Gastrostomy Utilization by Oropharyngeal Cancer Patients Is Partially Driven by Swallowing Function

Laryngoscope. 2020 Sep;130(9):2153-2159. doi: 10.1002/lary.28312. Epub 2019 Sep 30.


Objective: Oropharyngeal squamous cell carcinoma (OPSCC) incidence is rapidly increasing, as are survival rates, in large part due to the human papillomavirus (HPV). Treatment intensity, however, has remained unchanged, making treatment-related toxicity (i.e., dysphagia) a critical problem for an increasing number of patients. The primary objective of this study was to determine whether pretreatment objective swallowing measures can predict percutaneous fluoroscopic guided gastrostomy tube (PFG) utilization during OPSCC treatment.

Methods: Forty-one newly diagnosed OPSCC patients treated with radiation underwent evaluation of swallow function with modified barium swallow study (MBSS) prior to and at completion of radiation treatment using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST); a subset of patients were evaluated using the MD Anderson Dysphagia Inventory (MDADI).

Results: Patients were male (100%), primarily Caucasian (85.4%) and p16 positive (85.4%) with mean age of 65.7 years. PFG were placed in 70.7% patients (n = 29) and used by 63.4% (n = 26). Pre- and post-treatment DIGEST scores were associated with T-classification (t = -2.9, p = .001, t = -2.7, p = .01) and indicated deteriorating swallow function during treatment (mean change = 0.46 [t = -2.7, p = .01]). DIGEST and MDADI scores were generally not associated with patient PFG utilization. DIGEST and MDADI scores were significantly correlated prior to, but not following completion of treatment.

Conclusion: Pre-treatment DIGEST and patient reported swallowing outcomes (MDADI) can be useful in identifying patients with unsafe and/or grossly inefficient swallowing function. However, objectively measured swallow function was not associated with PFG utilization. Development of PFG placement algorithms (reactive vs. prophylactic) therefore require additional inputs/metrics.

Level of evidence: 4 Laryngoscope, 130:2153-2159, 2020.

Keywords: DIGEST; MDADI; Oropharynx; Veteran; gastrostomy; swallowing.

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell / complications
  • Carcinoma, Squamous Cell / physiopathology*
  • Carcinoma, Squamous Cell / therapy
  • Deglutition
  • Deglutition Disorders / epidemiology
  • Deglutition Disorders / etiology
  • Deglutition Disorders / therapy*
  • Female
  • Gastrostomy / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Oropharyngeal Neoplasms / complications
  • Oropharyngeal Neoplasms / physiopathology*
  • Oropharyngeal Neoplasms / therapy
  • Patient Acceptance of Health Care / statistics & numerical data*
  • United States / epidemiology
  • Veterans / statistics & numerical data