Modeling symptom drivers of oral intake in long-term head and neck cancer survivors

Purpose This study examined the relationship between self-reported symptom severity and oral intake in long-term head and neck cancer (HNC) survivors. Methods An observational survey study with retrospective chart abstraction was conducted. HNC patients who had completed an MD Anderson Symptom Inven...

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Bibliographic Details
Published in:Supportive care in cancer 2019-04, Vol.27 (4), p.1405-1415
Main Authors: Kamal, Mona, Barrow, Martha P., Lewin, Jan S., Estrella, Alicia, Gunn, G. Brandon, Shi, Quiling, Hofstede, Theresa M., Rosenthal, David I., Fuller, Clifton David, Hutcheson, Katherine A.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Analysis
Cancer
Cancer research
Cancer Survivors
Cancer therapies
Chemotherapy
Deglutition disorders
Deglutition Disorders - epidemiology
Deglutition Disorders - etiology
Diet
Dysphagia
Eating - physiology
Eating - psychology
Female
Gastrointestinal Diseases - epidemiology
Gastrointestinal Diseases - etiology
Head & neck cancer
Head and neck cancer
Head and Neck Neoplasms - complications
Head and Neck Neoplasms - metabolism
Head and Neck Neoplasms - physiopathology
Head and Neck Neoplasms - rehabilitation
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Motor vehicle drivers
Nursing
Nursing Research
Nutrition research
Oncology
Original Article
Pain Medicine
Palliative care
Patients
Pilot Projects
Quality of life
Questionnaires
Radiation
Rehabilitation Medicine
Retrospective Studies
Self Report
Surveys
Surveys and Questionnaires
Swallowing
Xerostomia
Xerostomia - epidemiology
Xerostomia - etiology
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Summary:Purpose This study examined the relationship between self-reported symptom severity and oral intake in long-term head and neck cancer (HNC) survivors. Methods An observational survey study with retrospective chart abstraction was conducted. HNC patients who had completed an MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) questionnaire and also had clinician graded oral intake ratings (Functional Oral Intake Scale [FOIS]) were included. Correlation coefficients were computed. FOIS scores were regressed on MDASI-HN symptom items using stepwise backwards elimination for multivariate models. Results One hundred and fifty-two survey pairings were included in the analysis (median 44 months follow-up, range 7–198). Per FOIS, 28% of survivors maintained a total oral diet with no restrictions, 67% reported a restricted oral diet (without tube), 3% were partially tube-dependent with some oral intake, and 2% were NPO. Of the 22 symptom items, the most severe items in decreasing order were dry mouth, difficulty swallowing\chewing, problems with mucus, tasting food, and choking/coughing. Significant bivariate correlations, after Bonferroni correction for multiple comparisons, were present for 8 of 22 symptoms with FOIS. On multivariate analysis, symptom severity for difficulty swallowing and problems with teeth/gums remained significantly associated with FOIS. Conclusions Oral intake in HNC survivorship is a multidimensional issue and functional outcome that is impacted not only by dysphagia but also by dental status. Symptom drivers of oral intake likely differ in acute survivorship. Nonetheless, these findings highlight the lack of specificity in this end point and also the need for multidisciplinary supportive care to optimize oral intake in survivors.
ISSN:0941-4355
1433-7339
DOI:10.1007/s00520-018-4434-4