Examining the Relationship Between Dysphagia, Eating-Related Symptoms, and Diet Quality Among Oropharyngeal Cancer Patients During Critical Stages of Cancer Survivorship: The U-DINE Study.

Abstract

Diet quality is a modifiable factor impacting treatment outcomes in oropharyngeal cancer (OPC), yet the effect of dysphagia and self-reported eating-related symptoms remains unclear. This study examined their associations with diet quality in OPC patients. A cross-sectional analysis was conducted with two parallel cohorts from MD Anderson Cancer Center and Michael E. DeBakey Veterans Affairs Medical Center as part of the Uncovering the Long-Term Impact of OPC and Dysphagia on Dietary Quality and Nutrition Among Cancer Survivors (U-DINE) Study. Participants at varying survivorship stages (prediagnosis, 3-6 and 18+ months posttreatment) were assessed for dysphagia (DIGEST scale) and six individual eating-related symptoms (MDASI-HN). Diet quality was measured using HEI-2020 scores from two 24-h dietary recalls. Among 178 survivors, mean HEI-2020 was 49.5 ± 11.3. In multivariable models, moderate-severe dysphagia (18.5% of the sample) was associated with higher diet quality (β = 7.11, p = 0.004), while eating-related symptoms showed no significant association. Unexpectedly, poor swallowing function correlated with better diet quality. However, overall diet quality was suboptimal, highlighting the need for interventions for all OPC survivors, regardless of swallowing function, to address diet quality as an independent risk factor throughout survivorship.