Modified Head and Neck Swallow Scale: Using EORTC-QLQ-H&N35 to Predict Overall Survival

Area of Science:

• Oncology
• Otolaryngology
• Quality of Life Research

Background:

• Dysphagia is a common and debilitating complication following head and neck cancer (HNCA) treatment.
• Accurate assessment of dysphagia is crucial for predicting patient outcomes and guiding supportive care.
• Existing quality of life questionnaires offer potential for developing novel predictive tools.

Purpose of the Study:

• To evaluate the predictive value of a modified head and neck swallow scale (m-HNSW) for overall survival in HNCA patients.
• To adapt and validate the m-HNSW using data from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35 (EORTC-QLQ-H&N35).

Main Methods:

• Retrospective cohort study of 736 HNCA patients treated at a tertiary referral center.
• Utilized prospectively collected EORTC-QLQ-H&N35 data from at least one of three defined post-treatment time points.
• Developed the 9-point m-HNSW scale and employed Cox proportional hazards models to assess survival prediction, controlling for clinical factors.

Main Results:

• A subset of 328 patients was analyzed at 3, 6, and 12 months post-treatment.
• The m-HNSW score at 3 months post-therapy significantly predicted 1-year (HR=1.24, P=0.0005) and 5-year survival (HR=1.19, P=0.0002).
• Scores at 6 and 12 months also predicted 5-year survival, with each 1-point increase associated with a 19-24% increase in mortality risk.

Conclusions:

• The m-HNSW is a simple, effective tool for assessing dysphagia in HNCA survivors.
• Utilizing validated EORTC-QLQ-H&N35 data, the m-HNSW measured at 3, 6, or 12 months post-therapy can predict overall survival.
• This scale offers a valuable method for prognostication and potentially informing clinical management decisions.