Advertisement

Radiotherapy-induced dysphagia and its impact on quality of life in patients with nasopharyngeal carcinoma

  • Honghong Li
  • Liting Li
  • Xiaolong Huang
  • Yi Li
  • Tangjie Zou
  • Xiaohuang Zhuo
  • Yan Chen
  • Yimin LiuEmail author
  • Yamei TangEmail author
Original Article
  • 40 Downloads

Abstract

Purpose

To investigate the swallowing status and its impact on quality of life (QOL) in patients who underwent radiotherapy for nasopharyngeal carcinoma (NPC).

Methods

In this study, 334 patients with NPC who underwent radiotherapy were reviewed. Clinical characteristics, videofluoroscopic swallowing studies (VFSSs), and scores of the World Health Organization quality of life-BREF (WHOQOL-BREF) were retrospectively analyzed for all patients.

Results

In this study, 143 of 334 (42.8%) patients showed dysphagia. The nodular stage N3 of NPC, neoadjuvant and concurrent chemotherapy were clinical predictors for dysphagia. VFSS of patients with dysphagia showed a high incidence of vallecular residue (100%), apraxia (99%), premature bolus loss (98%), bolus formation (98%), pyriform sinus residue (95%), and mastication (94%). Moreover, WHOQOL-BREF scores for the physical health, psychological, and environment domains were lower of the dysphagia group than those of the control group (P < 0.01). Videofluoroscopic dysphagia scale scores showed significant negative correlations with scores for the physical health (R = −0.66, P < 0.01), psychological (R = −0.70, P < 0.01), social relationships (R = −0.56, P < 0.01), and environment (R = −0.61, P < 0.01) domains of WHOQOL-BREF.

Conclusions

Radiotherapy-induced dysphagia is common in NPC patients and is correlated with poor quality of life. Patients, caregivers, and clinical physicians should be aware of these adverse effects and provide timely treatment for radiotherapy-induced dysphagia in collaboration with cross-disciplinary colleagues.

Keywords

Radiotherapy Dysphagia NPC Videofluoroscopic swallowing study Quality of life 

Strahlentherapieinduzierte Dysphagie und ihr Einfluss auf die Lebensqualität von Menschen mit Nasopharynxkarzinom

Zusammenfassung

Zielsetzung

Untersuchung der Schluckfunktion und ihre Auswirkungen auf die Lebensqualität (QOL) bei Patienten, die eine Strahlentherapie aufgrund eines Nasopharynxkarzinoms (NPC) erhalten haben.

Methoden

In dieser Studie wurden 334 Patienten mit NPC, die eine Strahlentherapie erhielten, überprüft. Klinische Parameter, videofluoroskopische Schluckstudien (VFSS) und Ergebnisse aus dem World Health Organization Quality of Life Bref (WHOQOL-BREF), der die Lebensqualität von Patienten einschätzt, wurden retrospektiv für alle Patienten analysiert.

Ergebnisse

In dieser Studie zeigten 143 von 334 (42,8%) Patienten eine Dysphagie. Das noduläre Stadium N3 von NPC, neoadjuvante und gleichzeitige Chemotherapie waren klinische Prädiktoren für Dysphagie. Die VFSS von Patienten mit Dysphagie zeigten eine hohe Inzidenz von vallekulären Rückständen (100%), Apraxie (99%), vorzeitigem Bolusverlust (98%), Bolusbildung (98%), Resten des Sinus piriformis (95%) und Mastikation (94%). Darüber hinaus waren die Ergebnisse des WHOQOL-BREF für psychische Gesundheit, physische und Umwelt-Domäne bei der Dysphagie-Gruppe niedriger als bei der Kontrollgruppe (P < 0,01). Die videofluoroskopischen Dysphagie-Skalenwerte der WHOQOL-BREF für die Bereiche körperliche Gesundheit (R = −0,66; P < 0,01), psychologische (R = −0,70; P < 0,01) und soziale Beziehungen (R = −0,56; P < 0,01) und Umwelt (R = −0,61; P < 0,01) zeigten signifikante negative Korrelationen.

