Prevalence of Long-Term Dysphagia in Head and Neck Cancer Survivors Not Receiving Dysphagia Treatment.

Objective: In head and neck cancer (HNC) survivors not actively receiving dysphagia care, long-term dysphagia prevalence, dysphagia-related complications, and quality of life outcomes remain poorly understood. Understanding these outcomes is critical for creating effective HNC survivorship programs.

Methods: HNC survivors who completed cancer treatment > 2 years prior who had not undergone a swallow evaluation or therapy for > 1 year completed the MD Anderson Dysphagia Inventory (MDADI) and reported dysphagia-related complications.

Results: Of 722 invited participants who met inclusion criteria, 143 responded at a median of 5.9 years (IQR: 2.5-10.2 years) post-treatment, including 65 at 2-5 years, 42 at 5-10 years, and 36 at > 10 years. Median time since last speech-language pathologist visit was 2.8 years (IQR 2.1-4.9 years), and 27% had not received any swallow therapy since cancer treatment completion. The most common tumor subsite was oropharynx (n = 103), and most underwent definitive (n = 72) or adjuvant (n = 60) (chemo)radiation. The overall median MDADI score was 80 points (IQR: 62.1-91.6) and 49.6% (n = 71) had moderate to severe dysphagia (MDADI < 80). The most common complications within the 6 months prior to patient contact were unintentional weight loss (7.7%), current gastrostomy tube dependence (4.9%), aspiration pneumonia (1.4%), and dehydration requiring intravenous fluids (1.4%). An MDADI score ≤ 80 was associated with 7.7 times higher odds of dysphagia-related adverse events (95% CI 2.1-28.2, p = 0.002).

Conclusions: Long-term dysphagia is prevalent among HNC survivors not actively receiving dysphagia care, highlighting the need for ongoing swallow function surveillance and proactive dysphagia management strategies tailored to this population.

Level of evidence: 3: