Quantitative Evaluation of Head and Neck Cancer Treatment-Related Dysphagia in the Development of a Personalized Treatment De-Intensification Paradigm

Publication date: Available online 12 August 2017
Source:International Journal of Radiation OncologyBiologyPhysics
Author(s): Harry Quon, Xuan Hui, Zhi Cheng, Scott Robertson, Luke Peng, Michael Bowers, Joseph Moore, Amanda Choflet, Alex Thompson, Mariah Muse, Ana Kiess, Brandi Page, Carole Fakhry, Christine Gourin, Jolyne O’Hare, Peter Graham, Michal Szczesniak, Julia Maclean, Ian Cook, Todd McNutt
ObjectiveWe hypothesize that quantifying swallow function with multiple patient-reported outcome (PRO) instruments is an important strategy to yield insights in the development of personalized de-intensified therapies seeking to reduce the risk of head and neck cancer treatment-related dysphagia (HNCTD).MethodsIrradiated HNC subjects seen in follow-up care (4/2015 to 12/2015) prospectively completed the Sydney Swallow Questionnaire (SSQ) and the MD Anderson Dysphagia Inventory (MDADI) concurrently on the web-interface to our Xxxxxxxxx database were evaluated. A correlation matrix quantified the relationship between the SSQ and MDADI. Machine-learning unsupervised cluster analysis using the elbow criterion and CLUSPLOT analysis to establish its validity was performed.ResultsWe identified 89 subjects. The MDADI and SSQ scores were moderately but significantly correlated (correlation coefficient -0.69). K-means cluster analysis demonstrated that three unique statistical cohorts (elbow criterion) could be identified with CLUSPLOT analysis confirming that 100% of variances were accounted. Correlation coefficients between the individual items in the SSQ and the MDADI demonstrated weak to moderate negative correlation except for SSQ17 (QoL question).ConclusionsPilot analysis demonstrates the MDADI and SSQ are complementary. Three unique clusters of patients can be defined suggesting that a unique dysphagia signature for HNCTD may be definable. Longitudinal studies relying on only a single PRO such as MDADI may be inadequate for classifying HNCTD.

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