Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", Rostock University Medical Center, D-18057 Rostock, Germany.
Department of Otorhinolaryngology, Head and Neck Surgery, RWTH Aachen University Hospital, D-52074 Aachen, Germany.
Curr Oncol. 2023 Dec 6;30(12):10336-10350. doi: 10.3390/curroncol30120753.
Head and neck squamous cell carcinoma (HNSCC) is linked to significant morbidity, adversely affecting survival and functional capacity. Post-treatment challenges such as pain, dysphonia, and dysphagia are common, prompting increased attention in survivorship research. Quality of Life (QoL) questionnaires, especially the MD Anderson Dysphagia Inventory (MDADI), are prevalent outcome measures in clinical studies but often lack parallel objective swallowing function evaluations, leading to potential outcome discrepancies. This study aimed to illuminate the relationship between subjective QoL (EQ-5D-5L and MDADI) measures and objective swallowing function (evaluated via Fiberoptic Endoscopic Evaluation of Swallowing, FEES) in patients with HNSCC. The analysis revealed a notable discordance between objective measures of swallowing function, such as the Penetration-Aspiration Scale (PAS) and residue ratings in the vallecula or piriform sinus, and patients' subjective QoL assessments ( = 0.21). Despite the lack of correlation, swallowing-related QoL, as measured by the MDADI, was more indicative of disease severity than generic QoL assessments. Generic QoL scores did not demonstrate substantial variation between patients. In contrast, MDADI scores significantly declined with advancing tumor stage, multimodal therapy, and reliance on feeding tubes. However, the clinical significance of this finding was tempered by the less than 10-point difference in MDADI scores. The findings of this study underline the limitations of QoL measures as standalone assessments in patients with HNSCC, given their reliance on patient-perceived impairment. While subjective QoL is a crucial aspect of evaluating therapeutic success and patient-centric outcomes, it may fail to capture critical clinical details such as silent aspirations. Consequently, QoL assessments should be augmented by objective evaluations of swallowing function in clinical research and practice to ensure a holistic understanding of patient well-being and treatment impact.
头颈部鳞状细胞癌（HNSCC）与显著的发病率相关，对生存和功能能力产生不利影响。治疗后出现的问题，如疼痛、声音障碍和吞咽困难等较为常见，这促使生存研究中增加了对这些问题的关注。生活质量（QoL）问卷，特别是 MD 安德森吞咽障碍指数（MDADI），是临床研究中常用的结果测量指标，但往往缺乏平行的客观吞咽功能评估，导致潜在的结果差异。本研究旨在阐明 HNSCC 患者的主观 QoL（EQ-5D-5L 和 MDADI）测量与客观吞咽功能（通过纤维内镜吞咽评估，FEES）之间的关系。分析显示，吞咽功能的客观测量指标（如渗透-吸入量表（PAS）和 vallecula 或梨状隐窝的残留评分）与患者的主观 QoL 评估之间存在显著差异（ = 0.21）。尽管没有相关性，但 MDADI 测量的与吞咽相关的 QoL 比一般的 QoL 评估更能反映疾病的严重程度。患者之间的一般 QoL 评分没有明显差异。相比之下，MDADI 评分随着肿瘤分期的进展、多模态治疗和对喂养管的依赖而显著下降。然而，由于 MDADI 评分差异不到 10 分，这一发现的临床意义受到限制。本研究的结果强调了 QoL 测量在 HNSCC 患者中的局限性，因为它们依赖于患者感知的损伤。虽然主观 QoL 是评估治疗成功和以患者为中心的结果的重要方面，但它可能无法捕捉到关键的临床细节，如无声的吸入。因此，在临床研究和实践中，QoL 评估应辅以吞咽功能的客观评估，以确保全面了解患者的健康状况和治疗效果。
Zotero 插件
