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Self-Reported Trismus: prevalence, severity and impact on quality of life in oropharyngeal cancer survivorship: a cross-sectional survey report from a comprehensive cancer center

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Abstract

Objective

The purpose of this study was to estimate prevalence/severity of self-reported trismus, determine association with quality of life (QOL), and examine clinical risk factors in a large population of patients treated for oropharyngeal cancer.

Materials and methods

A cross-sectional survivorship survey was conducted among patients who completed definitive treatment for oropharyngeal carcinoma, disease-free ≥ 1-year post-treatment (median survival, 7 years among 892 survivors). Associations between trismus and QOL were also analyzed using MDASI-HN, EQ-5D, and MDADI. Dietary and feeding tube status were also correlated to trismus status.

Results

Trismus was self-reported in 31%. Severity of trismus positively correlated (r = 0.29) with higher mean interference scores reflecting a moderate association with quality of life (p < 0.0001). There was a negative correlation for MDADI composite scores (r = − 0.33) indicating increased perceived dysphagia related to trismus severity (p < 0.0001). EQ-5D VAS scores were also negatively correlated with trismus severity (r = − 0.26, p < 0.0001). Larger T-stage (p ≤ 0.001), larger nodal stage (p = 0.03), tumor sub-site (p = 0.05), and concurrent chemoradiation (p = 0.01) associated with increased prevalence of trismus. Diet negatively correlated (r = − 0.27) with trismus severity (p = < 0.0001), and survivors with severe trismus were also more likely to be feeding tube-dependent.

Conclusion

Severity of trismus appears to negatively impact quality of life and associate with various adverse functional outcomes in long-term oropharyngeal cancer survivorship. Trismus remains associated with advanced disease stages, tumor sub-site (tonsil), and addition of chemotherapy. Further investigation is merited for the dose-effect relationship to the muscles of mastication.

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Funding

This work was directly supported by the Charles and Daneen Stiefel Oropharynx Fund at the University of Texas MD Anderson Cancer Center.

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Authors and Affiliations

  1. Departments of Head and Neck Surgery, Medical Oncology, and Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA

    Richard C. Cardoso, Mona Kamal, Jhankruti Zaveri, Mark S. Chambers, G. Brandon Gunn, Clifton D. Fuller, Stephen Y. Lai, Frank E. Mott, Holly McMillan & Katherine A. Hutcheson

Authors
  1. Richard C. Cardoso
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  2. Mona Kamal
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  3. Jhankruti Zaveri
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  4. Mark S. Chambers
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  5. G. Brandon Gunn
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  6. Clifton D. Fuller
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  7. Stephen Y. Lai
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  8. Frank E. Mott
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  10. Katherine A. Hutcheson
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Contributions

All listed co-authors performed the following:

1. Substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of data for the work;

2. Drafting the work or revising it critically for important intellectual content;

3. Final approval of the version to be published;

4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Specific additional individual cooperative effort contributions to study/manuscript design/execution/interpretation, in addition to all criteria above, are listed as follows:

RC, MK, JZ, HM, -Drafted manuscript, undertook supervised analysis and interpretation of data.

KH- Corresponding author; principal investigator; conceived, coordinated, and directed all study activities, responsible for data collection, project integrity, data collection infrastructure, programmatic oversight, direct oversight of classified personnel, manuscript content, and editorial oversight and correspondence.

MC, GBG, CDF, SYL, FM – Co-investigators; direct patient care provision, direct toxicity assessment, and clinical data collection; interpretation and analytic support.

JZ-Data coordination, collection, curation, and supervised analysis.

Corresponding author

Correspondence to Katherine A. Hutcheson.

Ethics declarations

Conflict of interest

RC: This author declares that he has no conflict of interest.

MK: This author declares that she has no conflict of interest.

JZ: This author declares that she has no conflict of interest.

MC: This author declares that he has no conflict of interest.

GBG: This author declares that he has no conflict of interest.

CF: This author declares that he has conflicts of interest as listed on the COI form.

SL: This author declares that he has no conflict of interest.

FM: This author declares that he has no conflict of interest.

HM: This author declares that she has no conflict of interest.

KH: This author declares that she has conflicts of interest as listed on the COI form.

Ethical approval

Ethical approval was waived by the local Ethics Committee of the University of Texas, M.D. Anderson Cancer Center, in view of the retrospective nature of the study, and all the procedures being performed were part of the routine care. Approval for this study was granted by the institutional review board of The University of Texas, M.D. Anderson Cancer Center, PA11-0936.

Consent to participate

Informed consent was obtained by all individual participants included in the study.

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All authors provided consent to publish this work.

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Appendix

Appendix

Fig. 5
figure 5

The participants were asked to measure their mouth opening using finger widths as a measure. In this figure, the question is presented along with a pictorial instruction about how to measure their own mouth opening

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Cardoso, R.C., Kamal, M., Zaveri, J. et al. Self-Reported Trismus: prevalence, severity and impact on quality of life in oropharyngeal cancer survivorship: a cross-sectional survey report from a comprehensive cancer center. Support Care Cancer 29, 1825–1835 (2021). https://doi.org/10.1007/s00520-020-05630-7

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  • DOI: https://doi.org/10.1007/s00520-020-05630-7

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