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



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.


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.


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.


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.


Dysphagia Swallowing Validation Assessment 


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)


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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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