Kenny Ciarán, Regan Julie, Balding Lucy, Higgins Stephen, O'Leary Norma, Kelleher Fergal, McDermott Ray, Armstrong John, Mihai Alina, Tiernan Eoin, Westrup Jennifer, Thirion Pierre, Walsh Declan
Department of Clinical Speech and Language Studies (C.K., J.R.), Trinity College Dublin, Ireland; Academic Department of Palliative Medicine (C.K., D.W.), Our Lady's Hospice & Care Services, Ireland; School of Medicine (C.K., D.W.), Trinity College Dublin, Ireland.
Department of Clinical Speech and Language Studies (C.K., J.R.), Trinity College Dublin, Ireland.
J Pain Symptom Manage. 2022 Dec;64(6):546-554. doi: 10.1016/j.jpainsymman.2022.08.019. Epub 2022 Sep 2.
Dysphagia is common in cancer, but underlying pathophysiology and manifestations within patients are unknown.
To examine dysphagia characteristics in those with solid malignancies outside the head, neck and upper gastrointestinal tract.
Seventy-three individuals with dysphagia (46 male, 27 female, aged 37-91) were recruited from a parent trial conducted in two acute hospitals and one hospice. Cranial nerve function, Oral Health Assessment Tool (OHAT), Mann Assessment of Swallowing Ability (MASA) and Functional Oral Intake Scale (FOIS) evaluated swallow profile.
Only 9/73 (12%) had documented dysphagia prior to study enrollment. MASA risk ratings found n=61/73 (84%) with dysphagia risk and n=22/73 (30%) with aspiration risk. Food texture modification was required for n=34/73 (47%), fluid texture modification for n=1/73 (1%). Compensatory strategies for food were needed by n=13/73 (18%) and for fluids by n=24/73 (33%). Cranial nerve deficits were present in n=43/73 (59%). Oral health problems were common, with xerostomia in two-thirds. Worse dysphagia on MASA was associated with disease progression, affecting hospice, and palliative care the most. Worse performance status was indicative of poorer MASA raw score (P<0.001, OR 2.2, 95% CI 1.5-3.4), greater risk of aspiration (P=0.005, OR 2.1, 95% CI 1.3-3.6) and lower FOIS (P=0.004, OR 2.0, 95% CI 1.2-3.2).
Dysphagia management in those with cancer requires robust assessment to uncover clinically important needs like food texture modification and safe swallowing advice. Better assessment tools should be developed for this purpose. Oral health problems should be routinely screened in this population since they exacerbate dysphagia.
吞咽困难在癌症患者中很常见，但患者潜在的病理生理学和表现尚不清楚。
研究头颈部及上消化道以外的实体恶性肿瘤患者的吞咽困难特征。
从两家急症医院和一家临终关怀机构进行的一项母试验中招募了73名吞咽困难患者（46名男性，27名女性，年龄37 - 91岁）。通过颅神经功能、口腔健康评估工具（OHAT）、吞咽能力曼氏评估（MASA）和功能性经口摄入量表（FOIS）评估吞咽情况。
在研究入组前，只有9/73（12%）的患者有吞咽困难记录。MASA风险评级发现，n = 61/73（84%）有吞咽困难风险，n = 22/73（30%）有误吸风险。n = 34/73（47%）的患者需要调整食物质地，n = 1/73（1%）的患者需要调整液体质地。n = 13/73（18%）的患者需要针对食物的代偿策略，n = 24/73（33%）的患者需要针对液体的代偿策略。n = 43/73（59%）的患者存在颅神经功能缺损。口腔健康问题很常见，三分之二的患者有口干症状。MASA评分中吞咽困难程度越严重，与疾病进展相关，对临终关怀和姑息治疗影响最大。较差的功能状态表明MASA原始评分较低（P < 0.001，OR 2.2，95% CI 1.5 - 3.4）、误吸风险更高（P = 0.005，OR 2.1，95% CI 1.3 - 3.6）以及FOIS更低（P = 0.004，OR 2.0，95% CI 1.2 - 3.2）。
癌症患者的吞咽困难管理需要进行全面评估，以发现食物质地调整和安全吞咽建议等重要临床需求。为此应开发更好的评估工具。该人群应常规筛查口腔健康问题，因为这些问题会加重吞咽困难。
