Background and Importance: Chemoradiation is often the primary treatment for advanced oropharyngeal squamous cell carcinoma. Functional outcomes, in particular swallowing outcomes, can vary significantly making patient counselling difficult. Several studies have evaluated post treatment swallowing outcomes. However, few have tracked the changes in swallowing function from pretreatment baseline through a significant post-treatment interval.
Objectives: To assess the evolution of swallowing function, both subjective and objective from pretreatment baseline to 1 year post chemoradiation.
Design, Setting and Participants: A prospective observational cohort study at a multidisciplinary academic cancer center, assessing swallowing function from pretreatment until 1 year post-treatment in patients with Stage III/IV (AJCC 7) oropharyngeal squamous cell carcinoma.
Outcome Measures: MDADI (MD Anderson Dysphagia Inventory) questionairre as well as an MBSImp (Modified Barium Swallow Impairment Profile) completed prior to treatment, as well as 1 month, 3 months and 12 months post-treatment
Results: 24 patients enrolled in the study. Mean total MDADI scores at pretreatment, 1 month, 3 months and 12 months postreatment were (out of 100, min-max) 80.7 (49.0-100), 58.5 (29.0-97.0), 67.6 (50.0-96.0) and 74.5 (51.0-92.0) respectively. Total MBSImp scores (higher score indicate decreasing function, min-max) at each timepoint were 11.1 (2-29), 13.1(3-26), 14.0 (4-22), and 11.3 (5-21) respectively. In general, those patients with the poorest pre-treatment function improved both subjectively and objectively from baseline to 1 year post-treatment whereas those with normal or near normal pretreatment function experienced deterioration.
Conclusions and Relevance: Swallowing outcomes, both subjective and objective, for patients undergoing chemoradiation for advanced oropharyngeal squamous cell carcinoma, in the context of regular speech pathologist guided swallowing rehabilitation, can be reasonably predicted based on patients' pretreatment swallowing status. The results of this study may be beneficial in pretreatment patient counselling, establishing some expectation of swallowing outcome after primary chemoradation.