MD Anderson Dysphagia Inventory Scores Research Articles

What is a clinically relevant difference in MDADI scores between groups of head and neck cancer patients?

To describe clinically relevant between-group differences in MD Anderson Dysphagia Inventory (MDADI) scores among head and neck cancer (HNC) patients. Retrospective cross-sectional study was conducted in 1,136 HNC patients seen for modified barium swallow (MBS) studies. The MDADI was administered by written questionnaire at the MBS appointment. MD Anderson Dysphagia Inventory global, composite, and subscale scores were calculated. Anchor-based methods were employed to determine clinically meaningful between-group differences by feeding tube status, aspiration status (per MBS study), and diet level. Mean MDADI scores for the 1,136 patients were: emotional 65.8 ± 17.3, functional 68.1 ± 19.6, physical 60.1 ± 18.6, global 59.3 ± 28.3, and composite 64.0 ± 17.1. Three hundred seventy-eight patients (33%) were feeding tube-dependent; 395 (34.8%) were aspirators; 122 (11%) were nothing per oral (Performance Status Scale-Head and Neck [PSS-HN] diet = 0); and 249 (22%) ate unrestricted, regular diets (PSS-HN diet = 100). Statistically significant (P < 0.0001) between-group differences (feeding tube vs. no feeding tube, aspirator vs. nonaspirator, oral vs. nonoral diet, PSS-HN diet levels) were observed for all mean MDADI scores (global, composite, and subscales). A mean difference of 10 points in composite MDADI scores differentiated feeding tube-dependent from nontube-dependent patients, aspirators from nonaspirators, and distinct PSS-HN diet levels. We identify that a 10-point between-group difference in composite MDADI scores was associated with clinically meaningful between-group differences in swallowing function. 4. Laryngoscope, 126:1108-1113, 2016.

Swallowing outcome after TORS for sleep apnea: short- and long-term evaluation.

The aim of this study was to evaluate outcomes related to swallowing function in patients who underwent transoral robotic surgery (TORS) for sleep apnea on both short- and long-term scales. 78 patients who underwent TORS for sleep apnea between 2011 and 2014 were followed up for an average period of 20 ± 7.12 months (range 7-32 months), then swallowing outcomes determined by MD Anderson Dysphagia Inventory (MDADI) questionnaire, gastrografin fluoroscopy imaging results, nasogastric tube dependence and subjectively by recording the patients' complaints were analyzed and reported. Minimal insignificant short-term impact on swallowing function (4.58 ± 7.03 preoperative MDADI score versus 5.18 ± 8.32 post-operative) (p = 0.56) was registered. Mean time for start of oral feeding was 1.05 ± 0.25 days (average, 1-3). In no case nasogastric tube feeding was required. Only five patients (6 %) showed significant aspiration on gastrografin fluoroscopy examination after 1 week; there was no significant correlation between the volume of tissue removed from both tongue base and epiglottis to the incidence of aspiration as shown by gastrografin fluoroscopy examination (p = 0.72). No long-term swallowing complaint was registered. Patients who underwent TORS tongue base reduction and supraglottoplasty for sleep apnea proved to have a reasonable short-term swallowing outcomes with no long-term sequelae.

Impact of early dysphagia intervention on swallowing function and quality of life in head and neck cancer patients treated with intensity-modulated radiation therapy or image guided radiation therapy with or without surgery/chemotherapy

