A Follow-up Survey Of Late Swallowing And Feeding Function In Patients With Head And Neck Cancer After Radiotherapy

Objective: To evaluate the late dysphagia of patients with head and neck cancer after radiotherapy,and to analyze the factors that affect the late dysphagia.That can identify high-risk groups in time,and provide a basis for the next preventive and intervention measures.Methods: 172 cases of head and neck cancer treated radiotherapy in the First Affiliated Hospital of Hainan Medical College from January 2015 to April 2020 have been retrospectively reviewed.Swallowing was evaluated by diet assessment tool(EAT-10),and the secondary outcome indicator was oral intake function which was evaluated by the functional oral intake scale(FOIS).In addition,voice function was subjectively evaluated by the GRBAS scale adopting the parameters of G,R,B.Univariate analysis was used to determine the influencing factors with statistical significance,and then used the Logistic multivariate regression analysis determine the main factors affecting swallowing.So builded a multi-parameter model based on the analysis results,drew its ROC curve to predict dysphagia,and evaluated its prediction value.Results:(1)Univariate analysis showed that age,smoking,hypertension,tumor location,T stage,tracheotomy,radiotherapy dose,voice overall grade,roughness and breathiness were statistically different from advanced dysphagia,Logistic multivariate regression analysis showed that age(OR=3.538,95%CI: 1.519-8.239),smoking(OR=8.041,95%CI: 2.111-30.629),radiotherapy dose(OR=2.759,95%CI:1.155-6.589),voice overall grade(OR=5.152,95%CI: 1.989-13.340),roughness(OR=4.866,95%CI: 1.734-13.657,P=0.003)were significantly associated with advanced dysphagia.(2)Univariate analysis showed that age,smoking,hypertension,diabetes,voice overall grade and roughness were statistically different from oral intake function.Logistic multivariate regression analysis showed that age(OR=3.815,95%CI: 1.886-7.714),voice overall grade(OR=6.067,95%CI: 2.973-12.380)was significantly associated with oral intake dysfunction.(3)Based on the results of logistic multivariate regression analysis of dysphagia,a multi-parameter model was constructed with age,smoking,radiotherapy dose,voice overall grade and roughness,and ROC curve analysis was performed.The results showed that the area under the ROC curve predicted by the model is 0.867.When the optimal cut-off value was0.742,the sensitivity was 67.9% and the specificity was 91.7%.Conclusion:(1)Dysphagia often occurs after 6 months of radiotherapy for head and neck cancer,which is a common complication.(2)Age,smoking,radiotherapy dose,and voice function are the independent factors of advanced dysphagia after radiotherapy for patients with head and neck cancer.(3)Age and voice function are the independent factors of oral intake dysfunction after radiotherapy for patients with head and neck cancer.(4)Voice function can be used as an evaluation index to identify whether the swallowing is impaired.