open access
The quality of life and the occurrence of dysphagia in patients with head and neck cancer following combined oncological treatment
Affiliations- University Children’s Hospital of Cracow, Jagiellonian University Medical College, Cracow, Poland
- Oncology Centre in Bydgoszcz, Poland
- Centrum Onkologii w Bydgoszczy, Romanowskiej 2, 85-796 Bydgoszcz
- Zakład Badania Narządów Zmysłów Collegium Medicum im. Ludwika Rydygiera Uniwersytetu Mikołaja Kopernika w Bydgoszczy, ul. M. Skłodowskiej-Curie 9, 85-094 Bydgoszcz
- Oddział Laryngologii Uniwersytecki Szpital Dziecięcy w Krakowie, ul. Wielicka 265, 30-663 Kraków
- Katedra i Klinika Onkologii, Radioterapii i Ginekologii Onkologicznej CM UMK
open access
Abstract
Introduction. The localisation of head and neck carcinomas influences the functions of speech, breathing, and swallowing, which, in turn, directly affect the patient’s quality of life. The poor prognosis associated with tumours of this type indicates that aggressive combined therapy protocols, including surgery, chemotherapy, and radiotherapy, should be implemented. Such treatments commonly cause acute toxicity and short- and long-term swallowing complications. Therefore, even though they can contribute significantly to survivorship, these treatments reduce the quality of life. The aim of this study was to analyse the influence of applied combined oncological treatments on the occurrence of dysphagia in patients with head and neck cancer and on their quality of life.
Methods. A group of 135 patients with head and neck carcinomas treated with combined protocol (surgery, chemotherapy, and radiotherapy) in the Lukaszczyk Oncological Centre in Bydgoszcz between 2010 and 2014 was analysed. The quality of life and subjective evaluation of the swallowing function was assessed using the MDADI (M.D. Anderson Dysphagia Inventory).
Results. A statistically significantly worse subjective evaluation of the quality of life was observed in the patients with dysphagia, who had undergone surgery with radiotherapy, compared to those who had not had surgery (p = 0.03). A statistically significantly worse subjective quality of life evaluation was found in patients who had the most locally advanced tumours (T4) (p = 0.04) as well as the highest stages of the disease (S3 and S4) (p = 0.04). A statistically significantly worse subjective quality of life with dysphagia was also seen in patients who had chemoradiotherapy in comparison to those who had radiotherapy alone (p = 0.01). A statistically significantly worse subjective quality of life with dysphagia was observed in the patients whose tumours were localised in the oral part of the pharynx and larynx compared to those patients with other tumour localisations (p = 0.02). A statistically significantly worse subjective quality of life with dysphagia was identified in the patients who had a higher dose of radiation (exceeding 45 Gy) in the upper oesophageal sphincter compared to those patients who had a lower dose (below 45 Gy) in the UES (p = 0.01).
Conclusions. In patients with dysphagia, surgical treatment negatively impacts their subjective quality of life. Moreover, the pattern of radiation therapy affects the quality of life in patients with dysphagia. A radiation therapy plan that spares the upper oesophageal sphincter by using a dose of less than 45 Gy may prevent dysphagia. Dysphagia is also associated with tumour localization, tumour stage, and local advancement of the disease.
Abstract
Introduction. The localisation of head and neck carcinomas influences the functions of speech, breathing, and swallowing, which, in turn, directly affect the patient’s quality of life. The poor prognosis associated with tumours of this type indicates that aggressive combined therapy protocols, including surgery, chemotherapy, and radiotherapy, should be implemented. Such treatments commonly cause acute toxicity and short- and long-term swallowing complications. Therefore, even though they can contribute significantly to survivorship, these treatments reduce the quality of life. The aim of this study was to analyse the influence of applied combined oncological treatments on the occurrence of dysphagia in patients with head and neck cancer and on their quality of life.
Methods. A group of 135 patients with head and neck carcinomas treated with combined protocol (surgery, chemotherapy, and radiotherapy) in the Lukaszczyk Oncological Centre in Bydgoszcz between 2010 and 2014 was analysed. The quality of life and subjective evaluation of the swallowing function was assessed using the MDADI (M.D. Anderson Dysphagia Inventory).