Introduction: Dysphagia is a very common problem associated with head and neck cancer patients. Inspite of best of technologies like Intensity Modulated Radiotherapy (IMRT) or Image Guided Radiotherapy (IGRT), Dysphagia remains a major problem in locally advanced head and neck cancer patients. Materials and Methods: We randomized 50 head and neck cancer patients, including all sites and stages into two groups, 25 patients in each group. In Group-A dysphagia prevention exercises were done from the day of the onset of radiation therapy and continued till 6 months, while in Group-B no dysphagia interventions were given. We analyzed rate of dysphagia, aspiration rate and its impact on quality of life. We used M.D. Anderson Dysphagia Inventory (MDADI) which is a validated and reliable questionnaire designed specifically for evaluating impact of dysphagia on quality of life (QOL) in head and neck cancer patients. American Speech language Hearing Association (ASHA) scale was used for assessing swallowing function. Penetration Aspiration Scale (PAS) was used to assess aspiration during swallowing with the help of Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Results: Quality of life was significantly better in dysphagia preventive exercise arm (group - A). There was significant improvement in the MDADI score, from the baseline to 6 months in exercise arm (14 versus 7.76, p= 0.017). Swallowing function score was also in favour of exercise arm (6.44 versus 5.8, p=0.002). Patients in exercise arm were able to swallow much better by the end of 6 months post radiotherapy. Risk of silent aspiration as evaluated by PAS score at the end of three months was 36% (Group A = 16%, Group B = 20%). At the end of six months, it improved to 24% (Group A = 8%, Group B = 16%). There was a trend towards lesser incidence of aspiration in exercise arm, although it was not statistically significant (p=0.21). Conclusion: Results from this study demonstrated that swallowing exercises, if administered from first week of chemo-radiation and continued till 6 months, results in significant improvement in swallowing function and quality of life. Use of FEES helps in detection of silent aspiration at an early stage and reduces aspiration related morbidities.

Respiratory-Swallow Training in Patients With Head and Neck Cancer

ObjectiveTo test a novel intervention to train swallowing to occur in the midexpiratory to low expiratory phase of quiet breathing to improve swallowing safety and efficiency. DesignSafety and efficacy nonrandomized controlled trial with 1-month follow-up. SettingAmbulatory clinics. ParticipantsPatients (N=30) with head and neck cancer (HNC) and chronic dysphagia completed the intervention. Fifteen of these patients participated in a 1-month follow-up visit. InterventionsTraining protocol based on hierarchy of motor skill acquisition to encourage autonomous and optimal respiratory-swallowing coordination. Visual feedback of respiratory phase and volume for swallowing initiation was provided by nasal airflow and rib cage/abdomen signals. Main Outcome MeasuresRespiratory-swallow phase pattern, Modified Barium Swallow Impairment Profile (MBSImP) scores, Penetration-Aspiration Scale (PAS) scores, and MD Anderson Dysphagia Inventory scores. ResultsUsing visual feedback, patients were trained to initiate swallows during the midexpiratory phase of quiet breathing and continue to expire after swallowing. This optimal phase patterning increased significantly after treatment (P<.0001). Changes in respiratory-swallowing coordination were associated with improvements in 3 MBSImP component scores: laryngeal vestibular closure (P=.0004), tongue base retraction (P<.0001), and pharyngeal residue (P=.01). Significant improvements were also seen in PAS scores (P<.0001). Relative to pretreatment values, patients participating in 1-month follow-up had increased optimal phase patterning (P<.0001), improved laryngeal vestibular closure (P=.01), tongue base retraction (P=.003), and pharyngeal residue (P=.006) MBSImP scores and improved PAS scores (P<.0001). ConclusionsImprovements in respiratory-swallowing coordination can be trained using a systematic protocol and respiratory phase-lung volume-related biofeedback in patients with HNC and chronic dysphagia, with favorable effects on airway protection and bolus clearance.

Voice and Swallowing Outcome following Radiotherapy for Head and Neck Squamous Carcinoma of Unknown Primary

