Decoding Dysphagia: How Patient and Doctor Scores Can Improve Head and Neck Cancer Treatment
"A new study reveals the importance of combining patient and physician assessments for better diagnosis and management of swallowing difficulties after radiotherapy."
Head and neck cancer treatments, particularly radiotherapy (RT) with or without chemotherapy (CT), often lead to a challenging side effect: dysphagia, or difficulty swallowing. While these treatments are crucial for survival, the resulting dysphagia can significantly impact a patient's quality of life. Therefore, accurately assessing and managing dysphagia is paramount.
Historically, there's been a disconnect between how patients perceive their swallowing difficulties and how physicians assess them. Some studies have shown conflicting results regarding the associations of patient-scored dysphagia and physician-scored dysphagia. This discrepancy may arise because patients may have a low socio-economic status, and thus, can be challenging.
A recent study published in Dysphagia aimed to bridge this gap by investigating the correlation between patient-reported dysphagia, physician evaluations, and objective measures obtained through videofluoroscopies (swallowing X-ray studies). This article breaks down the study's findings, highlighting the importance of considering both perspectives for optimal patient care.
The Study: Combining Perspectives for a Clearer Picture
Researchers at two centers evaluated 63 patients undergoing radiotherapy for head and neck cancer. They collected data at baseline, 6 months, and 12 months post-treatment, employing a comprehensive approach:
- Physician-Scored Dysphagia: Physicians assessed dysphagia using the Common Terminology Criteria for Adverse Events (CTCAE) and the Radiation Therapy Oncology Group (RTOG)/European Organisation for Research and Treatment of Cancer (EORTC) late toxicity scoring systems.
- Videofluoroscopies: These swallowing X-ray studies provided an objective assessment of swallowing function. Two observers evaluated the videofluoroscopies using the Penetration-Aspiration Scale (PAS) and the Swallowing Performance Status Scale (SPS). The PAS measures the depth of airway invasion by food or liquid, while the SPS assesses overall swallowing ability and aspiration risk.
Key Findings and Implications for Dysphagia Management
The study revealed a significant association between physician- and patient-scored dysphagia, both before and after treatment. This highlights the importance of considering both perspectives when assessing swallowing difficulties.
Furthermore, the risk of observing dysphagia on videofluoroscopies increased significantly with increasing scores of both physician- and patient-scored dysphagia. Interestingly, patient-scored dysphagia correlated better with the PAS, which focuses on airway invasion, while physician-scored dysphagia correlated better with the SPS, which assesses overall swallowing performance.
These findings suggest that patient reports capture the sensory experience of swallowing difficulties (like the feeling of food going down the wrong way), whereas physician evaluations may focus more on the functional aspects of swallowing. Therefore, the researchers advocate for using both patient- and physician-scored dysphagia in future clinical trials and in routine patient care to provide a more complete understanding of the patient's condition and individualize the treatment approach.