Correlation between swallowing-related quality of life and videofluoroscopy after head and neck cancer treatment

Andrade, Margareth Souza; Gonçalves, Aline Nogueira; Guedes, Renata Lígia Vieira; Barcelos, Camila Barbosa; Slobodticov, Luciana Dall’Agnol Siqueira; Lopes, Simone Aparecida Claudino; Francisco, Ana Lúcia Noronha; Angelis, Elisabete Carrara de

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Original Article • CoDAS 29 (1) • 2017 • https://doi.org/10.1590/2317-1782/20172015175 copy

Correlation between swallowing-related quality of life and videofluoroscopy after head and neck cancer treatment

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction

The use of symptom-specific questionnaires on head and neck cancer (HNC), together with objective swallowing measures, can be sensitive to changes in quality of life (QoL) resulting from dysphagia, but this tool is not broadly used as a complement to clinical evaluations.

Purpose

To analyze the correlation between the M. D. Anderson Dysphagia Inventory (MDADI) questionnaire and videofluoroscopy (VF) in patients treated for head and neck cancer.

Methods

This is a retrospective study with review of clinical data, VF and MDADI results. The study sample was composed of adult patients (>18 y.o.) treated for tumors at the oral cavity, oropharynx, hypopharynx, and larynx, regardless of treatment type. For the VF examination, swallowing of 5 and 20 ml of nectar-thick liquids were considered. The Mann-Whitney nonparametric test was applied to evaluate the correlations between the MDADI and VF.

Results

Thirty-nine patients, mostly men (87.18%), with mean age of 61 years participated in the study. Most patients (16) presented oral cavity tumors (41.03%). Twenty-two patients were in advanced clinical stage (IV). Surgery was the most prevalent treatment (41.03%). Approximately half of the participants (20) received oral feeding. The total mean (TM) on the MDADI was 63.36. Comparison between VF and MDADI data showed significant correlation between TM, emotional domain (ED), and physical domain (PD) with penetration during the swallowing of 5 ml. Penetration and aspiration with 20 ml determined worse QoL on the global (p=0.018 and p=0.0053), emotional (p=0.0012 and p=0.027) and physical (p=0.0002 and p=0.0051) domains, and TM (p=0.0023 and p=0.0299), respectively. The presence of stasis did not determine worse QoL.

Conclusion

Patients treated for HNC who presented penetration/aspiration showed worse QoL on the emotional and physical domains of the MDADI.

Keywords
Swallowing; Deglutition Disorders; Questionnaires; Mouth Neoplasms; Quality of Life; Retrospective Studies

Variable	Category	N(%)/measures
Gender	Male Female	34 (87.18) 5 (12.82)
Age	Mean (SD) Median min:max	61 (15) 63 21:91
Primary lesion site	Oral Cavity Oropharynge Hypopharynx Larynge	16 (41.03) 10 (25.64) 5 (12.82) 8 (20.51)
Staging (T)	1 2 3 4	6 (15.38) 13 (33.33) 7 (17.95) 13 (33.33)
Staging (N)	0 1-2 ^* * undetermined	20 (51.28) 17 (43.59) 2 (5.13)
Staging (M)	0 X ^* * undetermined	33 (84.61) 4 (10.26) 2 (5.13)
Clinical stage	I II III IV	5 (12.8) 6 (15.4) 6 (15.4) 22 (56.4)
Treatment	S RT CT S+RT RT+CT S+RT+CT	16 (41.03) 4 (10.26) 2 (5.13) 6 (15.38) 6 (15.38) 5 (12.82)
Neck dissection	No Yes	19 (48.72) 20 (51.28)
Reconstruction	No Myocutaneous Microsurgical	18 (46) 8 (21) 13 (33)
Traqueostomy	No Yes	34 (87.18) 5 (12.82)
Enteral feeding	No Yes	20 (51.28) 19 (48.72)

Domain	Mean ^* * When closer to the maximum value, the worse the quality of life ± SD	Median	Min-max
Overall Question:	53.33 ± 25.68	40	20 -100
Functional domain	68 ± 17.82	72	24-100
Emotional domain	64.47 ± 16.49	66.6	36.7-100
Physical domain	57.77 ± 15.09	57.5	20-97.5
Mean total	63.36 ± 14.70	64.47	35.3-95.3