Objectives: Patients with head and neck squamous cell carcinoma (HNSCC) of unknown primary present without voice or swallowing symptoms. This study aims to analyze the impact of radiotherapy on the voice and swallowing function in this subgroup of HNSCC patients. Methods: This was an original cross-sectional study. All patients with treated HNSCC of unknown primary identified from the head and neck cancer database in August 2012 in Greater Glasgow and Clyde had their voice assessed using the Voice Symptoms Scale (VoiSS) and their swallowing function assessed using the MD Anderson Dysphagia Inventory (MDADI). Results: Questionnaires were sent to 30 patients. A 67% response rate was obtained. There were 5 females and 15 males with a mean age of 61 years (range, 49-81 years). Six patients had no surgical intervention and oncological treatment alone. All patients were free of disease at the time of the study. The mean VoiSS score was 29.45 (range, 4-62) and mean MDADI score was 63.94 (range, 26-100). One patient did not complete the MDADI form so was excluded from this analysis. There was no statistically significant change in patient voice and swallowing function. There was a trend for improved function with longer duration since treatment. Conclusions: Functional assessment should form an integral part of the assessment of HNSCC patients. This cohort of patients did not have a significant voice and swallowing functional impact secondary to their treatment.

Reconstructive algorithm and classification system for transoral oropharyngeal defects

Transoral techniques for oropharyngeal tumors, such as transoral robotic surgery (TORS) and transoral laser microsurgery, require new reconstructive considerations. Defects from 92 patients undergoing TORS were classified into 4 classes. A reconstruction algorithm was followed. Perioperative outcomes and complications were assessed. Forty-seven patients completed the MD Anderson Dysphagia Inventory (MDADI) swallowing questionnaire and a modified Velopharyngeal Insufficiency Quality of Life (VPIQL) questionnaire postoperatively. The most common reconstructions involved velopharyngoplasties with local flaps (39%), local flaps alone (25%), or secondary healing (20%). More advanced defects (class III and IV defects) required regional and free flaps more often. No significant differences were found in MDADI scores or VPIQL scores among the 4 defect classes. Only adjuvant radiotherapy was a predictor of poor swallowing (p = .02). The classification system for transoral oropharyngeal defects maps defects into 4 classes and guides the reconstructive thought process.

Transoral Resection Technique and Resected Tissue Volume in Patients with Oropharyngeal Squamous Cell Carcinoma

Objectives: Elucidate the relationship between transoral resection technique and resected tissue volume in patients with early stage oropharyngeal squamous cell cancer (OPSCC) and determine if resection volume affects functional outcome. Methods: Forty-six patients with previously untreated early T-stage OPSCC underwent transoral laser microsurgery (TLMS) and transoral robotic surgery (TORS) between 2008 and 2013 at academic referral center were studied retrospectively. The resected tissue volume, the location of resection, and MD Anderson Dysphagia Inventory (MDADI) were described. Results: Mean resected tissue volume for T1 tumors with TORS was 11.44 cm3 and was 7.90 cm3 with TLMS, ( P = 0.44). Mean resected tissue volume for T2 tumors with TORS was 19.45 cm3 and 10.73 cm3 for TLMS ( P = 0.194). With a median follow-up of 11 months, the average of MDADI score was 77.9 for TORS and 74.2 for TLMS for T1 tumors, ( P = 1) and 67.9 for TORS and 50.1 for TLMS, ( P = 0.052) for T2 tumors. MDADI score for T1 with TLMS and TORS combined was 76.7 and for T2 was 63.45 ( P = 0.0048). Conclusions: TLMS and TORS are minimally invasive surgical approaches used to treat OPSCC. Both techniques employ different resection techniques; TLMS removes smaller, tumor specific volumes while TORS has anatomy-based predefined resection limits. Our study shows that despite these differences in surgical technique, there is no statistical difference in resected tissue volumes and swallowing function for T1 and T2 tumors removed by both techniques. However, functional outcome of both techniques combined for T1 tumors were superior to T2 tumors.

