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. 2021 Nov;131(11):2478-2482.
doi: 10.1002/lary.29559. Epub 2021 Apr 24.

Modified Head and Neck Swallow Scale: Using EORTC-QLQ-H&N35 to Predict Overall Survival

Douglas von Allmen  1 , Alice Tang  1 , Vinita Takiar  2 , Chad Zender  1 , Stephen Romeo  1 , Jessica Masch  1 , Keith Casper  3 , Yash Patil  1 , Keith Wilson  1 , Siddarth Khosla  1 , Liang Niu  4 , Mekibib Altaye  5 , Meredith Tabangin  4 , Rebecca J Howell  1
Affiliations

Modified Head and Neck Swallow Scale: Using EORTC-QLQ-H&N35 to Predict Overall Survival

Douglas von Allmen et al. Laryngoscope. 2021 Nov.

Abstract

Objectives/hypothesis: Dysphagia is a treatment-related complication of head and neck cancer (HNCA). We demonstrate the predictive value of a modified head and neck swallow scale (m-HNSW) adapted from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35 (EORTC-QLQ-H&N35).

Study design: Retrospective Cohort Study.

Methods: Retrospective, single-center cohort study utilizing a prospectively collected database of HNCA patients in a high-volume tertiary referral center. 736 HNCA patients more than 2 years from completion of treatment were identified. EORTC-QLQ-H&N35 data collected from at least one of three defined episodes of care were used. The m-HNSW uses three questions to form a 9-point dysphagia scale. A Cox proportional hazards model was used to determine the effect of the m-HNSW while controlling for demographics, tumor staging, site, and treatment.

Results: Using data from 3, 6, 12 months from treatment, we analyzed a subset that included 328 patients. Three months after the completion of therapy, the m-HNSW score had a significant association with 1 (HR = 1.24, P = .0005) and 5 year survival (HR = 1.19, P = .0002) after accounting for body mass index. Six (HR = 1.14, P = .014) and 12 month (hazard ratio (HR) = 1.33, P < .0001) scores post completion of therapy predict 5-year survival. An increase of the m-HNSW score by 1 point was associated with an increase in death by 24%, and 19% at 1 and 5 years following therapy.

Conclusions: The m-HNSW is a simple assessment of dysphagia using previously validated EORTC-QLC-H&N35 data that when taken at 3, 6, and 12 months after completion of therapy is predictive of overall survival.

Level of evidence: 4 Laryngoscope, 131:2478-2482, 2021.

Keywords: Head and neck cancer; dysphagia; outcomes; quality of life; survival; swallowing.

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References

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