Results. A statistically significantly worse subjective evaluation of the quality of life was observed in the patients with dysphagia, who had undergone surgery with radiotherapy, compared to those who had not had surgery (p = 0.03). A statistically significantly worse subjective quality of life evaluation was found in patients who had the most locally advanced tumours (T4) (p = 0.04) as well as the highest stages of the disease (S3 and S4) (p = 0.04). A statistically significantly worse subjective quality of life with dysphagia was also seen in patients who had chemoradiotherapy in comparison to those who had radiotherapy alone (p = 0.01). A statistically significantly worse subjective quality of life with dysphagia was observed in the patients whose tumours were localised in the oral part of the pharynx and larynx compared to those patients with other tumour localisations (p = 0.02). A statistically significantly worse subjective quality of life with dysphagia was identified in the patients who had a higher dose of radiation (exceeding 45 Gy) in the upper oesophageal sphincter compared to those patients who had a lower dose (below 45 Gy) in the UES (p = 0.01).
Conclusions. In patients with dysphagia, surgical treatment negatively impacts their subjective quality of life. Moreover, the pattern of radiation therapy affects the quality of life in patients with dysphagia. A radiation therapy plan that spares the upper oesophageal sphincter by using a dose of less than 45 Gy may prevent dysphagia. Dysphagia is also associated with tumour localization, tumour stage, and local advancement of the disease.
Keywords
dysphagia, combine oncological treatment, MDADI (M.D. Anderson Dysphagia Inventory)
About this articleTitle
The quality of life and the occurrence of dysphagia in patients with head and neck cancer following combined oncological treatment
Journal
Issue
Article type
Original article
Pages
13-19
Published online
2017-09-21
Page views
664
Article views/downloads
905
DOI
Bibliographic record
Medical Research Journal 2017;2(1):13-19.
Keywords
dysphagia
combine oncological treatment
MDADI (M.D. Anderson Dysphagia Inventory)
Authors
Magdalena Dutsch-Wicherek
Magdalena Bańkowska-Woźniak
Wojciech Kazmierczak
Klaudia Cierniak-Kożuch
Konrad Dziobek
Łukasz Wicherek
References (32)- Kawecki A. Nowotwory narządów głowy i szyi. In: Mender J. ed. Aktualne zasady postępowania diagnostyczno-terapeutycznego w onkologii. Centrum Medyczne Kształcenia Podyplomowego, Warszawa 2011: 5–20.
- Didkowska J, Wojciechowska U, Zatoński W. Nowotwory złośliwe w Polsce w 2011 roku. Krajowy Rejestr Nowotworów. : Warszawa.
- Russi EG, Corvò R, Merlotti A, et al. Swallowing dysfunction in head and neck cancer patients treated by radiotherapy: review and recommendations of the supportive task group of the Italian Association of Radiation Oncology. Cancer Treat Rev. 2012; 38(8): 1033–1049.
- Stręk P, Gawlik J, Składzień J, et al. Ankietowa samoocena zaburzeń połykania i jakości życia u chorych leczonych z powodu nowotworów głowy i szyi. Otorynolaryngologia. 2003; 3: 120–125.
- Stręk P, Hydzik-Sobocińska K, Składzień J, et al. Jakość życia a dysfagia u chorych po operacji raka krtani. Otorynolaryngologia. 2005; 4: 142–146.
- Chen AY, Frankowski R, Bishop-Leone J, et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg. 2001; 127(7): 870–876.
- Łomnicki A. Wprowadzenie do statystyki dla przyrodników. Wydawnictwo Naukowe PWN, Warszawa 2010: 141–177.
- Petrie A, Sabin C. Statystyka medyczna w zarysie. Wydawnictwo Lekarskie PZWL, Warszawa 2006: 51–71.
- Watała C. Biostatystyka – wykorzystanie metod statystycznych w pracy badawczej w naukach biomedycznych. Alfa Medica Press, Bielsko-Biała 2002: 64-86, 142-154–154.
- Stanisz A. Biostatystyka. Wydawnictwo Uniwersytetu Jagiellońskiego, Kraków 2005: 135–178.
- Piłatowska M. Repetytorium ze statystyki. Wydawnictwo Naukowe PWN, Warszawa 2006: 52–55.