Long‐term functional and survival outcomes after induction chemotherapy and risk‐based definitive therapy for locally advanced squamous cell carcinoma of the head and neck

The purpose of this study was to evaluate long-term outcomes after induction chemotherapy followed by "risk-based" local therapy for locally-advanced squamous cell carcinoma of the head and neck (SCCHN). Forty-seven patients (stage IV; ≥N2b) were enrolled in a phase II trial. Baseline and 24-month functional measures included modified barium swallow (MBS) studies, oropharyngeal swallow efficiency (OPSE), and the MD Anderson Dysphagia Inventory (MDADI). Functional status was assessed at 5 years. Five-year overall survival (OS) was 89% (95% confidence interval [CI], 81% to 99%). A nonsignificant 13% average reduction in swallowing efficiency (OPSE) was observed at 24 months relative to baseline (p = .191). MDADI scores approximated baseline at 24 months. Among 42 long-term survivors (median, 5.9 years), 3 patients (7.1%) had chronic dysphagia. The rate of final gastrostomy dependence was 4.8% (2 of 42). Sequential chemoradiotherapy achieved favorable outcomes among patients with locally advanced SCCHN, mainly of oropharyngeal origin. MBS and MDADI scores found modest swallowing deterioration at 2 years, and chronic aspiration was uncommon in long-term survivors.

Transoral robotic surgery and transoral laser microsurgery for oropharyngeal squamous cell cancer.

The aim of our study was to compare transoral laser microsurgery (TLM) and transoral robotic surgery (TORS) for primary resection of oropharyngeal squamous cell cancer (OPSCC). This was a retrospective chart analysis of 33 patients with OPSCC treated at one academic medical center with either TORS (n=17) or TLM (n=16) between July 2008 and December 2010. Six patients in the TLM group and seven patients in the TORS group had primary cancer of the tonsil; the remaining patients had base of tongue cancer. Two patients in the TORS group had Stage I or II disease; the other 31 patients had Stage III [1/16 (6%) TLM; 5/17 (29%) TORS] or Stage IV cancer [15/16 (94%) TLM; 10/17 (59%) TORS]. The intervention was transoral surgery for OPSCC, and the main outcome measures were perioperative variables and functional outcomes. Mean operative time was 170 versus 115min for TLM and TORS, respectively (p=0.057). One patient, in the TLM group, required a temporary tracheostomy. Perioperative feeding tubes were placed in 6/16 (38%) patients who underwent TLM and in 4/17 (24%) patients who underwent TORS (p=0.465). At a median follow-up of 14.5months, the average MD Anderson Dysphagia Inventory score was 65.2 for TLM and 70.8 for TORS (p=0.431). All TORS procedures were performed with a single oral retractor, while multiple laryngoscopes were required in 9/16 (56%) TLM cases (p=0.0003). The mean number of total specimens were 6.2 for TORS and 13.6 for TLM (p=0.002). These results demonstrate that TLM and TORS have comparable perioperative variables with no significant differences in functional outcomes. For a subset of patients, TORS reduced the spatial complexity of surgery, suggested by the decreased need for multiple laryngoscopes, fewer specimens, and shorter operative times, while larger tumors were more amenable to TLM.

Effects of tumor staging and treatment modality on functional outcome and quality of life after treatment for laryngeal cancer

An earlier stage of primary disease at diagnosis is associated with better survival from laryngeal cancer. It remains unproven whether earlier stage is also associated with improved end-organ function and quality of life after treatment. Questionnaire packs were posted to 250 patients with laryngeal cancer treated between January 2006 and December 2008 within the West of Scotland. Packs contained the Voice Symptom Scale (VoiSS), MD Anderson Dysphagia Inventory (MDADI), and University of Washington Quality of Life Questionnaire (UW-QOL). One hundred forty-seven eligible patients provided data for analysis (59% of original cohort). Patients with an earlier stage of primary disease reported significantly better VoiSS, MDADI, and UW-QOL scores (p < .05). No differences were found between scores of patients with T1 laryngeal disease treated with endoscopic laser resection (ELR) and radiotherapy. An earlier stage at diagnosis is associated with significantly better end-organ function and quality of life after treatment for laryngeal cancer.

