Pharyngeal Dysphagia in Cancer: Characterizing Functional and Physiological Swallow Targets Across 12 Cancer Types.
Beatrice Manduchi, Carla L Warneke, Carly E A Barbon and 4 others
Dysphagia is common across all 12 cancer types studied, but severity and the specific swallowing muscles affected differ by diagnosis.
Multiple cancers including head and neck carried the highest rates of severe impairment. SLPs should expect different swallowing problems depending on cancer type.
Key findings
1Dysphagia prevalence and severity differed significantly across cancer types. Overall impairment (DIGEST ≥1) was most common in patients with multiple cancers including head and neck (70.9%), multiple cancers without HN (62.7%), and CNS cancers (61.1%). Severe-to-profound impairment (DIGEST ≥3) was highest in the multiple-cancers-including-HN group (37.0%).
2The specific swallowing components impaired varied by cancer type. Pharyngeal swallow initiation impairment was most prevalent in multiple-cancer (95.2%) and CNS (93.8%) groups. Anterior hyoid excursion impairment was high in multiple-cancer groups (84.2% and 80.0%), and laryngeal vestibular closure impairment was prominent in multiple-cancers-including-HN (68.0%) and hematologic and gastrointestinal (66.7%) groups.
3The relationship between physiological impairment and functional outcome differed by cancer type. In multiple cancers including HN, safety was most tied to pharyngeal stripping wave and laryngeal vestibular closure, while efficiency was driven by tongue base retraction and pharyngeal contraction. In gastrointestinal cancers, safety correlated with airway protection components and efficiency with pharyngeal contraction and stripping wave.
Still to come
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Single institution (MD Anderson), so findings may not generalize to other cancer centers. Referral bias: MBS referrals typically follow overt symptoms like coughing or choking, so the sample is enriched for more severe impairment. The authors explicitly state that the reported frequencies should not be read as population prevalence. No treatment data were available, so the study cannot determine whether dysphagia was caused by the cancer itself, its treatment, or both. MBSImP data were available for only 704 of 6,423 patients and were not double-rated, introducing potential scoring variability in the physiological analyses. No data on BMI, nutritional status, or physical function were available, so the contribution of sarcopenia could not be formally quantified.
Declared interests
The authors declare no relevant financial or non-financial interests.
The easy way to misread this
Do not read the 70.9% impairment rate in multiple-cancer patients as the prevalence of dysphagia in that population. The sample came from a cancer center where MBS referrals typically follow overt symptoms such as coughing or choking, so the group is enriched for severe cases. The authors state this explicitly and note that the frequencies should not be confused with true prevalence.
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