Dysphagia Prevalence and Predictors in Cancers Outside the Head, Neck, and Upper Gastrointestinal Tract.

Ciarán Kenny, Julie Regan, Lucy Balding, Stephen Higgins, Norma O'Leary, Fergal Kelleher, Ray McDermott, John Armstrong, Alina Mihai, Eoin Tiernan, Jennifer Westrup, Pierre Thirion, Declan Walsh

Journal: Journal of pain and symptom management 2020;58(6):949-958.e2

PMID: 31445137

Free Full Text on Elsevier Science View on PubMed

Abstract

CONTEXT

Dysphagia is usually associated with malignancies of the head, neck, and upper gastrointestinal tract but also occurs in those with tumors outside anatomic swallow regions. It can lead to aspiration pneumonia, malnutrition, reduced quality of life, and psychosocial distress. No studies have yet reliably described dysphagia prevalence in those with malignancies outside anatomic swallow regions.

OBJECTIVE

The objective of this study was to establish the prevalence and predictors of dysphagia in adults with solid malignancies outside the head, neck, and upper gastrointestinal tract.

METHODS

A cross-sectional, observational study using consecutive sampling was conducted. There were 385 participants (mean age 66 ± 12 years) with 21 different primary cancer sites from two acute hospitals and one hospice. Locoregional disease was present in 33%, metastatic in 67%. Dysphagia was screened by empirical questionnaire and confirmed through swallow evaluation. Demographic and clinical predictors were determined by univariate and multivariate binary regression.

RESULTS

Dysphagia occurred in 19% of those with malignancies outside anatomic swallow regions. Prevalence was 30% in palliative care and 32% in hospice care. Dysphagia was most strongly associated with cough, nausea, and worse performance status. It was also associated with lower quality of life and nutritional difficulties.

CONCLUSION

Dysphagia was common and usually undiagnosed before study participation. It occurred at all disease stages but coincided with functional decline. It may therefore represent a cancer frailty marker. Oncology and palliative care services should routinely screen for this symptom. Timely dysphagia identification and management may improve patient well-being and prevent adverse effects like aspiration pneumonia and weight loss.

Address: Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland; Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland. Electronic address: [email protected].; Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland.; Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland.; Tallaght University Hospital, Dublin, Ireland.; Tallaght University Hospital, Dublin, Ireland; Beacon Hospital, Dublin, Ireland.; Beacon Hospital, Dublin, Ireland.; Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland; Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA.

DOI: 10.1016/j.jpainsymman.2019.06.030

Link outs

Free resources

Full Text Sources:

https://linkinghub.elsevier.com/retrieve/pii/S0885...

Medical:

https://medlineplus.gov/swallowingdisorders.html

Subscription / membership required

Full Text Sources:

https://www.clinicalkey.com/content/playBy/pii?v=S...

MeSH Terms: Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Deglutition, Deglutition Disorders, Female, Gastrointestinal Neoplasms, Head and Neck Neoplasms, Hospices, Humans, Male, Malnutrition, Middle Aged, Neoplasms, Palliative Care, Predictive Value of Tests, Prevalence, Quality of Life, Surveys and Questionnaires, Upper Gastrointestinal Tract