The Impact of Swallowing Function Pre and Post Head

1
The Impact of Swallowing Function Pre- and Post
Head Neck Cancer Treatment

• Jo Patterson Research Associate / Macmillan SALT
• University of Newcastle / Sunderland Royal
  Hospital
• Mike Drinnan Principal Medical Physicist,
• Freeman Hospital, Newcastle upon Tyne

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Outline

• Background
• Outcomes for swallowing focussed on biomechanical
  function
• Dysphagia associated with poorer QOL
• Development of dysphagia specific questionnaires
• Aim
• Describe swallowing difficulties in head and neck
  cancer from the patients perspective

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Methods

• Convenience sample (SALT) 2000-2004
• SWAL-QOL _at_ pre- 6, 12 months
• Exclusions
• Tumour recurrence
• Palliative patients

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Measurement tool

• SWAL-QOL 2002 (44 items, 11 domains)
• general burden (fatigue)
• food selection (sleep)
• eating duration (communication)
• eating desire
• fear of eating
• mental health
• social function
• symptom frequency

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Data Sample

• N65 (49 males 16 females)
• Age 32-80y mean 60y median 62y
• Oral (31) oropharyngeal (30) NPC (4)
• T1-2 (35) T3-4 (30)
• Surgery (10) surgery radiotherapy (36)
  chemoradiotherapy (13) radiotherapy (6)
• 35 completed pre post SWAL-QOL
• Analysed using ANOVA

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Pre-treatment
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Pre-treatment

• Females had lower scores
• T3-4 tumour group worse than T1-2
• Oropharyngeal patients worse than oral
• Nasopharyngeal patients reported few problems

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6 months post treatment
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Post-treatment

• Males reporting more problems
• T1-2 group reporting more symptoms at 6m, more
  mental health social issues at 12m
• Orals problems with chewing
• Oropharyngeals choking / sticking
• Combined modality treatment worse than single
  modality

10
Discussion

• Type of treatment
• Tumour site
• Tumour size
• Time post treatment
• Gender
• Age
• Nodal disease

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Limitations

• Biased sample
• Reduced questionnaire
• Small sample
• Functional status
• Some patients found questionnaire difficult

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Conclusions

• Assessment from different perspectives
• Keep assumptions in check
• Clinicians priorities vs patient priorities
• Rehabilitate symptoms and perceptions

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Acknowledgements

• Head and neck cancer patients at Sunderland Royal
  Hospital
• Research Development Capacity Grant Department
  of Health

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12 months post treatment