composite MDADI was 88.2±13.4 at baseline, dropping significantly to a nadir of 59.4±14.2 at end of IMPT (P<.001) with significant partial recovery by 10 weeks post-IMPT to 74.9±14.2 (P<.001) with stable average performance thereafter through 2 years (P>.003 compared to previous time point). Poor MDADI (score<60) were reported in 7%, 61%, 20%, and 13% of patients at baseline, end-IMPT, 10 weeks, and 2 years after IMPT, with 14% of patients showing persistently depressed MDADI Δ>20 at 2 years. Physical subscale performed lower than emotional or functional subscales at all points. Herein, we provide novel, prospective benchmark data suggesting potentially early recovery of perceived swallowing per MDADI after IMPT in OPC survivors. Expected performance patterns lend support to validity of MDADI after proton therapy.