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Supportive Care in Cancer

, Volume 22, Issue 3, pp 595–602 | Cite as

Development and validation of a cancer-specific swallowing assessment tool: MASA-C

  • Giselle D. CarnabyEmail author
  • Michael A. CraryEmail author
Original Article

Abstract

Objective

We present data from a sample of patients receiving radiotherapy for head/neck cancer to define and measure the validity of a new clinical assessment measure for swallowing.

Methods

Fifty-eight patients undergoing radiotherapy (±chemotherapy) for head/neck cancer (HNC) supported the development of a physiology-based assessment tool of swallowing (Mann Assessment of Swallowing Ability—Cancer: MASA-C) administered at two time points (baseline and following radiotherapy treatment). The new exam was evaluated for internal consistency of items using Cronbach’s alpha. Reliability of measurement was evaluated with intraclass correlation (ICC) and the Kappa statistic between two independent raters. Concurrent validity was established through comparison with the original MASA examination and against the referent standard videofluoroscopic swallowing examination (VFE). Sensitivity, specificity, and likelihood ratios along with 95 % confidence intervals (CIs) were derived for comparison of the two evaluation forms (MASA vs. MASA-C). Accuracy of diagnostic precision was displayed using receiver operator characteristic curves.

Results

The new MASA-C tool demonstrated superior validity to the original MASA examination applied to a HNC population. In comparison to the VFE referent exam, the MASA-C revealed strong sensitivity and specificity (Se 83, Sp 96), predictive values (positive predictive value (PPV) 0.95, negative predictive value (NPV) 0.86), and likelihood ratios (21.6). In addition, it demonstrated good reliability (ICC = 0.96) between speech–language pathology raters.

Conclusions

The MASA-C is a reliable and valid scale that is sensitive to differences in swallowing performance in HNC patients with and without dysphagia. Future longitudinal evaluation of this tool in larger samples is suggested. The development and refinement of this swallowing assessment tool for use in multidisciplinary HNC teams will facilitate earlier identification of patients with swallowing difficulties and enable more efficient allocation of resources to the management of dysphagia in this population. The MASA-C may also prove useful in future clinical HNC rehabilitation trials with this population.

Keywords

Dysphagia Swallowing Validation Assessment 

Notes

Conflict of interest

All authors are free of professional areas of conflict of interest such as financial remuneration as employee, consultant, or subcontractor with companies. We have full control of all primary data, and we agree to allow the journal to review our data if requested.

Supplementary material

520_2013_2011_MOESM1_ESM.docx (18 kb)
ESM 1 (DOCX 18 kb)

