A combination of outcome measures are required to provide important information on the physiological profile and associated impact of dysphagia in head and neck cancer (HNC). Choosing the most appropriate tool can be a difficult and time-consuming process. The aim of this study was to identify and then compare the content of tools commonly used to assess swallowing post HNC care using the International Classification of Functioning Disability and Health (ICF) as a reference. A literature audit of 11 databases was conducted for relevant articles published between January 2004 and June 2017 and total of 502 papers met the inclusionary criteria. These papers were audited and 27 tools were identified which met the study criteria. The meaningful concepts contained in each tool were mapped to the ICF. Within the 27 tools, 898 meaningful concepts were identified and matched to 60 ICF categories. The most frequently matched ICF categories related to body functions, while comparatively few concepts matched to activity and participation and environmental factors. This study has identified that a large number of tools are currently being used in HNC research to measure swallowing outcomes. The sheer number of tools available to explore dysphagia post HNC highlights the lack of a uniform approach to outcome measurement which limits the potential to compare and combine research studies in order to strengthen treatment evidence. There is a need to develop an international consensus for a core outcome set of swallowing related measures, that capture the holistic impact of dysphagia, for HNC.
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Wall LR, Cartmill B, Ward EC, Hill AJ. Physiological changes to the swallowing mechanism following (chemo)radiotherapy for head and neck cancer: a systematic review. Dysphagia. 2013;28:481–93. https://doi.org/10.1007/s00455-013-9491-8.
Hunter KU, et al. Aspiration pneumonia after chemo-intensity-modulated radiation therapy of oropharyngeal carcinoma and its clinical and dysphagia-related predictors. Head Neck. 2014;36:120–5. https://doi.org/10.1002/hed.23275.
Lazarus CL, et al. Functional outcomes and quality of life after chemoradiotherapy: baseline and 3 and 6 months post-treatment. Dysphagia. 2014;29:365–75. https://doi.org/10.1007/s00455-014-9519-8.
Nund RL, Ward EC, Scarinci NA, Cartmill B, Kuipers P, Porceddu SV. The lived experience of dysphagia following non-surgical treatment for head and neck cancer. Int J Speech Lang Pathol. 2014;16:282–9. https://doi.org/10.3109/17549507.2013.861869.
Cancer Council Australia. Optimal care pathway for people with head and neck cancers. https://www.cancer.orgu.au/ocp. Accessed 9 Dec 2018.
National Institute for Health and Care Excellence (2018) Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over. NICE GUIDELINE 36. https://www.nice.org.uk/guidance/ng36. Accessed 9 Dec 2018.
Nekhlyudov L, et al. Head and neck cancer survivorship care guideline: American Society of Clinical Oncology clinical practice guideline endorsement summary. J Oncol Pract. 2018;14:167–71. https://doi.org/10.1200/JOP.2017.029041.
Martino R, et al. A systematic review of current clinical and instrumental swallowing assessment methods. Curr Phys Med Rehabil Rep. 2013;1:267–79. https://doi.org/10.1007/s40141-013-0033-y.
Speyer R, et al. Psychometric properties of questionnaires on functional health status in oropharyngeal dysphagia: a systematic literature review. Biomed Res Int. 2014;2014:1–11. https://doi.org/10.1155/2014/458678.
Timmerman AA, Speyer R, Heijnen BJ, Klijn-Zwinjnenberg IR. Psychometric characteristics of health-related quality-of-life questionnaires in oropharyngeal dysphagia. Dysphagia. 2014;29:183–98. https://doi.org/10.1007/s00455-013-9511.
Barnhart M, Robinson R, Simms V, Ward EC, Cartmill B, Chandler S, Smee R. Treatment toxicities and their impact on oral intake following non-surgical management for head and neck cancer: a 3 year longitudinal study. Support Care Cancer. 2018;26:2341–51. https://doi.org/10.1007/s00520-018-4076-6.
Moroney LB, et al. Helical IMRT with concurrent chemotherapy for oropharyngeal SCC: a prospective investigation of acute swallowing and toxicity patterns. Head Neck. 2018;40:1955–66. https://doi.org/10.1002/hed.25182.
van der Molen L, van Rossum MA, Ackerstaff AH, Smeele LE, Rasch CR, Hilgers FJ. Pretreatment organ function in patients with advanced head and neck cancer: clinical outcome measures and patients’ views. BMC Ear Nose Throat Disord. 2009. https://doi.org/10.1186/1472-6815-9-10.
Patterson JM, McColl E, Wilson J, Carding P, Rapley T. Head and neck cancer patients’ perceptions of swallowing following chemoradiotherapy. Support Care Cancer. 2015;23:3531–8. https://doi.org/10.1007/s00520-015-2715-8.