Functional Swallowing Outcomes Following Transoral Robotic Surgery vs Primary Chemoradiotherapy in Patients With Advanced-Stage Oropharynx and Supraglottis Cancers

To evaluate functional swallowing outcomes in patients undergoing transoral robotic surgery vs primary chemoradiotherapy for the management of advanced-stage oropharynx and supraglottis cancers. Prospective nonrandomized clinical trial. Academic research. We studied 40 patients with stage III or stage IVA oropharynx and supraglottis squamous cell carcinoma. Group 1 comprised 20 patients who received transoral robotic surgery with adjuvant therapy, while group 2 comprised 20 patients whose disease was managed by primary chemoradiotherapy. Patients completed the M. D. Anderson Dysphagia Inventory (MDADI) before treatment and then at follow-up visits at 3, 6, and 12 months. The MDADI scores were analyzed and compared. The median follow-up period for both groups was 14 months (range, 12-16 months). When comparing the median MDADI scores between group 1 and group 2, we found no statistically significant differences before treatment or at the 3-month follow-up visit. However, this difference was significant at the posttreatment visits at 6 months (P = .004) and 12 months (P = .006), where group 1 had better swallowing MDADI scores. We also found significant differences in swallowing MDADI scores between the groups at the 6-month posttreatment visit for patients with T1, T2, and T3 disease and at the 12-month follow-up visit for patients with T2 and T3 disease, where group 1 had significantly better MDADI scores. Comparing tumor subsites, group 1 fared significantly better at the follow-up visits at 6 months (P = .02) and 12 months (P = .04) for patients with primary tumor at the tonsil. Compared with group 2, group 1 patients having base of tongue cancers exhibited significantly better swallowing MDADI scores at the 6-month follow-up visit (P = .02), and group 1 patients having lateral oropharynx disease had significantly better swallowing MDADI scores at the 12-month follow-up visit (P = .04). Advanced-stage oropharynx and supraglottis cancers managed by transoral robotic surgery with adjuvant therapy resulted in significantly better swallowing MDADI outcomes at the follow-up visits at 6 and 12 months compared with tumors treated by primary chemoradiotherapy.

Evaluation of the limitations of using the University of Washington Quality of Life swallowing domain alone to screen patients in the routine clinical setting

A broad patient-completed screening tool in routine clinical practice in head and neck oncology has merit, but clinicians should be aware that its simplicity could lead to some patients and the detail of their problems being missed. The purpose of this study was to compare the University of Washington Quality of Life (UWQoL) swallowing domain with the MD Anderson Dysphagia Inventory (MDADI) in relation to the need for interventions for swallowing around one year after treatment. The group comprised 112 consecutively referred patients to speech and language therapy between January 2007 and August 2009 after primary operation for previously untreated oral and oropharyngeal squamous cell carcinoma (SCC). A total of 78 patients completed questionnaires (median time of assessment 11.7 months, IQR 6.1–12.2). There were significant (p<0.001) and moderately strong correlations (rs=0.51–0.62) between the UWQoL swallowing domain score and MDADI subscales and total scores, and also with individual MDADI questions: taking a great deal of effort (rs=0.71); being upset (rs=0.61); and not going out (rs=0.62) were the strongest in regard to swallowing. Use of a gastrostomy tube was associated with worse UWQoL and MDADI scores. In conclusion, patients who score 100 on the UWQoL do not require swallowing to be evaluated further. Those who score 70 could benefit from the detailed MDADI to help to clarify the specific problem and the impact it has before being referred to speech and language therapy. Those who score less than 70 should be brought to the attention of speech and language therapists to confirm that appropriate support and intervention are in place.

