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Analysis of the factors influencing dysphagia severity upon diagnosis of head and neck cancer

¹ Department of Radiation Oncology, University of Arizona, Tucson, AZ, ² Department of Biostatistics, East Carolina University, Greenville, NC, Departments of ³ Audiology and Speech Pathology and and ⁴ Radiology, VA North Texas Health Care System, Dallas, TX, ⁵ Department of Radiation Oncology, University of Southern California, Los Angeles, CA, ⁶ Department of Radiation Oncology, Albert Einstein University, New York, NY, ⁷ Radiation Oncology, VA North Texas Health Care System, Dallas, TX, ⁸ Department of Radiation Oncology, East Carolina University, Greenville, NC, ⁹ School of Public Health, University of Michigan, Ann Arbour, MI, USA, ¹⁰ Department of Hematological Research, Novo Nordisk, Athens, Greece

Correspondence: Nam P Nguyen, Associate Professor of Radiation Oncology, University of Arizona, N. Campbell Avenue, Tucson, AZ 85724–5081. E-mail: NamPhong.Nguyen{at}yahoo.com

Our aim was to assess the influence of age, co-morbidity factors and tumour characteristics on dysphagia severity in the diagnosis of head and neck cancer. Modified barium swallow (MBS) examinations were performed in patients at diagnosis of head and neck cancer. Dysphagia was graded on a scale of 1 to 7 of increasing severity. Between 2000 and 2006, 236 patients with dysphagia underwent MBS at diagnosis of their head and neck cancer. 82 patients were scored as Grade 1, 88 as Grade 2, 29 as Grade 3, 15 as Grade 4, 9 as Grade 5, 5 as Grade 6, and 8 as Grade 7. Grade 3–7 dysphagia occurred in 20% and 31% of patients with T1–T2 and T3–T4 tumours, respectively (p = 0.004). Corresponding values for N0–N1 and N2–N3 tumours were 20% and 39%, respectively (p = 0.002). The percentage of patients with Grade 3–7 dysphagia was 5%, 29%, 33% and 52% for oral cavity, laryngeal, oropharyngeal and hypopharyngeal tumours, respectively, (p = 0.002). Age and co-morbidity factors (e.g. diabetes, hypertension, coronary artery disease, peripheral vascular diseases and arthritis) did not appear to have an impact on swallowing in this limited retrospective study. Patients with locally advanced stages (T3–T4, N2–N3) are at risk of severe dysphagia. Patients with oral cavity tumours appear to be less at risk of dysphagia than those with tumours in different anatomic locations. The role of age and co-morbidity factors should be investigated in future prospective studies.

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