Prevalence of Long-Term Dysphagia in Head and Neck Cancer Survivors Not Receiving Dysphagia Treatment.

Abstract

In head and neck cancer (HNC) survivors not actively receiving dysphagia care, long-term dysphagia prevalence, dysphagia-related complications, and quality of life outcomes remain poorly understood. Understanding these outcomes is critical for creating effective HNC survivorship programs. HNC survivors who completed cancer treatment > 2 years prior who had not undergone a swallow evaluation or therapy for > 1 year completed the MD Anderson Dysphagia Inventory (MDADI) and reported dysphagia-related complications. Of 722 invited participants who met inclusion criteria, 143 responded at a median of 5.9 years (IQR: 2.5-10.2 years) post-treatment, including 65 at 2-5 years, 42 at 5-10 years, and 36 at > 10 years. Median time since last speech-language pathologist visit was 2.8 years (IQR 2.1-4.9 years), and 27% had not received any swallow therapy since cancer treatment completion. The most common tumor subsite was oropharynx (n = 103), and most underwent definitive (n = 72) or adjuvant (n = 60) (chemo)radiation. The overall median MDADI score was 80 points (IQR: 62.1-91.6) and 49.6% (n = 71) had moderate to severe dysphagia (MDADI < 80). The most common complications within the 6 months prior to patient contact were unintentional weight loss (7.7%), current gastrostomy tube dependence (4.9%), aspiration pneumonia (1.4%), and dehydration requiring intravenous fluids (1.4%). An MDADI score ≤ 80 was associated with 7.7 times higher odds of dysphagia-related adverse events (95% CI 2.1-28.2, p = 0.002). Long-term dysphagia is prevalent among HNC survivors not actively receiving dysphagia care, highlighting the need for ongoing swallow function surveillance and proactive dysphagia management strategies tailored to this population.