Predicting two-year longitudinal MD Anderson Dysphagia Inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma

Ryan P. Goepfert; Jan S. Lewin; Martha P. Barrow; C. David Fuller; Stephen Y. Lai; Juhee Song; Brian P. Hobbs; G. Brandon Gunn; Beth M. Beadle; David I. Rosenthal; Adam S. Garden; Merrill S. Kies; Vali A. Papadimitrakopoulou; David L. Schwartz; Katherine A. Hutcheson

doi:10.1002/lary.26153

Predicting two-year longitudinal MD Anderson Dysphagia Inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma

Ryan P. Goepfert, Jan S. Lewin, Martha P. Barrow, C. David Fuller, Stephen Y. Lai, Juhee Song, Brian P. Hobbs, G. Brandon Gunn, Beth M. Beadle, David I. Rosenthal, Adam S. Garden, Merrill S. Kies, Vali A. Papadimitrakopoulou, David L. Schwartz, Katherine A. Hutcheson

Research output: Contribution to journal › Article › peer-review

35 Scopus citations

Abstract

Objectives/Hypothesis: To determine the factors associated with longitudinal patient-reported dysphagia as measured by the MD Anderson Dysphagia Inventory (MDADI) in locoregionally advanced oropharyngeal carcinoma (OPC) survivors treated with split-field intensity modulated radiotherapy (IMRT). Study Design: Retrospective patient analysis. Methods: A retrospective analysis combined data from three single-institution clinical trials for stage III/IV head and neck carcinoma. According to trial protocols, patients had prospectively collected MDADI at baseline, 6, 12, and 24 months after treatment. OPC patients with baseline and at least one post-treatment MDADI were included. Longitudinal analysis was completed with multivariate linear mixed effects modeling. Results: There were 116 patients who met inclusion criteria. Mean baseline MDADI composite was 88.3, dropping to 73.8 at 6 months, and rising to 78.6 and 83.3 by 12 and 24 months, respectively (compared to baseline, all P <.0001). Tumor stage and smoking status were significant predictors of longitudinal MDADI composite scores. Patients with T1, T2, and T3 tumors had 15.9 (P =.0001), 10.9 (P =.0049), and 7.5 (P =.0615), respectively, higher mean MDADI composite than those with T4 tumors, and current smokers had a 9.4 (P =.0007) lower mean MDADI composite than never smokers. Conclusions: Patients report clinically meaningful dysphagia early after split-field IMRT for locoregionally advanced OPC that remains apparent 6 months after treatment. MDADI scores recover slowly thereafter, but remain depressed at 24 months compared to baseline. Higher tumor stage and smoking status are important markers of patient-reported function through the course of treatment, suggesting these are important groups for heightened surveillance and more intensive interventions to optimize swallowing outcomes. Level of Evidence: 4 Laryngoscope, 127:842–848, 2017.

Original language	English (US)
Pages (from-to)	842-848
Number of pages	7
Journal	Laryngoscope
Volume	127
Issue number	4
DOIs	https://doi.org/10.1002/lary.26153
State	Published - Apr 1 2017

Keywords

MD Anderson Dysphagia Inventory
dysphagia
intensity modulated radiotherapy
oropharyngeal carcinoma
patient-reported outcomes

ASJC Scopus subject areas

Otorhinolaryngology

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10.1002/lary.26153

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Goepfert, R. P., Lewin, J. S., Barrow, M. P., Fuller, C. D., Lai, S. Y., Song, J., Hobbs, B. P., Gunn, G. B., Beadle, B. M., Rosenthal, D. I., Garden, A. S., Kies, M. S., Papadimitrakopoulou, V. A., Schwartz, D. L., & Hutcheson, K. A. (2017). Predicting two-year longitudinal MD Anderson Dysphagia Inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma. Laryngoscope, 127(4), 842-848. https://doi.org/10.1002/lary.26153

