OBJECTIVETo determine associations between objective assessments (swallowing function and weight change) and subjective quality-of-life (QOL) measures.DESIGNObservational case series using clinical testing and questionnaires.SETTINGUniversity hospital-based tertiary clinical practice.PATIENTSConvenience sample of 5-year survivors of head and neck cancer (62 nonlaryngectomy survivors were studied).INTERVENTIONSObjective testing included examination, weight history, videofluoroscopic swallow studies (VFSS), and oropharyngeal swallowing efficiency (OPSE). Subjective testing included QOL questionnaires (University of Washington Quality-of-Life [UWQOL] Scale, Performance Status Scale for Head and Neck Cancer Patients [PSS-HN], Functional Assessment of Cancer Treatment-General [FACT-G] Scales, and Functional Assessment of Cancer Therapy-Head and Neck [FACT-H&N] Scale).MAIN OUTCOME MEASURESAspiration (identified by VFSS), weight change, and QOL measures.RESULTSAspiration was associated with the decreased QOL scores in chewing, swallowing, normalcy of diet, and additional concerns of the FACT-H&N Scale. No association was found between aspiration and willingness to eat in public, subjective understandability, or any of the FACT-G scales. Of the nonlaryngectomy survivors, 27 (44%) demonstrated some degree of aspiration during VFSS. Associations were found between aspiration, primary tumor T stage, weight change, and OPSE. Aspirators lost a mean of 10.0 kg from precancer treatment weight, while nonaspirators gained a mean of 2.3 kg (P<.001). Mean OPSE scores were 69 for nonaspirators and 53 for aspirators (P =.01).CONCLUSIONSAlmost half of long-term nonlaryngectomy head and neck cancer survivors demonstrated at least some degree of aspiration. The presence of aspiration is associated with substantial weight loss, advanced initial tumor stage, diminished oropharyngeal swallowing efficiency, and lower scores on a variety of QOL scales.

Schultz, David J MD; Brasel, Karen J MD, MPH; Spinelli, Kristine S MD; Rasmussen, Jason BS; Weigelt, John A MD Author Information

Swallowing is a highly coordinated sequence of physiologic events. Many disease processes affect the patient's ability to have a functional swallow. The traditional videofluoroscopic swallowing study is an effective and established method for evaluating these patients and is the current examination of choice. Videoendoscopic evaluation is a safe and affordable procedure that can be used in an outpatient or office setting. It can also be a complementary technique, allowing direct visualization of pharyngeal structures and aspiration. We discuss the use of both techniques.