Long-Term Quality of Life in Young Adults Treated for Oral Cavity Squamous Cell Cancer

We assessed the long-term quality of life (QOL) in patients who survived oral cavity squamous cell cancer when they were young and looked for any clinical factors that might adversely affect function and QOL. We performed a retrospective case series and questionnaire survey in a tertiary care center. The subjects were consecutive patients treated for oral cancers during a 25-year period, when they were 40 years of age or less. The patients completed the University of Washington Quality of Life questionnaire and the M. D. Anderson Dysphagia Inventory (MDADI). We made an overall descriptive report of swallowing and QOL measures in the study population and looked for any clinical factors associated with functional outcomes. Among the 62 patients treated over the course of 25 years, 46 were alive and disease-free. Twenty-six participated. The median follow-up duration was 14.7 years (range, 3 to 27 years). Age at diagnosis and duration of follow-up did not correlate with overall QOL or health-related QOL. Seventy-seven percent rated their overall QOL as outstanding, very good, or good. The key domains affected by cancer were appearance, mood, saliva, and shoulder function. Radiotherapy significantly adversely affected the QOL. The median MDADI scores on all 4 subscales were at least 85%. Higher T-stage and radiotherapy were significantly associated with lower scores on all subscales. The long-term health-related QOL in this cohort was quite good. Radiotherapy and tumor stage correlated with swallowing outcomes, and only radiotherapy seemed to adversely affect the overall QOL.

The relationship between depressive symptoms, quality of life, and swallowing function in head and neck cancer patients 1 year after definitive therapy

To determine the incidence of depression in head and neck cancer (HNCA) patients following definitive treatment and the relationship between depression and head and neck-specific measures of quality of life and function. Prospective cohort analysis. Two hundred forty-six patients were evaluated with the Beck Depression Inventory Fast-Screen (BDI-FS), University of Washington Quality of Life (UW QOL), Voice Handicap Index (VHI), and MD Anderson Dysphagia Inventory (MDADI) questionnaires. Patients with a preexisting diagnosis of depression were excluded. Complete 1-year post-treatment data were available for 46 HNCA patients, with depression identified in nine patients (20%). On multivariate analysis, depression was significantly associated with poorer global UW QOL (β = -40.3, P < .001) and overall MDADI scores (β = -21.8, P = .038), but not with VHI scores, after controlling for other clinical variables including initial treatment modality. BDI-FS scores were significantly correlated with global UW QOL (r = -0.7, P < .001) and overall MDADI scores (r = -0.5, P = .0045), and global UW QOL correlated significantly with overall MDADI scores (r = 0.4, P = .0166). After controlling for clinical variables, MDADI, and VHI scores, only depression was associated with global UW QOL score (β = -30.5, P = .019). There is a high incidence of depressive symptoms in HNCA patients at 1 year following definitive therapy, which is independent of primary treatment modality and is associated with poorer global QOL and MDADI scores. Although depression and swallowing function are highly correlated, depression has a greater effect on QOL than swallowing scores, suggesting that early identification and aggressive treatment of patients with depressive symptoms is warranted to maximize post-treatment QOL.

The impact of enteral feeding route on patient-reported long term swallowing outcome after chemoradiation for head and neck cancer

Prospective evidence suggests that the selection of feeding tube during chemoradiation (CRT) indirectly affects swallowing outcome. This study explores the patients' perspective on long-term swallowing ability comparing these two feeding routes. Two groups, receiving nutritional supplementation via a prophylactic gastrostomy tube (group G) and by the oral route or via a nasogastric tube (group NG) during CRT, disease-free at ≥24 months following treatment were matched for age, site and stage of tumour. Patient-reported swallowing outcomes for both groups were assessed using the MD Anderson Dysphagia Inventory (MDADI). Group G consisted of 16 patients and group NG of 15 patients. There was statistically significant difference in MDADI scores between the two groups in all domains of the questionnaire (p<0.001), with superior outcomes in group NG. Use of gastrostomy tubes during CRT conferred a worse swallowing outcome in the long term in this tightly matched cohort of patients.