Goepfert, RP, Lewin, JS, Barrow, MP, Fuller, CD, Lai, SY, Song, J, Hobbs, BP, Gunn, GB, Beadle, BM, Rosenthal, DI, Garden, AS, Kies, MS, Papadimitrakopoulou, VA, Schwartz, DL & Hutcheson, KA 2017, 'Predicting two-year longitudinal MD Anderson Dysphagia Inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma', Laryngoscope, vol. 127, no. 4, pp. 842-848. https://doi.org/10.1002/lary.26153

@article{a17a29b69d52457f93874dea30f1c722,

title = "Predicting two-year longitudinal MD Anderson Dysphagia Inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma",

abstract = "Objectives/Hypothesis: To determine the factors associated with longitudinal patient-reported dysphagia as measured by the MD Anderson Dysphagia Inventory (MDADI) in locoregionally advanced oropharyngeal carcinoma (OPC) survivors treated with split-field intensity modulated radiotherapy (IMRT). Study Design: Retrospective patient analysis. Methods: A retrospective analysis combined data from three single-institution clinical trials for stage III/IV head and neck carcinoma. According to trial protocols, patients had prospectively collected MDADI at baseline, 6, 12, and 24 months after treatment. OPC patients with baseline and at least one post-treatment MDADI were included. Longitudinal analysis was completed with multivariate linear mixed effects modeling. Results: There were 116 patients who met inclusion criteria. Mean baseline MDADI composite was 88.3, dropping to 73.8 at 6 months, and rising to 78.6 and 83.3 by 12 and 24 months, respectively (compared to baseline, all P <.0001). Tumor stage and smoking status were significant predictors of longitudinal MDADI composite scores. Patients with T1, T2, and T3 tumors had 15.9 (P =.0001), 10.9 (P =.0049), and 7.5 (P =.0615), respectively, higher mean MDADI composite than those with T4 tumors, and current smokers had a 9.4 (P =.0007) lower mean MDADI composite than never smokers. Conclusions: Patients report clinically meaningful dysphagia early after split-field IMRT for locoregionally advanced OPC that remains apparent 6 months after treatment. MDADI scores recover slowly thereafter, but remain depressed at 24 months compared to baseline. Higher tumor stage and smoking status are important markers of patient-reported function through the course of treatment, suggesting these are important groups for heightened surveillance and more intensive interventions to optimize swallowing outcomes. Level of Evidence: 4 Laryngoscope, 127:842–848, 2017.",

keywords = "MD Anderson Dysphagia Inventory, dysphagia, intensity modulated radiotherapy, oropharyngeal carcinoma, patient-reported outcomes",

author = "Goepfert, {Ryan P.} and Lewin, {Jan S.} and Barrow, {Martha P.} and Fuller, {C. David} and Lai, {Stephen Y.} and Juhee Song and Hobbs, {Brian P.} and Gunn, {G. Brandon} and Beadle, {Beth M.} and Rosenthal, {David I.} and Garden, {Adam S.} and Kies, {Merrill S.} and Papadimitrakopoulou, {Vali A.} and Schwartz, {David L.} and Hutcheson, {Katherine A.}",

note = "Publisher Copyright: {\textcopyright} 2016 The American Laryngological, Rhinological and Otological Society, Inc.",

year = "2017",

month = apr,

day = "1",

doi = "10.1002/lary.26153",

language = "English (US)",

volume = "127",

pages = "842--848",

journal = "Laryngoscope",

issn = "0023-852X",

publisher = "John Wiley and Sons Inc.",

number = "4",

}

TY - JOUR

T1 - Predicting two-year longitudinal MD Anderson Dysphagia Inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma

AU - Goepfert, Ryan P.

AU - Lewin, Jan S.

AU - Barrow, Martha P.

AU - Fuller, C. David

AU - Lai, Stephen Y.

AU - Song, Juhee

AU - Hobbs, Brian P.

AU - Gunn, G. Brandon

AU - Beadle, Beth M.

AU - Rosenthal, David I.

AU - Garden, Adam S.

AU - Kies, Merrill S.