Domain	Videofluoroscopy		N	Mean (SD)	P ^* * Nonparametric Mann-Whitney test, p <0.05
Domain	5 ml	Category	N	Mean (SD)	P ^* * Nonparametric Mann-Whitney test, p <0.05
Overall	Stasis Penetration Aspiration Silent aspiration	No Yes No Yes No Yes No Yes	4 35 24 15 29 10 30 9	65 (19.1) 52 (26.2) 59.2 (26) 44 (22.9) 55.9 (25.8) 46 (25) 56.7 (25.8) 42.2 (23.3)	0.2791 0.0719 0.2701 0.1232
Functional	Stasis Penetration Aspiration Silent aspiration	No Yes No Yes No Yes No Yes	5 35 24 15 29 10 30 9	70 (16.8) 67.8 (18.1) 71.5 (16.6) 62.4 (18.8) 69.4 (17.6) 64 (18.7) 69.6 (17.4) 62.7 (19.3)	1.0000 0.2405 0.5395 0.3842
Emotional	Stasis Penetration Aspiration Silent aspiration	No Yes No Yes No Yes No Yes	4 35 24 15 29 10 30 9	59.9 (11.2) 65 (17) 69 (16.5) 57.3 (14.2) 66.8 (16.7) 57.6 (14.6) 67.1 (16.5) 55.6 (13.9)	0.4716 0.0426^* * Nonparametric Mann-Whitney test, p <0.05 0.1557 0.0763
Physical	Stasis Penetration Aspiration Silent aspiration	No Yes No Yes No Yes No Yes	4 35 24 15 29 10 30 9	57.8 (9.2) 57.8 (15.7) 62.1 (16.8) 50.8 (8.3) 60.9 (14.7) 48.7 (12.8) 60.9 (14.5) 47.4 (12.9)	0.9079 0.0075^* * Nonparametric Mann-Whitney test, p <0.05 0.0298^* * Nonparametric Mann-Whitney test, p <0.05 0.0171^* * Nonparametric Mann-Whitney test, p <0.05
Mean total	Stasis Penetration Aspiration Silent aspiration	No Yes No Yes No Yes No Yes	4 35 24 15 29 10 30 9	62.5 (7.1) 63.5 (15.4) 67.5 (14.8) 56.7 (12.2) 65.7 (14.6) 56.6 (13.5) 65.9 (14.4) 55 (13.3)	0.9079 0.0315^* * Nonparametric Mann-Whitney test, p <0.05 0.1266 0.0596

Domain	Videofluoroscopy		N	Mean (SD)	P ^* * Nonparametric Mann-Whitney test, p <0.05
Domain	20 ml	Category	N	Mean (SD)	P ^* * Nonparametric Mann-Whitney test, p <0.05
Overall	Stasis Penetration Aspiration Silent aspiration	No Yes No Yes No Yes No Yes	4 35 20 19 29 10 30 9	70 (25.8) 51.4 (25.3) 63 (26.2) 43.2 (21.4) 60 (25.6) 34 (13.5) 56.7 (25.8) 42.2 (23.3)	0.1704 0.0180 0.0053 0.1232
Functional	Stasis Penetration Aspiration Silent aspiration	No Yes No Yes No Yes No Yes	4 35 20 19 29 10 30 9	79 (8.9) 67.7 (18.2) 72.8 (17.7) 62.9 (17) 70.1 (17.4) 62 (18.6) 69.6 (17.4) 62.7 (19.3)	0.1497 0.0688 0.2794 0.3842
Emotional	Stasis Penetration Aspiration Silent aspiration	No Yes No Yes No Yes No Yes	4 35 20 19 29 10 30 9	64 (14.0) 64.5 (16.9) 72.4 (15.9) 56.1 (12.8) 67.9 (16.1) 54.5 (13.8) 67.1 (16.5) 55.6 (13.9)	1.0000 0.0012 0.0271 0.0763
Physical	Stasis Penetration Aspiration Silent aspiration	No Yes No Yes No Yes No Yes	4 35 20 19 29 10 30 9	55.1 (8.8) 58.1 (15.7) 66 (14) 49.2 (11) 61.2 (15.4) 47.9 (8.9) 60.9 (14.5) 47.4 (12.9)	0.5941 0.0002 0.0051 0.0171
Mean total	Stasis Penetration Aspiration Silent aspiration	No Yes No Yes No Yes No Yes	4 35 20 19 29 10 30 9	66 (6.8) 63.1 (15.4) 70.4 (14.3) 56 (11.3) 66.4 (14.6) 54.6 (11.7) 65.9 (14.4) 55 (13.3)	0.6601 0.0023 0.0299 0.0596

