Dysphagia in solid malignancies outside the head, neck and upper gastrointestinal tract
Citation:KENNY, CIARAN, Dysphagia in solid malignancies outside the head, neck and upper gastrointestinal tract, Trinity College Dublin.School of Medicine, 2019
Background Dysphagia is often associated with head, neck, and upper gastrointestinal (GI) tract cancers. It also occurs in those with solid malignancies outside anatomic swallow regions. When present, it leads to clinical and quality of life (QoL) complications. Existing studies inadequately describe dysphagia in those with malignancies outside the head, neck, and upper GI tract. This thesis identifies the most appropriate published tools to screen, evaluate, and measure QoL impact of dysphagia in this population. It determines whether a novel wireless intra-oral pressure measurement device ('OroPress') may be diagnostically useful. It establishes dysphagia prevalence, predictors, and characteristics in the cohort of interest. Methods A systematic review methodology identified swallow screening, evaluation, and QoL impact measurement tools. A pilot study investigated the feasibility of using OroPress in a cancer population. Once the best-available tools were identified, an epidemiological study examined dysphagia prevalence and predictors, clinical characteristics, nutritional associations, and impact. For this, 385 individuals with malignancies outside the head, neck, and upper GI tract were recruited by consecutive sampling from hospital and hospice settings. Results Systematic review identified no tools that were solely validated in the population of interest, but some with partial validation. These were used for the epidemiological study. OroPress was not feasible to use in a cancer population. Sensor adhesion problems meant that swallow measurement was abandoned, leading to unnecessary burden for patients. Epidemiological analysis showed that 73/385 (19%; 95% CI 15-23) had dysphagia. 64 (88%) were previously undiagnosed. Dysphagia was not severe by Mann Assessment of Swallowing Ability, but diet modification or swallow strategies were required in 73% of cases. Dysphagia was predicted by: cognitive impairment (p=0.03); hospice setting (p=0.002); under palliative care (p=0.004). Dysphagia risk was higher with: increasing age (p=0.003); more cranial nerve deficits (p=0.001); poorer oral health (p=0.048). Swallowing difficulties were associated with cancer cachexia (p=0.03), potentially exacerbating functional decline. Dysphagia presence was associated with poorer global QoL (p=0.002). Thematic analysis showed it caused fear, loss of participation, and loss of pleasure from eating and drinking. Participants associated dysphagia with oral dryness, reduced intake, and taste changes. Conclusions There is an absence of validated tools to adequately examine dysphagia in this population. Development of such tools is urgently needed. Potential tool content is recommended based on findings. Dysphagia was common, high-impact, and under-recognised. It existed throughout the disease trajectory, regardless of tumour of site. It appeared to occur alongside functional decline and was more common in those under hospice and palliative care. Swallow screening should be routine for all oncology and palliative care patients to adequately identify and manage this important symptom.
Author: KENNY, CIARAN
Publisher:Trinity College Dublin. School of Medicine. Discipline of Public Health & Primary Care
Type of material:Thesis
Availability:Full text available