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Baseline dysphagia affected quality of life in patients with HNSCC
Baseline dysphagia affected multiple domains of quality of life and also was associated with disease recurrence and disease-related death in patients with head and neck squamous cell carcinoma, according to prospective study results.
Researchers evaluated quality of life among 159 patients using the SWAL-QOL — a dysphagia-specific quality-of-life measure — and the EuroQOL-5D-3L before treatment.
Results of the EuroQOL-5D-3L showed 45% of patients reported their pain or discomfort as moderate, and 5% reported it as severe. Thirty-seven percent of patients reported moderate anxiety or depression, and 3% reported severe anxiety or depression.
Researchers found advanced T classification and weight loss before treatment were associated with baseline dysphagia, pain and a diminished patient-reported health state.
Among patients who reported dysphagia (n=40), 58% experienced a more than 5% weight loss.
When controlling for T classification, patients who did not experience weight loss but reported dysphagia were more likely to report having pain (OR=3.8; 95% CI, 1.4-10), anxiety or depression (OR=3.6; 95% CI, 1.4-9) and poor health (OR=2.7; 95% CI, 1.1-7).
When controlling for T classification, performance status and weight loss, women were more likely than men to experience pain and discomfort, anxiety or depression, a decreased patient-reported health state, problems performing usual activities and dysphagia (OR=4; 95% CI, 1.3-12).
In survival analyses that controlled for T and N classification, ECOG performance status, smoking status, weight loss and competing risks for death, dysphagia was predictive of disease recurrence (HR=3.8; 95% CI, 1.7-8.4) and disease-related death (HR=4.2; 95% CI, 1.04-5).
“Most patient-reported measures tested were found to be highly associated with pretreatment weight loss, but the associations among dysphagia, pain and diminished health perceptions were observed even in the absence of pre-existing weight loss,” the researchers wrote. “Patient-reported measures such as dysphagia provide independent prognostic information that is readily obtained from the patient and that is likely less related to the individual’s functional status than to their cancer’s intrinsic behavior.”
Disclosure: One researcher reports grant support from the NIH/NCI, as well as personal fees from Teva Pharmaceuticals for work unrelated to this study.