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.
Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland.
J Pain Symptom Manage. 2019 Dec;58(6):949-958.e2. doi: 10.1016/j.jpainsymman.2019.06.030. Epub 2019 Aug 22.
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.
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.
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.
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.
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.
吞咽困难通常与头颈部和上消化道的恶性肿瘤有关，但也发生在解剖吞咽区域以外有肿瘤的患者中。它可导致吸入性肺炎、营养不良、生活质量下降和心理社会困扰。目前尚无研究可靠地描述解剖吞咽区域以外恶性肿瘤患者的吞咽困难患病率。
本研究旨在确定头、颈和上消化道以外实体恶性肿瘤患者吞咽困难的患病率和预测因素。
采用连续抽样的横断面观察性研究。共有来自两家急性医院和一家临终关怀医院的 385 名参与者（平均年龄 66 ± 12 岁），患有 21 种不同的原发性癌症。局部区域疾病占 33%，转移性疾病占 67%。通过经验性问卷筛查吞咽困难，并通过吞咽评估进行确认。通过单变量和多变量二元回归确定人口统计学和临床预测因素。
解剖吞咽区域以外恶性肿瘤患者中吞咽困难的发生率为 19%。在姑息治疗中为 30%，在临终关怀中为 32%。吞咽困难与咳嗽、恶心和更差的表现状态最密切相关。它还与生活质量和营养困难有关。
吞咽困难很常见，通常在研究参与前未被诊断。它发生在所有疾病阶段，但与功能下降同时发生。因此，它可能代表癌症脆弱性标志物。肿瘤学和姑息治疗服务应常规筛查该症状。及时识别和管理吞咽困难可能会改善患者的生活幸福感并预防吸入性肺炎和体重减轻等不良后果。