Schlussfolgerung

Strahlentherapieinduzierte Dysphagie ist bei NPC-Patienten häufig und korreliert mit schlechter Lebensqualität. Patienten, Pflegepersonal und klinische Ärzte sollten sich dieser Nebenwirkungen bewusst sein und eine zeitnahe Behandlung von strahlentherapieinduzierter Dysphagie in Zusammenarbeit mit interdisziplinären Kollegen anbieten.

Schlüsselwörter

Strahlentherapie Dysphagie NPC Videofluoroskopische Schluckstudie Lebensqualität 

Notes

Author Contributions

H. Li, L. Li and X. Huang, Yimin Liu and Yamei Tang contributed equally to the study. Honghong Li, data acquisition and evaluation, manuscript writing. Liting Li, data collection, analysis and interpretation. Xiaolong Huang, data analysis, drafting and manuscript revision. Yi Li, data collection and analysis. Tangjie Zou, data collection. Xiaohuang Zhuo, data interpretation, manuscript revision. Yan Chen, data collection. Yimin Liu, manuscript revision. Yamei Tang, study conception and design, manuscript revision, and approval of the version to be published.

Funding

This study was funded by National Natural Science Foundation of China (No. 81471249, 81622041), Major Program of Collaborative Innovation Specialized in Livehood Science Topics (201604020097), Science and Technology Planning Project of Guangdong Province (2016A050502016), and Tip-top Scientific and Technical Innovative Youth Talents of the Guangdong special support program (No. 2016TQ03R559) to Yamei Tang. Science and Technology Planning Project of Guangzhou (201704030033), and Young Teacher Training Program of Sun Yat-sen University (17ykpy38) to Yi Li.

Compliance with ethical guidelines

Conflict of interest

H. Li, L. Li, X. Huang, Y. Li, T. Zou, X. Zhuo, Y. Chen, Y. Liu and Y. Tang declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

