Elevated prevalence of late-onset dysphagia among head and neck cancer survivors and identifying risk factors
Reviewed by Richard (Wei Chern) Gan

Dysphagia is one of the most common problems affecting head and neck cancer (HNC) survivors. There are few studies investigating late-onset dysphagia post-treatment. The authors set out to investigate the prevalence of dysphagia-related diagnoses and procedures five years’ post-treatment, changes in rates over varying time periods and risk factors. They conducted a retrospective study of cases identified from the Utah Population Database from 1992 to 2012. For each case, up to five cancer-free controls were matched based on birth year, sex and state of birth. The study cohort included 1901 HNC survivors and 7796 controls. At diagnosis, 23.4% were stage I, 13.8% stage II, 14.0% stage III, 35.6% stage IV and 13.3% had stage information missing; 90.2% had squamous histology. The most common primary sites were oropharynx 33.3%, oral cavity 29.8% and larynx 24.5%. A third were treated with surgery alone, 20.9% with surgery and radiotherapy, and 11.2% with chemoradiotherapy. There was persistently elevated prevalence of new dysphagia-related diagnoses (e.g. dysphagia, malnutrition, oesophageal stricture) or procedures (e.g. gastrostomy, fluoroscopic evaluation of swallowing) at zero to two years, two to five years (15.4% prevalence) and over five years (27.6%) in the HNC group compared to controls. Aspiration pneumonia prevalence was 3.1% at two to five years and 6.8% at more than five years. Gastrostomy prevalence was 2.8% at two to five years and 3.3% at more than five years. Increasing stage of cancer was associated with an increased risk of dysphagia-related diagnoses in the initial two years following HNC diagnosis but this effect did not persist over time.

Rates of Dysphagia-Related Diagnoses in Long-Term Survivors of Head and Neck Cancers.
Aylward A, Abdelaziz S, Hunt JP, et al.
OTOLARYNGOLOGY- HEAD AND NECK SURGERY.
2019;161(4):643-51.