Questions		Penetration 5 ml		p	Penetration 20 ml		p	Aspiration 20 ml			p
Questions		no	yes	p	no	yes	p	no	yes		p
I am ashamed of my eating habits	1+2	3 (12)	4 (27)	0.50	2 (10)	5 (26)	0.29	4 (14)		3 (30)	0.45
	3	1 (4)	2 (13)		1 (5)	2 (11)		2 (7)		1 (10)
	4+5	21 (83)	9 (60)		17 (85)	12 (63)		23 (79)		6 (60)
Other people get irritated because of my swallowing problem	1+2	1 (4)	3 (20)	0.26	2 (10)	2 (11)	0.53	2 (7)		2 (20)	0.26
	3	3 (12)	1 (7)		1 (5)	3 (16)		4 (14)		0 (0)
	4+5	20 (83)	11 (73)		17 (85)	14 (74)		23 (79)		8 (80)
I am sad because of my swallowing problem	1+2	12 (50)	9 (60)	0.61	8 (40)	13 (68)	0.15	14 (48)		7 (70)	0.33
	3	2 (8)	2 (13)		2 (10)	2 (11)		4 (14)		0 (0)
	4+5	10 (42)	4 (27)		10 (50)	4 (21)		11 (38)		3 (30)
I stopped going out to eat due to my swallowing problem	1+2	3 (12)	8 (53)	0.01	2 (10)	9 (47)	0.03	6 (21)		5 (50)	0.17
	3	1 (4)	1 (7)		1 (5)	1 (5)		2 (7)		0 (0)
	4+5	20 (83)	6 (40)		17 (85)	9 (47)		21 (72)		5 (50)
I have low self-esteem due to my swallowing problem.	1+2	6 (25)	5 (33)	0.04	3 (15)	8 (42)	0.10	7 (24)		4 (40)	0.55
	3	0 (0)	3 (20)		1 (5)	2 (11)		2 (7)		1 (10)
	4+5	18 (75)	7 (47)		16 (80)	9 (47)		20 (69)		5 (50)
I feel insecure when I eat	1+2	13 (54)	12 (80)	0.23	10 (50)	15 (79)	0.056	15 (52)		10 (100)	0.02
	3	2 (8)	1 (7)		1 (5)	2 (11)		3 (10)		0 (0)
	4+5	9 (38)	2 (13)		9 (45)	2 (11)		11 (38)		0 (0)