References

  1. 1.
    Zhang LF, Li YH, Xie SH et al (2015) Incidence trend of nasopharyngeal carcinoma from 1987 to 2011 in Sihui County, Guangdong Province, South China: an age-period-cohort analysis. Chin J Cancer 34:350–357Google Scholar
  2. 2.
    Dong YY, Xiang C, Lu JX et al (2016) Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: a matched-pair multicenter analysis of outcomes. Strahlenther Onkol 192:394–402CrossRefGoogle Scholar
  3. 3.
    Tonoli S, Alterio D, Caspiani O et al (2016) Nasopharyngeal carcinoma in a low incidence European area: a prospective observational analysis from the Head and Neck Study Group of the Italian Society of Radiation Oncology (AIRO). Strahlenther Onkol 192:931–943CrossRefGoogle Scholar
  4. 4.
    Lertbutsayanukul C, Prayongrat A, Kannarunimit D et al (2018) A randomized phase III study between sequential versus simultaneous integrated boost intensity-modulated radiation therapy in nasopharyngeal carcinoma. Strahlenther Onkol.  https://doi.org/10.1007/s00066-017-1251-5 Google Scholar
  5. 5.
    Sahai P, Mohanti BK, Sharma A et al (2017) Clinical outcome and morbidity in pediatric patients with nasopharyngeal cancer treated with chemoradiotherapy. Pediatr Blood Cancer 64:259–266CrossRefGoogle Scholar
  6. 6.
    De Felice F, de Vincentiis M, Luzzi V et al (2018) Late radiation-associated dysphagia in head and neck cancer patients: evidence, research and management. Oral Oncol 77:125–130CrossRefGoogle Scholar
  7. 7.
    Tribius S, Meyer MS, Pflug C et al (2018) Socioeconomic status and quality of life in patients with locally advanced head and neck cancer. Strahlenther Onkol.  https://doi.org/10.1007/s00066-018-1305-3 Google Scholar
  8. 8.
    Ursino S, D’Angelo E, Mazzola R et al (2017) A comparison of swallowing dysfunction after three-dimensional conformal and intensity-modulated radiotherapy: a systematic review by the Italian head and neck radiotherapy study group. Strahlenther Onkol.  https://doi.org/10.1007/s00066-017-1160-7 Google Scholar
  9. 9.
    Pikus L, Levine MS, Yang YX et al (2003) Videofluoroscopic studies of swallowing dysfunction and the relative risk of pneumonia. AJR Am J Roentgenol 180:1613–1616CrossRefGoogle Scholar
  10. 10.
    Chang YC, Chen SY, Lui LT et al (2003) Dysphagia in patients with nasopharyngeal cancer after radiation therapy: a videofluoroscopic swallowing study. Dysphagia 18:135–143CrossRefGoogle Scholar
  11. 11.
    Iwasaki H, Mizushima T, Suzuki Y et al (2017) Factors that affect stent-related complications in patients with malignant obstruction of the esophagus or gastric cardia. Gut Liver 11:47–54CrossRefGoogle Scholar
  12. 12.
    Keage MJ, Delatycki MB, Gupta I et al (2017) Dysphagia in Friedreich Ataxia. Dysphagia.  https://doi.org/10.1007/s00455-017-9804-4 Google Scholar
  13. 13.
    Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474CrossRefGoogle Scholar
  14. 14.
    Costa MM (2010) Videofluoroscopy: the gold standard exam for studying swallowing and its dysfunction. Arq Gastroenterol 47:327–328CrossRefGoogle Scholar
  15. 15.
    Ding X, Gao J, Xie C et al (2017) Prevalence and clinical correlation of dysphagia in Parkinson disease: a study on Chinese patients. Eur J Clin Nutr.  https://doi.org/10.1038/ejcn.2017.100 Google Scholar
  16. 16.
    Rofes L, Arreola V, Mukherjee R et al (2014) The effects of a xanthan gum-based thickener on the swallowing function of patients with dysphagia. Aliment Pharmacol Ther 39:1169–1179CrossRefGoogle Scholar
  17. 17.
    Kim J, Oh BM, Kim JY et al (2014) Validation of the videofluoroscopic dysphagia scale in various etiologies. Dysphagia 29:438–443CrossRefGoogle Scholar
  18. 18.
    Han TR, Paik NJ, Park JW, Kwon BS (2008) The prediction of persistent dysphagia beyond six months after stroke. Dysphagia 23:59–64CrossRefGoogle Scholar
  19. 19.
    Skevington SM, Lotfy M, O’Connell KA (2004) The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res 13:299–310CrossRefGoogle Scholar
  20. 20.
    Visser S, de Mol M, Cheung K et al (2018) Treatment satisfaction of patients with advanced non-small-cell lung cancer receiving platinum-based chemotherapy: results from a prospective cohort study (PERSONAL). Clin Lung Cancer 19:e503–e516CrossRefGoogle Scholar
  21. 21.
