Evaluation of Swallowing Function and Aspiration in Newly Diagnosed Head and Neck Cancer Patients.

Abstract

Swallowing difficulties are common in head and neck cancer (HNC) patients, significantly affecting nutrition and quality of life. Early identification of risk factors is essential for timely intervention. A retrospective analysis of 244 newly diagnosed HNC patients was conducted. Swallowing function was assessed using the Penetration-Aspiration Scale (PAS) alongside subjective measures, including the Eating Assessment Tool (EAT-10) and Functional Oral Intake Scale (FOIS). PAS served as the gold standard for identifying aspiration risk factors. Aspiration events, defined as a PAS score of ≥ 6, varied by tumor site. The highest rate of aspiration events was observed in patients with hypopharyngeal cancers (35%), followed by oropharyngeal (24%), oral cavity (12%), and laryngeal cancers (11%). Notably, no aspiration events were identified in cases of nasopharyngeal carcinoma. Multivariate logistic regression analyses identify age, BMI and tumor site as independent predictors of aspiration. A prediction model was then created as follows: Score = (0.060 × Age) - (0.120 × BMI) + 1.587 (if tumor site is oral cavity) + 1.915 (if tumor site is oropharynx) + 2.425 (if tumor site is hypopharynx) + 0 (if tumor site is larynx, nasopharynx, or other sites) - 5.552. This model achieved an AUC of 0.78, with an optimal cutoff score of -2.15, yielding a sensitivity of 45%, specificity of 93%, and accuracy of 86% for predicting aspiration risk. This research highlights the multifactorial nature of dysphagia in HNC patients and introduces a predictive model for aspiration risk. Early identification of high-risk patients enables timely swallowing evaluations and interventions, improving safety and quality of life.