Questions		Penetration 5 ml		p	Penetration 20 ml		P	Aspiration 5 ml		p	Aspiration 20 ml		p	Silent aspiration 5 ml		p	Silent aspiration 20 ml		p
Questions		no	yes	p	no	yes	P	no	yes	p	no	yes	p	no	yes	p	no	yes	p
I have lost weight due to my swallowing problem.	1+2	11 (46)	10 (67)	0.35	9 (45)	12 (63)	0.09	13 (45)	8 (80)	0.14	15 (52)	6 (60)	0.57	14 (45)	7 (78)	0.24	15 (52)	6 (60)	0.57
	3	1 (4)	1 (7)		0 (0)	2 (11)		2 (7)	0 (0)		1 (3)	1 (10)		2 (7)	0 (0)		1 (3)	1 (10)
	4+5	12 (50)	4 (27)		11 (55)	5 (26)		14 (48)	2 (20)		13 (45)	3 (30)		14 (47)	2 (22)		13 (45)	3 (30)
It is harder to swallow at the end of the day	1+2	1 (4)	5 (33)	0.05	0 (0)	6 (32)	0.02	4 (14)	2 (20)	0.89	2 (7)	4 (40)	0.04	4 (13)	2 (22)	0.79	2 (7)	4 (40)	0.04
	3	3 (12)	1 (7)		2 (10)	2 (11)		3 (10)	1 (10)		3 (10)	1 (10)		3 (10)	1 (11)		3 (10)	1 (10)
	4+5	20 (83)	9 (60)		18 (90)	11 (58)		22 (76)	7 (70)		24 (83)	5 (50)		23 (77)	6 (67)		24 (83)	5 (50)
People ask me, “Why can´t you eat this?”	1+2	8 (33)	9 (60)	0.25	5 (25)	12 (63)	0.02	13 (45)	4 (40)	0.93	10 (34)	7 (70)	0.12	13 (43)	4 (44)	0.60	10 (34)	7 (70)	0.12
	3	2 (8)	1 (7)		1 (5)	2 (11)		2 (7)	1 (10)		3 (10)	0 (0)		3 (10)	0 (0)		3 (10)	0 (0)
	4+5	14 (58)	5 (33)		14 (70)	5 (26)		14 (48)	5 (50)		16 (55)	3 (30)		14 (47)	5 (56)		16 (55)	3 (30)
I feel like I am able to swallow a lot of different foods	1+2	14 (58)	8 (53)	0.95	11 (55)	11 (58)	0.77	15 (52)	7 (70)	0.33	17 (59)	5 (50)	0.72	16 (53)	6 (67)	0.41	17 (59)	5 (50)	0.72
	3	3 (12)	2 (13)		2 (10)	3 (16)		5 (17)	0 (0)		3 (10)	2 (20)		5 (17)	0 (0)		3 (10)	2 (20)
	4+5	7 (29)	5 (33)		7 (35)	5 (26)		9 (31)	3 (30)		9 (31)	3 (30)		9 (30)	3 (33)		9 (31)	3 (30)
I limit my diet because of my difficulty in swallowing	1+2	14 (58)	13 (87)	0.1	10 (50)	17 (89)	0.01	18 (62)	9 (90)	0.24	18 (62)	9 (90)	0.08	19 (63)	8 (89)	0.33	18 (62)	9 (90)	0.08
	3	1 (4)	1 (7)		1 (5)	1 (5)		2 (7)	0 (0)		1 (3)	1 (10)		2 (7)	0 (0)		1 (3)	1 (10)
	4+5	9 (38)	1 (7)		9 (45)	1 (5)		9 (31)	1 (10)		10 (34)	0 (0)		9 (30)	1 (11)		10 (34)	0 (0)
Swallowing takes a great effort	1+2	7 (29)	12 (80)	0.01	6 (30)	13 (68)	0.047	11 (38)	8 (80)	0.06	11 (38)	8 (80)	0.06	11 (37)	8 (89)	0.02	11 (38)	8 (80)	0.06
	3	2 (8)	0 (0)		1 (5)	1 (5)		2 (7)	0 (0)		2 (7)	0 (0)		2 (7)	0 (0)		2 (7)	0 (0)
	4+5	15 (62)	3 (20)		13 (65)	5 (26)		16 (55)	2 (20)		16 (55)	2 (20)		17 (57)	1 (11)		16 (55)	2 (20)
I take more time to eat because of my swallowing problem	1+2	16 (67)	12 (80)	0.51	13 (65)	15 (79)	0.57	20 (69)	8 (80)	0.64	20 (69)	8 (80)	0.41	21 (70)	7 (78)	0.71	20 (69)	8 (80)	0.41
	3	1 (4)	1 (7)		1 (5)	1 (5)		2 (7)	0 (0)		1 (3)	1 (10)		2 (7)	0 (0)		1 (3)	1 (10)
	4+5	7 (29)	2 (13)		6 (30)	3 (16)		7 (24)	2 (20)		8 (28)	1 (10)		7 (23)	2 (22)		8 (28)	1 (10)
I cough when I try to drink fluids	1+2	9 (38)	6 (40)	0.53	7 (35)	8 (42)	0.12	10 (34)	5 (50)	0.46	11 (38)	4 (40)	0.20	10 (33)	5 (56)	0.37	11 (38)	4 (40)	0.20
	3	1 (4)	2 (13)		0 (0)	3 (16)		3 (10)	0 (0)		1 (3)	2 (20)		3 (10)	0 (0)		1 (3)	2 (20)
	4+5	14 (58)	7 (47)		13 (65)	8 (42)		16 (55)	5 (50)		17 (59)	4 (40)		17 (57)	4 (44)		17 (59)	4 (40)

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[1] Conflict of interests: nothing to declare.