Chan KMK, Chan HKW, Siu JYL, Pu D, Nund RL, Ward EC. Impact of head and neck cancer treatment on survivors mealtime experience. Laryngoscope. 2018. https://doi.org/10.1002/lary.27501.
Hutcheson KA, Lewin JS. Functional assessment and rehabilitation: how to maximize outcomes. Otolaryngol Clin N Am. 2013;46:657–70. https://doi.org/10.1016/j.otc.2013.04.006.
World Health Organization. International Classification of Functioning, Disability and Health. Geneva: World Health Organization; 2001.
Nund RL, Ward EC, Scarinci NA, Cartmill B, Kuipers P, Porceddu SV. Application of the International Classification of Functioning, Disability and Health (ICF) to people with dysphagia following non-surgical head and neck cancer management. Dysphagia. 2014;29:692–703. https://doi.org/10.1007/s00455-014-9563-4.
Tschiesner UM, Rogers SN, Harreus U, Berghaus A, Cieza A. Content comparison of quality of life questionnaires used in head and neck cancer based on the international classification of functioning, disability and health: a systematic review. Eur Arch Otorhinolaryngol. 2008;265:627–37. https://doi.org/10.1007/s00405-008-0641-9.
Stucki A, Borchers M, Stucki G, Cieza A, Amann E, Ruof J. Content comparison of health status measures for obesity based on the international classification of functioning, disability and health. J Obes. 2006;30:1791–9. https://doi.org/10.1038/sj.ijo.0803335.
Brockow T, Cieza A, Kuhlow H, Sigl T, Franke T, Harder M, Stucki G. Identifying the concepts contained in outcome measures of clinical trials on musculoskeletal disorders and chronic widespread pain using the International Classification of Functioning, Disability and Health as a reference. J Rehabil Med. 2004;44:30–6. https://doi.org/10.1080/16501960410015371.
Granberg S, Moller K, Skagerstrand A, Moller C, Danermark B. The ICF Core Sets for hearing loss: researcher perspective, part II: linking outcome measures to the International Classification of Functioning, Disability and Health (ICF). Int J Audiol. 2014;53:77–87. https://doi.org/10.3109/14992027.2013.858279.
Cieza A, Brockow T, Ewert T, Amman E, Kolleritis B, Chatterji S, Ustun TB, Stucki G. Linking health-status measurements to the international classification of functioning, disability and health. J Rehabil Med. 2002;34:205–10.
Cieza A, Geyh S, Chatterji S, Kostanjsek N, Ustun B, Stucki G. ICF linking rules: an update based on lessons learned. J Rehabil Med. 2005;37:212–8. https://doi.org/10.1080/16501970510040263.
Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ. Validity and reliability of the eating assessment tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117:919–24. https://doi.org/10.1177/000348940811701210.
List MA, D’Antonio LL, Cella DF, Siston A, Mumby P, Haraf D, Vokes E. The Performance Status Scale for Head and Neck Cancer patients and the Functional Assessment of Cancer Therapy-Head and Neck Scale. A study of utility and validity. Cancer. 1996;77:2294–301.
Perry A, Skeat J. Australian therapy outcome measures (AusTOMs) for speech pathology. Victoria: La Trobe University; 2004.
Trotti A, Colevas AD, Setser A, Rusch V, Jaques D, Budach V, Rubin P. CTCAE v3. 0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol. 2003;13:176–81. https://doi.org/10.1016/S1053-4296(03)00031-6.
Silbergleit AK, Schultz L, Jacobson BH, Beardsley T, Johnson AF. The Dysphagia Handicap Index: development and validation. Dysphagia. 2012;27:46–52. https://doi.org/10.1007/s00455-011-9336-2.
O’Neil KH, Purdy M, Falk J, Gallo L. The dysphagia outcome and severity scale. Dysphagia. 1999;14:139–45. https://doi.org/10.1007/PL00009595.
Bjordal K, et al. Development of a European Organization for Research and Treatment of Cancer (EORTC) questionnaire module to be used in quality of life assessments in head and neck cancer patients. Acta Oncol. 1994;33:879–85.
Bjordal K, et al. Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35. J Clin Oncol. 1999;17:1008–19. https://doi.org/10.1200/JCO.19220.127.116.118.
Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Archiv Phys Med Rehabil. 2005;86:1516–20. https://doi.org/10.1016/j.apmr.2004.11.049.
Salassa JR. A functional outcome swallowing scale for staging oropharyngeal dysphagia. Dig Dis. 1999;7:230–4. https://doi.org/10.1159/000016941.
Funk GF, Karnell LH, Christensen AJ, Moran PJ, Ricks J. Comprehensive head and neck oncology health status assessment. Head Neck. 2003;25:561–75. https://doi.org/10.1002/hed.10245.
