Pretreatment swallowing assessment in head and neck cancer patients

Objectives/Hypothesis: To discuss patient variables associated with swallowing dysfunction in head and neck cancer (HNCA) patients prior to intervention. Study Design: Prospective, multi-institutional cohort study. Methods: All patients included had newly diagnosed head and neck malignancies. Patients undergoing instrumental swallowing evaluations prior to oncologic management were included for analysis. Pretreatment Penetration Aspiration Scores (PAS) were analyzed by primary tumor site, tumor stage, and standard demographic variables. Results: The final study sample was comprised of 204 consecutive individuals with newly diagnosed HNCA. Patients with advanced primary tumor (T) stage laryngeal/hypopharyngeal tumors had higher mean PAS scores (5.18) in contrast to early stage larynx/hypopharynx (1.93), advanced stage oral cavity/oropharynx (2.24), and early stage oral cavity/oropharynx (1.54, P < .0001), indicative of poorer function. Age, race, and sex were not associated with PAS scores. Multivariate logistic regression revealed significantly poorer PAS scores in patients with advanced primary tumors (odds ration [OR] = 3.83, 95% confidence interval [CI], 1.84-8.00, P < .0001) and laryngeal/hypopharyngeal primary site disease (OR = 3.04, 95% CI, 1.41-6.54, P = .004), after controlling for all other variables. Conclusions: This series demonstrates that swallowing dysfunction in high-risk patients may be present in the pretreatment state and should be considered when determining candidacy for organ preservation modalities. These data highlight the importance of instrumental swallowing evaluations prior to intervention, particularly for those individuals with advanced stage and/or laryngeal/hypopharyngeal tumors.