Patient-Reported Outcomes After Swallowing (SWOARs)-Sparing IMRT in Head and Neck Cancers: Primary Results from a Prospective Study Endorsed by the Head and Neck Study Group (HNSG) of the Italian Association of Radiotherapy and Clinical Oncology (AIRO).
Stefano Ursino, Elisa Calistri, Francesca De Felice and 12 others
PMID 35587295WHAT IT FOUND
Patients with head and neck cancer who had poor swallowing before treatment reported better quality of life after chemoradiotherapy.
Those with good swallowing before treatment reported worse swallowing afterwards. Overall scores stayed similar because these two groups moved in opposite directions.
Key findings
01The overall average swallowing quality of life score did not change significantly from before treatment to 12 months after.
02Patients who started with poor or adequate swallowing scores improved significantly, while those who started with optimal scores worsened.
03Tumours at the base of the tongue were associated with a greater decline in swallowing quality of life scores in patients who started with optimal function.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study used a patient-reported outcome (PRO) as the primary measure, which may underestimate actual swallowing disorders compared to instrumental assessments like FEES or VFS. The classification of patients into 'optimal', 'adequate', and 'poor' groups based on MDADI scores was a post-hoc analysis and the cut-offs are not robustly validated. The minimal clinically important difference (MCID) for longitudinal changes in MDADI scores is not well-established, making it difficult to interpret the clinical significance of the score changes. There was no control group receiving standard IMRT, so it is unclear if the SWOARs-sparing technique specifically prevented worse outcomes or if the observed improvements/declines are typical of all head and neck radiotherapy. Attrition and missing data reduced the sample size from 63 enrolled to 47 analysed, which may introduce bias.
Declared interests
No specific funding sources or conflicts of interest were declared in the provided text.
The easy way to misread this
Do not assume that SWOARs-sparing IMRT universally improves swallowing outcomes. The overall stability in scores masks a significant decline in patients who started with good function, particularly those with base of tongue tumours, and an improvement in those who started with poor function. The results are based on patient perception, not objective swallowing tests.