Ho KF, Farnell DJ, Routledge JA, Burns MP, Sykes AJ, Slevin NJ, Davidson SE. Comparison of patient-reported late treatment toxicity (LENT-SOMA) with quality of life (EORTC QLQ-C30 and QLQ-H&N35) assessment after head and neck radiotherapy. Radiother Oncol. 2010;97:270–5. https://doi.org/10.1016/j.radonc.2010.01.017.
Carnaby GD, Crary MA. Development and validation of a cancer-specific swallowing assessment tool: MASA-C. Support Care Cancer. 2014;22:595–602. https://doi.org/10.1007/s00520-013-2011-4.
Martin-Harris B, et al. MBS measurement tool for swallow impairment–MBSImp: establishing a standard. Dysphagia. 2008;23:392–405. https://doi.org/10.1007/s00455-008-9185-9.
Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin J, Goepfert H. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg. 2001;127:870–6.
Rademaker AW, Pauloski BR, Logemann JA, Shanahan TK. Oropharyngeal swallow efficiency as a representative measure of swallowing function. J Speech Hear Res. 1994;37:314–25.
Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–8.
List MA, D’Antonio LL, Cella DF, Siston A, Mumby P, Haraf D, Vokes E. The Performance Status Scale for Head and Neck Cancer patients and the Functional Assessment of Cancer Therapy-Head and Neck Scale: a study of utility and validity. Cancer. 1996;77:2294–301.
Ward EC, Conroy AL. Validity, reliability and responsivity of the Royal Brisbane Hospital outcome measure for swollowing. Asia Pacific J Speech Lang Hear. 1999;4:109–29. https://doi.org/10.1179/136132899805577051.
Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European organization for research and treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31:1341–6. https://doi.org/10.1016/0360-3016(95)00060-C.
Dwivedi RC, et al. Validation of the Sydney Swallow Questionnaire (SSQ) in a cohort of head and neck cancer patients. Oral Oncol. 2010;46:e10–4. https://doi.org/10.1016/j.oraloncology.2010.02.004.
McHorney CA, Robbins J, Lomax K, Rosenbek JC, Chignell K, Kramer AE, Bricker DE. The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III documentation of reliability and validity. Dysphagia. 2002;17:97–114. https://doi.org/10.1007/s00455-001-0109-1.
Terrell JE, Nanavati KA, Esclamado RM, Bishop JK, Bradford CR, Wolf GT. Head and neck cancer-specific quality of life. Arch Otolaryngol Head Neck Surg. 1997;123:1125–32.
Rogers SN, Gwanne S, Lowe D, Humphris G, Yueh B, Weymuller EA Jr. The addition of mood and anxiety domains to the University of Washington quality of life scale. Head Neck. 2002;24:521–9. https://doi.org/10.1002/hed.10106.
Murphy BA, et al. Reliability and validity of the Vanderbilt Head and Neck Symptom Survey: a tool to assess symptom burden in patients treated with chemoradiation. Head Neck. 2010;32:26–37. https://doi.org/10.1002/hed.21143.
Patterson JM, Hildreth A, McColl E, Carding PN, Hamilton D, Wilson JA. The clinical application of the 100 mL water swallow test in head and neck cancer. Oral Oncol. 2011;47:180–4. https://doi.org/10.1016/j.oraloncology.2010.11.020.
Henson BS, Inglehart MR, Eisbruch A, Ship JA. Preserved salivary output and xerostomia-related quality of life in head and neck cancer patients receiving parotid-sparing radiotherapy. Oral Oncol. 2001;37:84–93. https://doi.org/10.1016/S1368-8375(00)00063-4.
Chera BS, et al. Recommended patient-reported core set of symptoms to measure in head and neck cancer treatment trials. J Natl Cancer Inst. 2014;106:dju127-dju131. https://doi.org/10.1093/jnci/dju127.
Hutcheson KA, et al. Dynamic Imaging Grade of Swallowing Toxicity (DIGEST): scale development and validation. Cancer. 2017;123:62–70. https://doi.org/10.1002/cncr.30283.
Bressan V, Bagnasco A, Aleo G, Catania G, Zanini MP, Timmins F, Sasso L. The life experience of nutrition impact symptoms during treatment for head and neck cancer patients: a systematic review and meta-synthesis. Support Care Cancer. 2017;25:1699–712. https://doi.org/10.1007/s00520-017-3618-7.
Threats TT. Use of the ICF in dysphagia management. Semin Speech Lang. 2007;28:323–33. https://doi.org/10.1055/s-2007-986529.
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Nund, R.L., Brown, B., Ward, E.C. et al. What Are We Really Measuring? A Content Comparison of Swallowing Outcome Measures for Head and Neck Cancer Based on the International Classification of Functioning, Disability and Health (ICF). Dysphagia 34, 575–591 (2019). https://doi.org/10.1007/s00455-019-10005-0
- Deglutition disorders
- Head and neck cancer
- Outcome measures