References

  1. 1.
    American Cancer Society (2010) Cancer facts and figures 2010. American Cancer Society, AtlantaGoogle Scholar
  2. 2.
    Jemal A, Siegel R, Xu J, Ward EM (2010) Cancer statistics, 2010. CA Cancer J Clin 60(5):277–300PubMedCrossRefGoogle Scholar
  3. 3.
    Blot WJ, McLaughlin JK, Devesa SS, Fraumeni JFJ (1996) Cancers of the oral cavity and pharynx. In: Schottenfeld D, Fraumeni JFJ (eds) Cancer epidemiology and prevention, 2nd edn. Oxford University Press, New YorkGoogle Scholar
  4. 4.
    Chen VW, Wu XC, Andrews PA (eds) (1998) Cancer incidence in North America: 1990–1994, volume 1: incidence. Sacramento, CA; April, 1998. North American Association of Central Cancer RegistriesGoogle Scholar
  5. 5.
    Kulbersh BD, Rosenthal EL, McGrew BM et al (2006) Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. Laryngoscope 116(6):883–886PubMedCrossRefGoogle Scholar
  6. 6.
    Carroll WR et al (2008) Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope 118(1):39–43PubMedCrossRefGoogle Scholar
  7. 7.
    vanDerMolen L et al (2011) A randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: feasibility, compliance, and short-term effects. Dysphagia 26(2):155–70CrossRefGoogle Scholar
  8. 8.
    Kotz T et al (2012) Prophylactic swallowing exercises in patients with head and neck cancer undergoing chemoradiation: a randomized trial. Arch Otolaryngol Head Neck Surg 138(4):376–82PubMedCrossRefGoogle Scholar
  9. 9.
    Carnaby-Mann G et al (2012) “Pharyngocise”: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys 83(1):210–9PubMedCrossRefGoogle Scholar
  10. 10.
    Chen AY, Frankowski R, Bishop-Leone J et al (2001) The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg 127(7):870–876PubMedGoogle Scholar
  11. 11.
    List MA, Ritter-Sterr C, Lansky SB (1990) A performance status scale for head and neck cancer patients. Cancer 66(3):564–569PubMedCrossRefGoogle Scholar
  12. 12.
    Rosenthal DI, Mendoza TR, Chambers MS, Burkett VS, Garden AS, Hessell AC, Lewin JS (2008) The MD Anderson symptom inventory-head and neck module, a patient-reported outcome instrument, accurately predicts the severity of radiation induced mucositis. Int J Radiat Oncol Biol Phys 72(5):1355–61PubMedCrossRefGoogle Scholar
  13. 13.
    Mann G (2002) The Mann Assessment of Swallowing Ability. Singular, Thompson, Delmar Learning, Clifton ParkGoogle Scholar
  14. 14.
    Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL (1996) A penetration-aspiration scale. Dysphagia 11(4):225–233PubMedCrossRefGoogle Scholar
  15. 15.
    Belafsky PC, Mouadeb DA, Rees CJ et al (2008) Validity and reliability of the eating assessment tool (EAT-10). Ann Otol Rhinol Laryngol 117(12):919–924PubMedGoogle Scholar
  16. 16.
    Crary MA, Mann GD, Groher ME (2005) Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil 86(8):1516–1520PubMedCrossRefGoogle Scholar
  17. 17.
    Mann G, Hankey GJ, Cameron D (2000) Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cerebrovasc Dis 10(5):380–386PubMedCrossRefGoogle Scholar
  18. 18.
    Logemann J (1993) Manual for the videofluorographic study of swallowing. 2nd edition: Pro-Ed.Google Scholar
  19. 19.
    Gardner M, Altman D (1989) Calculating confidence intervals for proportions and their differences. Statistics with confidence. The Universities’ Press, BelfastGoogle Scholar
  20. 20.
    Hanley J, McNeil B (1982) The meaning and use of the area under a receiver operator (ROC) curve. Radiology 143:29–36PubMedGoogle Scholar
  21. 21.
    Haas M (1991) Statistical methodology for reliability studies. J Manip Physiol Ther 14(2):119–132Google Scholar
  22. 22.
    Salama J, Stenson K, List M, Mell L et al (2008) Characteristics associated with swallowing changes after concurrent chemotherapy and radiotherapy in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 134(10):1060–1065PubMedCrossRefGoogle Scholar
  23. 23.
    Martin-Harris B, Brodsky M, Michel Y et al (2008) MBS measurement tool for swallow impairment-MBSImp: establishing a standard. Dysphagia 23(4):392–405PubMedCrossRefGoogle Scholar
  24. 24.
    Speyer R, Heijnen B, Baijens L et al (2011) Quality of Life in oncological patients with oropharyngeal dysphagia: validity and reliability of the Dutch version of the MD Anderson Dysphagia Inventory and the Deglutition Handicap Index. Dysphagia 26(4):407–414PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Fletcher R, Fletcher S, Wagner E (1996) Clinical epidemiology: the essentials. Williams and Wilkins, BaltimoreGoogle Scholar
  26. 26.
    Weinstein S, Obuchowski N, Leiber M (2005) Clinical evaluation of diagnostic tests. AJR 184(1):14–19PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Behavioral Science and Community Health, College of Public Health and Health ProfessionsUniversity of FloridaGainesvilleUSA
  2. 2.Department of Speech, Language, and Hearing Science, College of Public Health and Health ProfessionsUniversity of FloridaGainesvilleUSA

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