AU - Papadimitrakopoulou, Vali A.

AU - Schwartz, David L.

AU - Hutcheson, Katherine A.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Objectives/Hypothesis: To determine the factors associated with longitudinal patient-reported dysphagia as measured by the MD Anderson Dysphagia Inventory (MDADI) in locoregionally advanced oropharyngeal carcinoma (OPC) survivors treated with split-field intensity modulated radiotherapy (IMRT). Study Design: Retrospective patient analysis. Methods: A retrospective analysis combined data from three single-institution clinical trials for stage III/IV head and neck carcinoma. According to trial protocols, patients had prospectively collected MDADI at baseline, 6, 12, and 24 months after treatment. OPC patients with baseline and at least one post-treatment MDADI were included. Longitudinal analysis was completed with multivariate linear mixed effects modeling. Results: There were 116 patients who met inclusion criteria. Mean baseline MDADI composite was 88.3, dropping to 73.8 at 6 months, and rising to 78.6 and 83.3 by 12 and 24 months, respectively (compared to baseline, all P <.0001). Tumor stage and smoking status were significant predictors of longitudinal MDADI composite scores. Patients with T1, T2, and T3 tumors had 15.9 (P =.0001), 10.9 (P =.0049), and 7.5 (P =.0615), respectively, higher mean MDADI composite than those with T4 tumors, and current smokers had a 9.4 (P =.0007) lower mean MDADI composite than never smokers. Conclusions: Patients report clinically meaningful dysphagia early after split-field IMRT for locoregionally advanced OPC that remains apparent 6 months after treatment. MDADI scores recover slowly thereafter, but remain depressed at 24 months compared to baseline. Higher tumor stage and smoking status are important markers of patient-reported function through the course of treatment, suggesting these are important groups for heightened surveillance and more intensive interventions to optimize swallowing outcomes. Level of Evidence: 4 Laryngoscope, 127:842–848, 2017.

AB - Objectives/Hypothesis: To determine the factors associated with longitudinal patient-reported dysphagia as measured by the MD Anderson Dysphagia Inventory (MDADI) in locoregionally advanced oropharyngeal carcinoma (OPC) survivors treated with split-field intensity modulated radiotherapy (IMRT). Study Design: Retrospective patient analysis. Methods: A retrospective analysis combined data from three single-institution clinical trials for stage III/IV head and neck carcinoma. According to trial protocols, patients had prospectively collected MDADI at baseline, 6, 12, and 24 months after treatment. OPC patients with baseline and at least one post-treatment MDADI were included. Longitudinal analysis was completed with multivariate linear mixed effects modeling. Results: There were 116 patients who met inclusion criteria. Mean baseline MDADI composite was 88.3, dropping to 73.8 at 6 months, and rising to 78.6 and 83.3 by 12 and 24 months, respectively (compared to baseline, all P <.0001). Tumor stage and smoking status were significant predictors of longitudinal MDADI composite scores. Patients with T1, T2, and T3 tumors had 15.9 (P =.0001), 10.9 (P =.0049), and 7.5 (P =.0615), respectively, higher mean MDADI composite than those with T4 tumors, and current smokers had a 9.4 (P =.0007) lower mean MDADI composite than never smokers. Conclusions: Patients report clinically meaningful dysphagia early after split-field IMRT for locoregionally advanced OPC that remains apparent 6 months after treatment. MDADI scores recover slowly thereafter, but remain depressed at 24 months compared to baseline. Higher tumor stage and smoking status are important markers of patient-reported function through the course of treatment, suggesting these are important groups for heightened surveillance and more intensive interventions to optimize swallowing outcomes. Level of Evidence: 4 Laryngoscope, 127:842–848, 2017.

KW - MD Anderson Dysphagia Inventory

KW - dysphagia

KW - intensity modulated radiotherapy

KW - oropharyngeal carcinoma

KW - patient-reported outcomes

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Predicting two-year longitudinal MD Anderson Dysphagia Inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma

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