- Locher JL, Bonner JA, Carroll WR, et al. Patterns of prophylactic gastrostomy tube placement in head and neck cancer patients: a consideration of the significance of social support and practice variation. Laryngoscope. 2013; 123(8): 1918–1925.
- Eisbruch A, Schwartz M, Rasch C, et al. Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys. 2004; 60(5): 1425–1439.
- Russi EG, Corvò R, Merlotti A, et al. Swallowing dysfunction in head and neck cancer patients treated by radiotherapy: review and recommendations of the supportive task group of the Italian Association of Radiation Oncology. Cancer Treat Rev. 2012; 38(8): 1033–1049.
- Feng FY, Kim HM, Lyden TH, et al. Intensity-modulated chemoradiotherapy aiming to reduce dysphagia in patients with oropharyngeal cancer: clinical and functional results. J Clin Oncol. 2010; 28(16): 2732–2738.
- Brizel D. Radiotherapy and concurrent chemotherapy for the treatment of locally advanced head and neck squamous cell carcinoma. Seminars in Radiation Oncology. 1998; 8(4): 237–246.
- Manikantan K, Khode S, Sayed SI, et al. Dysphagia in head and neck cancer. Cancer Treat Rev. 2009; 35(8): 724–732.
- Murphy BA, Gilbert J. Dysphagia in head and neck cancer patients treated with radiation: assessment, sequelae, and rehabilitation. Semin Radiat Oncol. 2009; 19(1): 35–42.
- Rütten H, Pop LAM, Janssens GO, et al. Long-term outcome and morbidity after treatment with accelerated radiotherapy and weekly cisplatin for locally advanced head-and-neck cancer: results of a multidisciplinary late morbidity clinic. Int J Radiat Oncol Biol Phys. 2011; 81(4): 923–929.
- Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003; 349(22): 2091–2098.
- Bernier J, Domenge C, Ozsahin M, et al. Postoperative Irradiation with or without Concomitant Chemotherapy for Locally Advanced Head and Neck Cancer. New England Journal of Medicine. 2004; 350(19): 1945–1952.
- Levendag PC, Teguh DN, Voet P, et al. Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: a dose-effect relationship. Radiother Oncol. 2007; 85(1): 64–73.
- Poulsen MG, Riddle B, Keller J, et al. Predictors of acute grade 4 swallowing toxicity in patients with stages III and IV squamous carcinoma of the head and neck treated with radiotherapy alone. Radiother Oncol. 2008; 87(2): 253–259.
- Deantonio L, Masini L, Brambilla M, et al. Dysphagia after definitive radiotherapy for head and neck cancer. Correlation of dose-volume parameters of the pharyngeal constrictor muscles. Strahlenther Onkol. 2013; 189(3): 230–236.
- Larson DL, Lindberg RD, Lane E, et al. Major complications of radiotherapy in cancer of the oral cavity and oropharynx. A 10 year retrospective study. Am J Surg. 1983; 146(4): 531–536.
- Hutcheson KA, Lewin JS, Barringer DA, et al. Late dysphagia after radiotherapy-based treatment of head and neck cancer. Cancer. 2012; 118(23): 5793–5799.
- Kulbersh BD, Rosenthal EL, McGrew BM, et al. Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. Laryngoscope. 2006; 116(6): 883–886.
- Shune SE, Karnell LH, Karnell MP, et al. Association between severity of dysphagia and survival in patients with head and neck cancer. Head Neck. 2012; 34(6): 776–784.
- Cartmill B, Cornwell P, Ward E, et al. A prospective investigation of swallowing, nutrition, and patient-rated functional impact following altered fractionation radiotherapy with concomitant boost for oropharyngeal cancer. Dysphagia. 2012; 27(1): 32–45.
- van der Molen L, van Rossum MA, Burkhead LM, et al. Functional outcomes and rehabilitation strategies in patients treated with chemoradiotherapy for advanced head and neck cancer: a systematic review. Eur Arch Otorhinolaryngol. 2009; 266(6): 889–900.
- van der Molen L, van Rossum MA, Burkhead LM, et al. A randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: feasibility, compliance, and short-term effects. Dysphagia. 2011; 26(2): 155–170.
- Shinn EH, Basen-Engquist K, Baum G, et al. Adherence to preventive exercises and self-reported swallowing outcomes in post-radiation head and neck cancer patients. Head Neck. 2013; 35(12): 1707–1712.