How Can Physicians Identify Dysphagia in Patients with Head and Neck Cancer?

Abstract

Objective: The investigators sought to determine the most sensitive indicator for identifying a swallowing problem in patients with HNC who are treated with radiotherapy—patient-report of dysphagia or diet level consumed.

Method: Data were taken from 113 HNC patients. Prevalence of dysphagia was determined by patient report and diet level, then broken out by gender and age. A web-based survey of clinical practice included 759 SLPs who work with HNC patients. Referral patterns and time of first intervention were queried.

Results: Over the first year, prevalence of dysphagia was 8% to 20% higher (worse) by diet restriction than by report of a swallowing problem. Men reported a worse swallowing problem and more diet restrictions than did women (P = .057). Patients younger than 60 years reported worse diet levels and diet restrictions than did older patients (ns). The survey found that 70.6% of SLPs reported no institutional policy, with referrals made on a case by case basis. The prevalent trend (nearly 50%) was for patients to be referred only when a dysphagia presented.

Conclusion: Since most MDs do not refer to SLPs for dysphagia unless the patient reports a problem, it is critical to query the patient carefully. Patients tend to underreport a problem compared to diet level, thus physicians should ask specifically about diet in order to maximize sensitivity. A standardized diet scale is recommended.