Prevalence, nature and trajectory of dysphagia postoesophageal cancer surgery: a prospective longitudinal study protocol

Abstract

Introduction: Dysphagia is a common problem following oesophagectomy, and is associated with aspiration pneumonia, malnutrition, weight loss, prolonged enteral feeding tube dependence, in addition to an extended in-hospital stay and compromised quality of life (QOL). To date, the prevalence, nature and trajectory of post-oesophagectomy dysphagia has not been systematically studied in a prospective longitudinal design. The study aims (1) to evaluate the prevalence, nature and trajectory of dysphagia for participants undergoing an oesophagectomy as part of curative treatment, (2) to determine the risk factors for, and post-operative complications of dysphagia in this population and (3) to examine the impact of oropharyngeal dysphagia on health-related QOL across time points.

Methods and analysis: A videofluoroscopy will be completed and analysed on both post-operative day (POD) 4 or 5 and at 6-months post-surgery. Other swallow evaluations will be completed preoperatively, POD 4 or 5, 1-month and 6-month time points will include a swallowing screening test, tongue pressure measurement, cough reflex testing and an oral hygiene evaluation. Nutritional measurements will include the Functional Oral Intake Scale to measure feeding tube reliance, Malnutrition Screening Tool and the Strength, Assistance With Walking, Rise From a Chair, Climb Stairs and Falls questionnaire. The Reflux Symptom Index will be administered to investigate aerodigestive symptoms commonly experienced by adults post-oesophagectomy. Swallowing-related QOL outcome measures will be determined using the European Organisation for Research and Treatment of Cancer QLQ-18, MD Anderson Dysphagia Inventory and the Swallowing Quality of Life Questionnaire.

Ethics and dissemination: Ethical approval has been granted by the Tallaght University Hospital/St. James' Hospital Research Ethics Committee (JREC), Dublin, Ireland (Ref. No. 2021-Jul-310). The study results will be published in peer-reviewed journals and presented at national and international scientific conferences.

Keywords: adult intensive & critical care; gastrointestinal tumours; oesophageal disease.

Figure 1

Study flowchart. CRT, cough reflex testing; EORTC-20, EORTC Quality of Life Questionnaire-18; FOIS, Functional Oral Intake Scale; IOPI, Iowa Oral Performance Instrument; MDADI, MD Anderson Dysphagia Inventory; MST, malnutrition screening tool; OHAT, oral health assessment tool; PIL, patient information leaflet; SARC-F, Strength, Assistance with Walking, Rise from a Chair, Climb Stairs, and Falls; SWAL-QOL, The Quality of Life in Swallowing Disorders; UGI, upper gastrointestinal; VFS, videofluoroscopy.

Figure 2

Videofluoroscopy protocol. DIGEST, Dynamic Imaging Grade of Swallowing Toxicity; IDDSI, International Dysphagia Diet Standardisation Initiative.