The relationship between depressive symptoms and initial quality of life and function in head and neck cancer

To determine the incidence of depression in head and neck cancer (HNCA) patients and the effect of depression on baseline head- and neck-specific measures of quality of life and function. Prospective cohort analysis. A total of 255 patients were prospectively evaluated using the Beck Depression Inventory Fast-Screen (BDI-FS) survey, University of Washington Quality of Life (UW QOL), Voice Handicap Index (VHI), and MD Anderson Dysphagia Inventory (MDADI) questionnaires. Patients with a preexisting diagnosis of depression were excluded. Complete data were available for 77 patients with HNCA and 53 controls. Depressive symptoms were identified in 9% of controls and 19% of HNCA patients, and were significantly associated with a HNCA diagnosis (OR = 4.1, P = .044). Among patients with HNCA, depression was significantly more common in black patients (OR = 15.8, P = .017). A significant negative correlation was found between BDI-FS score and UW global QOL score (r = -0.4, P = .0019). Depression was significantly associated with poorer UW global QOL (β = -22.46, P = .0004), recreation (β = -13.77, P = .037), speech (β = -24.05, P = .004), and MDADI functional (β = -17.31, P = .009), physical (β = -14.99, P = .032), and emotional (β = -11.60, P = .049) domain scores but not with other UW QOL or VHI domains, after controlling for all other variables. Patients with HNCA have a high incidence of depressive symptoms at diagnosis, which is significantly higher in black patients, and is associated with poorer QOL and MDADI scores. Pretreatment depression may serve as a marker for patients with increased risk of swallowing impairment and reduced QOL who would benefit from targeted intervention.

Efficacy survey of swallowing function and quality of life in response to therapeutic intervention following rehabilitation treatment in dysphagic tongue cancer patients

PurposeThis quasi-experimental parallel cluster study was carried out to investigate the utility of interdisciplinary swallowing therapy exercises in improving swallowing function and quality of life (QOL) in dysphagic cancer patients following tongue resection and subsequent rehabilitation treatment. MethodsAll subjects in the experimental group underwent a structured swallowing training program. The subjects in the experimental group (n = 23) received 30 min of swallowing training each day, 6 days per week for 2 weeks. The control group (n = 23) received no training. Analysis of variance was used, and the M.D. Anderson Dysphagia Inventory (MDADI) discriminated between groups of subjects. ResultsPatients who underwent structured swallowing training (n = 23) showed improvement in the overall MDADI score (P < 0.01) compared with the control population. Furthermore, a separate analysis of individual domains of the MDADI (global, emotional, functional, and physical) demonstrated improved QOL. Although the mean score for tongue rehabilitation indicated that ≥50% subjects in the functional subscale were improved compared with the control population, the difference was not statistically significant (P > 0.05). ConclusionsThis study used objectively timed swallowing tests, an interdisciplinary swallowing therapy protocol, and a swallowing questionnaire to evaluate the effects of swallowing training. We found that implementation of swallowing education and exercises improved dysphagia and QOL in cancer patients following tongue resection and rehabilitation. Furthermore, this study indicated that swallowing safety and dysphagia training for nursing professionals is effective.

Voice, swallowing, and quality of life after total laryngectomy—Results of the west of Scotland laryngectomy audit

The purpose of this study was to determine the effects of radiotherapy and surgical voice restoration on functional outcome after total laryngectomy. Questionnaire packs were posted to all 258 laryngectomy patients in the West of Scotland Managed Clinical Network. Packs contained the Voice Symptom Scale (VoiSS), MD Anderson Dysphagia Inventory (MDADI), and University of Washington Quality of Life Questionnaire (UW-QOL). Significantly better VoiSS and MDADI scores were reported by patients undergoing laryngectomy alone in comparison with patients receiving adjuvant radiotherapy and patients undergoing salvage laryngectomy (p < .02). Patients using tracheoesophageal voice reported significantly better VoiSS scores than patients using other communication methods (p < .005). Radiotherapy has a highly significant and detrimental effect on voice and swallowing outcome after total laryngectomy. Surgical voice restoration confers significant benefit in terms of self-reported voice outcome. These findings have implications for patients with advanced laryngeal cancer considering laryngectomy and organ preservation.

