Comparison of Swallowing Measures to Patient-Reported Dysphagia Symptoms in Assessment of Swallowing Function in Head and Neck Cancer Patients.

Abstract Patient-reported outcomes (PROs) such as the SWAL-QOL have been developed to assess quality of life (QOL) burden in Head and Neck Cancer (HNC) patients, while objective swallowing assessments such as the Modified Barium Swallow Study (MBSS) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) provide information about the safety and efficiency of a patient’s swallow. Using a combination of these tools may lead to better clinical outcomes. The purpose of this study was to compare an objective measure of swallow function, the Penetration-Aspiration Scale (PAS) score obtained from MBSS/FEES data, with patient-reported dysphagia using the SWAL-QOL survey. On the SWAL-QOL, the domains of burden, desire, duration, food selection, fear, mental health, and social role were used for the Dysphagia Domain Score (DDS). In the analysis of all patient data points, a statistically significant relationship between PAS and DDS was observed (p<.05, chi sq). When stratified by tumor site, PAS and DDS relationships were significant for oral cavity and larynx subsites. When stratified by T stage, only T4 tumors had a statistically significant relationship between PAS and DDS. Patients were also observed to have less dysphagia symptoms with elevated PAS as they were further removed from treatment. Understanding how subjective and objective measures of swallowing function overlap will better inform the assessment of HNC patients. Further research should focus on how to incorporate these complementary assessments to better formulate clinical recommendations.