Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Apr;33(2):185-191.
doi: 10.1007/s00455-017-9843-x. Epub 2017 Aug 23.

Grading Dysphagia as a Toxicity of Head and Neck Cancer: Differences in Severity Classification Based on MBS DIGEST and Clinical CTCAE Grades

Ryan P Goepfert  1 , Jan S Lewin  1 , Martha P Barrow  1 , Carla L Warneke  2 , Clifton D Fuller  3 , Stephen Y Lai  1 , Randal S Weber  1 , Katherine A Hutcheson  4
Affiliations

Grading Dysphagia as a Toxicity of Head and Neck Cancer: Differences in Severity Classification Based on MBS DIGEST and Clinical CTCAE Grades

Ryan P Goepfert et al. Dysphagia. 2018 Apr.

Abstract

Clinician-reported toxicity grading through common terminology criteria for adverse events (CTCAE) stages dysphagia based on symptoms, diet, and tube dependence. The new dynamic imaging grade of swallowing toxicity (DIGEST) tool offers a similarly scaled five-point ordinal summary grade of pharyngeal swallowing as determined through results of a modified barium swallow (MBS) study. This study aims to inform clinicians on the similarities and differences between dysphagia severity according to clinical CTCAE and MBS-derived DIGEST grading. A cross-sectional sample of 95 MBS studies was randomly selected from a prospectively-acquired MBS database among patients treated with organ preservation strategies for head and neck cancer. MBS DIGEST and clinical CTCAE dysphagia grades were compared. DIGEST and CTCAE dysphagia grades had "fair" agreement per weighted κ of 0.358 (95% CI .231-.485). Using a threshold of DIGEST ≥ 3 as reference, CTCAE had an overall sensitivity of 0.50, specificity of 0.84, and area under the curve (AUC) of 0.67 to identify severe MBS-detected dysphagia. At less than 6 months, sensitivity was 0.72, specificity was 0.76, and AUC was 0.75 while at greater than 6 months, sensitivity was 0.22, specificity was 0.90, and AUC was 0.56 for CTCAE to detect dysphagia as determined by DIGEST. Classification of pharyngeal dysphagia on MBS using DIGEST augments our understanding of dysphagia severity according to the clinically-derived CTCAE while maintaining the simplicity of an ordinal scale. DIGEST likely complements CTCAE toxicity grading through improved specificity for physiologic dysphagia in the acute phase and improved sensitivity for dysphagia in the late-phase.

Keywords: Clinical trials; Deglutition and deglutition disorders; Head and neck cancer; Toxicity grading.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
Graphical representation of agreement between MBS-derived DIGEST score and clinical CTCAE dysphagia grade
See this image and copyright information in PMC

References

    1. Wilson JA, Carding PN, Patterson JM: Dysphagia after nonsurgical head and neck cancer treatment: patients’ perspectives. Otolaryngol Head Neck Surg 145: 767–-771., 2011. - PubMed
    1. Roe JW, Drinnan MJ, Carding PN, Harrington KJ, Nutting CM: Patient-reported outcomes following parotid-sparing intensity-modulated radiotherapy for head and neck cancer. How important is dysphagia? Oral Oncol 50: 1182–1187, 2014. - PubMed
    1. Feng FY, Kim HM, Lyden TH, Haxer MJ, Worden FP, Feng M, Moyer JS, Prince ME, Carey TE, Wolf GT, Bradford CR, Chepeha DB, Eisbruch A: Intensity-modulated chemoradiotherapy aiming to reduce dysphagia in patients with oropharyngeal cancer: Clinical and functional results. J Clin Oncol 28: 2732–-2738., 2010. - PMC - PubMed
    1. Hunter KU, Schipper M, Feng FY, Lyden T, Haxer M, Murdoch-Kinch CA, Cornwall B, Lee CSY, Chepeha DB, Eisbruch A: Toxicities affecting quality of life after chemo-IMRT of oropharyngeal cancer: Prospective study of patient-reported, observer-rated, and objective outcomes. International Journal of Radiation Oncology Biology Physics 85: 935–-940., 2013. - PMC - PubMed
    1. Vainshtein JM, Moon DH, Feng FY, Chepeha DB, Eisbruch A, Stenmark MH: Long-term quality of life after swallowing and salivary-sparing chemo-intensity modulated radiation therapy in survivors of human papillomavirus-related oropharyngeal cancer. Int J Radiat Oncol Biol Phys 91: 925–933, 2015. - PMC - PubMed

Publication types

LinkOut - more resources