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Head & neck
11, 2019;41 (11): 3880-3894.

Swallowing-related outcomes associated with late lower cranial neuropathy in long-term oropharyngeal cancer survivors: cross-sectional survey analysis.

Puja Aggarwal, Jhankruti S Zaveri, Ryan P Goepfert, Qiuling Shi, Xianglin L Du, Michael Swartz, Stephen Y Lai, C David Fuller, Jan S Lewin, Linda B Piller, Katherine A Hutcheson
Author Information
  1. Puja Aggarwal: Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas. ORCID
  2. Jhankruti S Zaveri: Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
  3. Ryan P Goepfert: Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas. ORCID
  4. Qiuling Shi: Department of Symptom Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
  5. Xianglin L Du: University of Texas School of Public Health, Houston, Texas.
  6. Michael Swartz: University of Texas School of Public Health, Houston, Texas.
  7. Stephen Y Lai: Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
  8. C David Fuller: Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas. ORCID
  9. Jan S Lewin: Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
  10. Linda B Piller: University of Texas School of Public Health, Houston, Texas.
  11. Katherine A Hutcheson: Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas. ORCID
PMID: 31441572 DOI: 10.1002/hed.25923

Abstract

BACKGROUND: The purpose of this study was to quantify the association of late lower cranial neuropathy (late LCNP) with swallowing-related quality of life (QOL) and functional status among long-term oropharyngeal cancer (OPC) survivors.
METHODS: Eight hundred eighty-nine OPC survivors (median survival time: 7 years) who received primary treatment at a single institution between January 2000 and December 2013 completed a cross-sectional survey (56% response rate) that included the MD Anderson Dysphagia Inventory (MDADI) and self-report of functional status. Late LCNP events ≥3 months after cancer therapy were abstracted from medical records. Multivariate models regressed MDADI scores on late LCNP status adjusting for clinical covariates.
RESULTS: Overall, 4.0% (n = 36) of respondents developed late LCNP with median time to onset of 5.25 years post-treatment. LCNP cases reported significantly worse mean composite MDADI (LCNP: 68.0 vs no LCNP: 80.2; P < .001). Late LCNP independently associated with worse mean composite MDADI (β = -6.7, P = .02; 95% confidence interval [CI], -12.0 to -1.3) as well as all MDADI domains after multivariate adjustment. LCNP cases were more likely to have a feeding tube at time of survey (odds ratio [OR] = 20.5; 95% CI, 8.6-48.9), history of aspiration pneumonia (OR = 23.5; 95% CI, 9.6-57.6), and tracheostomy (OR = 26.9; 95% CI, 6.0-121.7).
CONCLUSIONS: In this large survey study, OPC survivors with late LCNP reported significantly poorer swallowing-related QOL and had significantly higher likelihood of poor functional status. Further efforts are necessary to optimize swallowing outcomes to improve QOL in this subgroup of survivors.

Keywords

dysphagia lower cranial neuropathy oropharyngeal cancer radiotherapy survivorship

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Grants

  1. /Charles and Daneen Stiefel Oropharynx Fund
  2. R01 DE025248/NIDCR NIH HHS
  3. R21 CA226200/NCI NIH HHS
  4. P50CA097007-10/NIH/National Cancer Institute (NCI) Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program Award
  5. R21CA226200-01/NIH/NCI
  6. 1R01CA218148-01/NIH/NCI Early Phase Clinical Trials in Imaging and Image-Guided Interventions Program
  7. R01 CA218148/NCI NIH HHS
  8. K12 CA088084-06/Paul Calabresi Clinical Oncology Program Award
  9. 1R01DE025248-01/R56DE025248-01/National Institutes of Health (NIH)/National Institute for Dental and Craniofacial Research

MeSH Term

Adult
Aged
Aged, 80 and over
Cancer Survivors
Cranial Nerve Diseases
Cross-Sectional Studies
Deglutition Disorders
Female
Humans
Male
Middle Aged
Oropharyngeal Neoplasms
Quality of Life
Risk Factors
Surveys and Questionnaires
Time Factors
Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't
Article has an altmetric score of 1

Word Cloud

Created with Highcharts 10.0.0LCNPlateMDADIstatuscancersurvivorssurvey95%lowercranialneuropathyQOLfunctionaloropharyngealOPC5significantlyCI9studyswallowing-relatedlong-termmediancross-sectionalLatetimecasesreportedworsemeancompositeLCNP:0associated76outcomesBACKGROUND:purposequantifyassociationqualitylifeamongMETHODS:Eighthundredeighty-ninesurvivaltime:7 yearsreceivedprimarytreatmentsingleinstitutionJanuary2000December2013completed56%responserateincludedMDAndersonDysphagiaInventoryself-reportevents≥3monthstherapyabstractedmedicalrecordsMultivariatemodelsregressedscoresadjustingclinicalcovariatesRESULTS:Overall40%n = 36respondentsdevelopedonset25 yearspost-treatment68vs802P <001independentlyβ = -6P = 02confidenceinterval[CI]-12-13welldomainsmultivariateadjustmentlikelyfeedingtubeoddsratio[OR] = 2086-48historyaspirationpneumoniaOR = 236-57tracheostomyOR = 260-121CONCLUSIONS:largepoorerhigherlikelihoodpooreffortsnecessaryoptimizeswallowingimprovesubgroupSwallowing-relatedsurvivors:analysisdysphagiaradiotherapysurvivorship

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