Grading Dysphagia as a Toxicity of Head and Neck Cancer: Differences in Severity Classification Based on MBS DIGEST and Clinical CTCAE Grades.
Ryan P Goepfert, Jan S Lewin, Martha P Barrow and 5 others
PMID 28836005WHAT IT FOUND
Clinical symptom ratings often mismatch swallowing scans.
Early after treatment, feeding tubes may reflect other side effects rather than true pharyngeal dysphagia. Later on, patients can eat normally despite severe silent dysfunction. Relying on one method alone misses the full picture of swallowing safety.
Key findings
01Agreement between clinical CTCAE grades and MBS DIGEST scores was fair but not strong, with clinical grades overestimating severity in 25% of exams and underestimating it in 39%.
02In patients less than 6 months post-treatment, 17.4% of those rated as having severe dysphagia by clinical standards had no or mild pharyngeal dysphagia on the swallow scan.
03In patients more than 6 months post-treatment, 50% of those with severe pharyngeal dysphagia on the swallow scan had lower clinical grades, with some eating regular diets despite severe dysfunction.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was retrospective, though the data was prospectively collected. The sample size was small (95 patients), so the analysis of timing effects (early vs. late) was exploratory and not sufficiently powered. The study combined patients with different treatment modalities (surgery and non-surgery) and tumor subsites, which may limit generalizability to specific subgroups. The CTCAE grading was done in a highly standardized clinical setting, which may be more sensitive than typical routine practice.
Declared interests
Funded by the National Institutes of Health (N.I.H., Extramural). No other conflicts of interest were reported in the provided text.
The easy way to misread this
Do not assume that a patient eating a regular diet has safe swallowing. In the late post-treatment phase, half of the patients with severe pharyngeal dysfunction on the scan had lower clinical grades, and some reported no symptoms. Clinical assessment alone can miss silent aspiration in long-term survivors.