Dosimetric Predictors of Long-term Dysphagia Following Oropharyngeal IMRT

Recent studies have focused on identification of vulnerable bystander anatomy associated with acute dysphagia following head and neck intensity modulated radiotherapy (IMRT). No data are currently available for chronic swallowing outcomes (≥6 months post-treatment). We investigated the impact of specific regional doses delivered by IMRT on long-term swallowing function in oropharyngeal cancer patients prospectively evaluated with serial modified barium swallow (MBS) studies and the M.D. Anderson Dysphagia Inventory (MDADI) up to two years. Forty-eight patients with stage IV head and neck squamous cell carcinoma were enrolled on an institutional trial examining induction chemotherapy followed by IMRT +/− chemotherapy. We studied a subgroup of 31 oropharyngeal cancer patients who were evaluated with MBS and MDADI at baseline, 6, 12, and 24 months after radiation. Oropharyngeal swallow efficiency (OPSE) was defined as the ratio of the percent swallowed into the esophagus divided by oropharyngeal transit time. Potential dysphagia-associated structures, including oral cavity, pharyngeal constrictors, larynx, tongue base, and salivary glands were retrospectively contoured. These structures were not assigned specific cost functions for IMRT planning. Twenty-one (68%) patients had disease of the base of tongue, and 10 (32%) had tonsillar disease. T stage distribution was T1 (12), T2 (10), T3 (4), T4 (2), and TX (3); N stage distribution was N2 (24), N3 (5), and NX (2). Median age was 52.8 years (range: 42-78). Thirteen patients (42%) received concurrent chemotherapy during radiation. Long-term OPSE was most closely associated with oral cavity dose (V30Gy, V50Gy) and baseline OPSE scores (p < 0.001) using a random-effects linear regression model to evaluate changes in OPSE at 6-, 12-, and 24-months from scores obtained at baseline. Mean doses to pharyngeal constrictors, tongue base, and larynx were also associated with worse long-term OSPE (p < 0.04). Patients with base of tongue cancer had better OPSE than patients with tonsillar cancer (p = 0.01). Mean MDADI scores were lower than baseline at 6 months post-IMRT, but improved by 12 months (p = 0.04). Only mean doses to the ipsilateral parotid were significantly associated with MDADI scores (p = 0.04). No patient demonstrated aspiration per MBS study at 24 months. This is the first investigation to associate long-term swallowing outcomes with detailed doses to normal anatomy in patients with oropharyngeal cancer treated with IMRT. Although pharyngeal and laryngeal doses were important, oral cavity doses were most closely associated with long-term dysphagia in this cohort. The relationship between perceptual and instrumental measures of dysphagia in patients treated with different cancer regimens needs to be clarified.

Pretreatment, Preoperative Swallowing Exercises May Improve Dysphagia Quality of Life

Dysphagia is commonly associated with head and neck cancer treatment. Traditional dysphagia management strategies focus on post-treatment therapy. This study evaluated the utility of pretreatment swallowing exercises in improving post-treatment swallowing quality of life (QOL). Prospective cohort study and cross-sectional QOL analysis. This study includes 37 patients who underwent primary radiation or combined chemoradiation treatment for newly diagnosed hypopharyngeal, laryngeal, or oropharyngeal primary tumors at the University of Alabama at Birmingham. Of the 37, 25 patients underwent swallowing exercises beginning 2 weeks prior to the start of radiation. The M.D. Anderson Dysphagia Inventory (MDADI) was administered an average of 14 months after treatment to assess the success of the protocol. Analysis of QOL scores related to gender, primary site, stage, and race were obtained. Patients who performed pretreatment swallowing exercises (n = 25) showed improvement in the overall MDADI score (P = .0002) compared to the control population (n = 12) who underwent post-treatment therapy. Furthermore, a separate analysis of individual domains of the MDADI (global, emotional, functional, and physical) demonstrated improved quality of life. Implementation of pretreatment swallowing education and exercise may improve dysphagia-specific QOL in head and neck cancer patients undergoing radiation and/or chemoradiation therapy.