Patient-reported outcomes following parotid-sparing intensity-modulated radiotherapy for head and neck cancer. How important is dysphagia?

Objectives: Swallowing can be significantly affected during and following radiotherapy for head and neck cancer (HNC). The purpose of this study was to understand: (1) the trajectory of swallowing recovery following parotid-sparing intensity-modulated radiotherapy (IMRT) and (2) overall physical and social-emotional wellbeing and how patients prioritise swallowing following treatment. Materials and methods: Sixty-one HNC patients completed questionnaires as part of a prospective study exploring patient-reported swallowing outcomes following parotid-sparing IMRT. Participants were asked to complete the M.D. Anderson Dysphagia Inventory (MDADI) and University of Washington Quality of Life Questionnaire (UW-QoL) v.04 before treatment and 3, 6 and 12 months after treatment. Given the rise in human papilloma virus (HPV) and associated oropharyngeal cancers, we completed a sub analysis of the data in those participants. Results: There was a significant reduction in the MDADI composite scores 3 months after completion of treatment. Improvements were observed by 12 months, however, scores did not recover to baseline. The recovery in physical function was limited in comparison to social-emotional recovery at 12 months. When oropharyngeal cancer scores were analysed, there was not a substantial difference to the whole group results. There was a shift in priorities following treatment. Swallowing was highlighted as a concern by 44% of HNC patients up to 12 months after treatment with swallowing-related factors (saliva, taste and chewing) rated highly. Conclusions: Patient reported swallowing outcomes were significantly affected from baseline to all follow-up time points and remained a priority concern at 12 months following treatment. Overall social-emotional functioning does improve, suggesting that patients have the potential to adapt to their “new normal” following IMRT for HNC.