Residue influences quality of life independently of penetration and aspiration in head and neck cancer survivors. Laryngoscope 2017 Jul;127(7):1615-1621
Date
11/20/2016Pubmed ID
27861932Pubmed Central ID
PMC5423863DOI
10.1002/lary.26387Scopus ID
2-s2.0-85001777616 (requires institutional sign-in at Scopus site) 28 CitationsAbstract
OBJECTIVES/HYPOTHESIS: Dysphagia is one of the most significant side effects of the treatment of head and neck cancer. Residue and aspiration are two indicators of dysphagia, but aspiration is historically the only indicator of interest, because it may impact health outcomes. Clinicians have anecdotally used residue as another marker of swallowing dysfunction, but it is understudied. This project investigated the impact of aspiration versus residue on function and quality of life (QoL) in these patients.
STUDY DESIGN: Observational study.
METHODS: A total of 168 head and neck cancer survivors with moderate to severe dysphagia were enrolled in a randomized clinical trial comparing two swallow therapy interventions. Data at time of entry were used for the current study. A modified barium swallow study was done to compute Penetration-Aspiration Scale (PAS) scores, percentage oral residue, and percentage pharyngeal residue with three bolus consistencies (5 mL thin, nectar, and pudding). The Performance Status Scale (PSS) and the Head Neck Cancer Inventory (HNCI) questionnaires were administered. Data were analyzed to determine associations between aspiration and residue estimates with function and QoL scores.
RESULTS: Worsening aspiration and residue estimates were all correlated with decreased scores on the PSS functional scales (r = -0.190 to -0.324, P ≤ .031). However, only increasing residue estimates were significantly related to decreased patient-perceived QoL on the HNCI (r = -.178 to -.194, P < .046). This effect was more pronounced with oral versus pharyngeal residue.
CONCLUSIONS: In this group of head and neck cancer survivors, penetration/aspiration and residue show independent effects. PAS affects functional status only, but residue affects both functional status and QoL. This study supports that residue should be considered a primary measurement of swallowing function and be a target for identification, treatment, and evaluation of swallowing.
LEVEL OF EVIDENCE: 2c. Laryngoscope, 127:1615-1621, 2017.
Author List
Meyer TK, Pisegna JM, Krisciunas GP, Pauloski BR, Langmore SEAuthor
Barbara R. Pauloski PhD, CCC-SLP Associate Professor in the Communication Sciences & Disorders department at University of Wisconsin - MilwaukeeMESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Barium Sulfate
Combined Modality Therapy
Deglutition Disorders
Female
Humans
Male
Middle Aged
Otorhinolaryngologic Neoplasms
Quality of Life
Respiratory Aspiration
Single-Blind Method
Statistics as Topic
Surveys and Questionnaires
Survivors