    Tang Y, Luo D, Rong X et al (2012) Psychological disorders, cognitive dysfunction and quality of life in nasopharyngeal carcinoma patients with radiation-induced brain injury. PLoS ONE 7:e36529CrossRefGoogle Scholar
  22. 22.
    Feng FY, Kim HM, Lyden TH et al (2010) Intensity-modulated chemoradiotherapy aiming to reduce dysphagia in patients with oropharyngeal cancer: clinical and functional results. J Clin Oncol 28:2732–2738CrossRefGoogle Scholar
  23. 23.
    Schindler A, Denaro N, Russi EG et al (2015) Dysphagia in head and neck cancer patients treated with radiotherapy and systemic therapies: literature review and consensus. Crit Rev Oncol Hematol 96:372–384CrossRefGoogle Scholar
  24. 24.
    Eisbruch A, Lyden T, Bradford CR et al (2002) Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 53:23–28CrossRefGoogle Scholar
  25. 25.
    Lastrucci L, Bertocci S, Bini V et al (2017) Late toxicity, evolving radiotherapy techniques, and quality of life in nasopharyngeal carcinoma. Radiol Med 122:303–308CrossRefGoogle Scholar
  26. 26.
    Chang A, Hung A, Cheung F et al (2016) Comparison of planning quality and efficiency between conventional and knowledge-based algorithms in nasopharyngeal cancer patients using intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 95:981–990CrossRefGoogle Scholar
  27. 27.
    Chen J, Hu F (2015) Clinical and prognostic analysis in 32 pediatric nasopharyngeal carcinoma. J Cancer Res Ther 11(Suppl 2):C226–C229Google Scholar
  28. 28.
    Murphy BA, Deng J (2015) Advances in supportive care for late effects of head and neck cancer. J Clin Oncol 33:3314–3321CrossRefGoogle Scholar
  29. 29.
    Carrion S, Cabre M, Monteis R et al (2015) Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohort of older patients admitted with an acute disease to a general hospital. Clin Nutr 34:436–442CrossRefGoogle Scholar
  30. 30.
    Pauloski BR, Rademaker AW, Lazarus C et al (2009) Relationship between manometric and videofluoroscopic measures of swallow function in healthy adults and patients treated for head and neck cancer with various modalities. Dysphagia 24:196–203CrossRefGoogle Scholar
  31. 31.
    Kapur TR (1968) Late post radiation changes in the larynx, pharynx, oesophagus and the trachea. J Laryngol Otol 82:447–457CrossRefGoogle Scholar
  32. 32.
    Hughes PJ, Scott PM, Kew J et al (2000) Dysphagia in treated nasopharyngeal cancer. Head Neck 22:393–397CrossRefGoogle Scholar
  33. 33.
    Wu CH, Hsiao TY, Ko JY, Hsu MM (2000) Dysphagia after radiotherapy: endoscopic examination of swallowing in patients with nasopharyngeal carcinoma. Ann Otol Rhinol Laryngol 109:320–325CrossRefGoogle Scholar
  34. 34.
    Patterson M, Brain R, Chin R et al (2014) Functional swallowing outcomes in nasopharyngeal cancer treated with IMRT at 6 to 42 months post-radiotherapy. Dysphagia 29:663–670CrossRefGoogle Scholar
  35. 35.
    Eisbruch A, Levendag PC, Feng FY et al (2007) Can IMRT or brachytherapy reduce dysphagia associated with chemoradiotherapy of head and neck cancer? The Michigan and Rotterdam experiences. Int J Radiat Oncol Biol Phys 69:S40–S42CrossRefGoogle Scholar
  36. 36.
    Lim SH, Lieu PK, Phua SY et al (2001) Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients. Dysphagia 16:1–6CrossRefGoogle Scholar
  37. 37.
    Carroll WR, Locher JL, Canon CL et al (2008) Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope 118:39–43CrossRefGoogle Scholar
  38. 38.
    Kulbersh BD, Rosenthal EL, McGrew BM et al (2006) Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. Laryngoscope 116:883–886CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Honghong Li
    • 1
  • Liting Li
    • 2
  • Xiaolong Huang
    • 3
  • Yi Li
    • 1
  • Tangjie Zou
    • 1
  • Xiaohuang Zhuo
    • 1
  • Yan Chen
    • 1
  • Yimin Liu
    • 2
    Email author
  • Yamei Tang
    • 1
    • 4
    • 5
    Email author
  1. 1.Department of Neurology, Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhou, Guangdong ProvinceChina
  2. 2.Department of Radiation Oncology, Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhouChina
  3. 3.Department of Intensive Care MedicineThe First Affiliated Hospital of Xiamen UniversityXiamen cityChina
  4. 4.Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhouChina
  5. 5.Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of MedicineSun Yat-Sen UniversityGuangzhouChina

Personalised recommendations