Possible Clinical Predictors for Dysphagia in Head and Neck Cancer Patients after Surgery

Abstract

Introduction: Dysphagia is one of the most frequent sequels of the head and neck cancer (HNC). For postoperative HNC patients, several clinical parameters such as wet voice are used in the dysphagia assessment. However, most of these parameters were validated for stroke and geriatric patients. Seven clinical parameters were scrutinized in the current study for HNC patients regarding quality criteria for the prediction of dysphagia. Methods: Seven core clinical parameters (dysglossia, wet voice, abnormal volitional cough, reduced mouth opening, limited tongue motility and strength, gag reflex) and three combinations of such parameters were assessed in 184 postoperative HNC patients. The penetration-aspiration scale and Functional Oral Intake Scale were phi-correlated and cross-tabulated with the clinical parameters for the analysis of their quality criteria. The predictive power of clinical parameters was assessed by three logistic regressions and three classification trees, with dysphagia, aspiration, and limitations of oral intake as dependent variables. Results: All phi-correlations between clinical parameters and both scales were low to nonexistent (ρ = 0.002-0.320). Sensitivity, specificity, positive likelihood ratio, and efficiency of clinical parameters and their combinations also yielded unsatisfactory results in the prediction of dysphagia. In regression analyses, wet voice showed a weak but significant influence on the dysphagia, aspiration, and limitations of oral intake. In classification trees, none of the clinical parameters yielded significant results. Conclusion: Neither clinical parameters nor their combinations can predict dysphagia in HNC patients. No factors can be recommended for the clinical use. Water swallow tests should be used clinically because they demonstrated better quality criteria for this population in the previous research.