, Volume 28, Issue 1, pp 24–32 | Cite as

Validation and Application of the M.D. Anderson Dysphagia Inventory in Patients Treated for Head and Neck Cancer in Brazil

  • Renata Lígia Vieira Guedes
  • Elisabete Carrara-de Angelis
  • Amy Y. Chen
  • Luiz Paulo Kowalski
  • José Guilherme VartanianEmail author
Original Article


Analysis of quality of life (QOL) has revealed that preservation of swallowing, speech, and breathing functions has a direct impact on QOL and that these functions are important patient-reported outcomes. The purposes of this study were to adapt and culturally validate the M.D. Anderson Dysphagia Inventory (MDADI) to the Brazilian Portuguese language and to evaluate QOL related to dysphagia in patients treated for head and neck cancer. This was a cross-sectional study that included 72 adult patients with a mean age of 63 years who were treated for head and neck cancer. Construct validity and reliability analyses were performed through the comparison of the MDADI with three other health-related QOL questionnaires administered at the time of enrollment and MDADI application 2 weeks thereafter, respectively. Reliability was established by assuring both internal consistency (Cronbach’s α) and test–retest reliability (intraclass correlation coefficient, ICC). Test–retest reliability for the total score in the MDADI had an ICC greater than 0.795 (p < 0.001). The MDADI had significant statistical correlations with the other questionnaires. Patients treated for head and neck cancer had a mean total score of 83 on the MDADI, which is indicative of minimal limitation in overall QOL. In conclusion, the present study validates the adaptation of the MDADI to the Brazilian Portuguese language and provides another tool to evaluate the impact of dysphagia on the QOL of head and neck cancer patients.


Quality of life Deglutition Deglutition disorders Head and neck neoplasms Questionnaires 



R. L. V. Guedes thanks CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) for financial support.

Conflict of interest

The authors declare that they have no conflicts of interest or financial ties to disclose.


  1. 1.
    Vartanian JG, Carvalho AL, Yueh B, Priante AV, de Melo RL, Correia LM, Köhler HF, Toyota J, Kowalski IS, Kowalski LP. Long-term quality-of-life evaluation after head and neck cancer treatment in a developing country. Arch Otolaryngol Head Neck Surg. 2004;130:1209–13.PubMedCrossRefGoogle Scholar
  2. 2.
    Gillespie MB, Brodsky MB, Day TA, Sharma AK, Lee FS, Martin-Harris B. Laryngeal penetration and aspiration during swallowing after the treatment of advanced oropharyngeal cancer. Arch Otolaryngol Head Neck Surg. 2005;131:615–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Thomas L, Jones TM, Tandon S, Katre C, Lowe D, Rogers SN. An evaluation of the University of Washington quality of life swallowing domain following oropharyngeal cancer. Eur Arch Otorhinolaryngol. 2008;265(Suppl 1):S29–37.PubMedCrossRefGoogle Scholar
  4. 4.
    Gillespie MB, Brodsky MB, Day TA, Lee F, Martin-Harris B. Swallowing-related quality of life after head and neck cancer treatment. Laryngoscope. 2004;114:1362–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin J, Goepfert H. 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. 2001;127:870–6.PubMedGoogle Scholar
  6. 6.
    Kazi R, Prasad V, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Questionnaire analysis of swallowing-related outcomes following glossectomy. ORL J Otorhinolaryngol Relat Spec. 2008;70:151–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Ministério da Saúde. Instituto Nacional de Câncer. Estimativa/2010 incidência de câncer no Brasil. Rio de Janeiro: INCA; 2010.Google Scholar
  8. 8.
    Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46:1417–32.PubMedCrossRefGoogle Scholar
  9. 9.
    Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-reported measure. Spine. 2000;25:3186–91.PubMedCrossRefGoogle Scholar
  10. 10.
    Peters M, Passchier J. Translating instruments for cross-cultural studies in headache research. Headache. 2006;46:82–91.PubMedCrossRefGoogle Scholar
  11. 11.
    Vartanian JG, Carvalho AL, Yueh B, Furia CL, Toyota J, McDowell JA, Weymuller EA Jr, Kowalski LP. Brazilian–Portuguese validation of the University of washington quality of life questionnaire for patients with head and neck cancer. Head Neck. 2006;28:1115–21.PubMedCrossRefGoogle Scholar
  12. 12.
    McHorney CA, Bricker DE, Kramer AE, Rosenbek JC, Robbins J, Chignell KA, Logemann JA, Clarke C. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I—conceptual foundation and item development. Dysphagia. 2000;15:115–21.PubMedGoogle Scholar
  13. 13.
    McHorney CA, Bricker DE, Robins J, Kramer AE, Rosenbek JC, Chignel K. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: II—item reduction and preliminary scaling. Dysphagia. 2000;15:122–33.PubMedGoogle Scholar
  14. 14.
    McHorney CA, Bricker DE, Robins J, Kramer AE, Rosenbek JC, Chignel K. The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III—documentation of reliability and validity. Dysphagia. 2002;17:97–114.PubMedCrossRefGoogle Scholar
  15. 15.
    Portas JG. Validação para a língua portuguesa–brasileira dos questionários: qualidade de vida em disfagia (SWAL-QOL) e satisfação do paciente e qualidade do cuidado no tratamento da disfagia (SWALCARE). São Paulo: Dissertação de Mestrado-Fundação Antônio Prudente; 2009.Google Scholar
  16. 16.
    Botega NJ, Bio MR, Zomignani MA, Garcia C Jr, Pereira WAB. Mood disorders among medical in-patients: a validation study of the hospital anxiety and depression scale (HAD). Rev Saúde Pública. 1995;29:355–63.PubMedCrossRefGoogle Scholar
  17. 17.
    Hassan SJ, Weymuller EA Jr. Assessment of quality of life in head and neck cancer patients. Head Neck. 1993;15(6):485–96.PubMedCrossRefGoogle Scholar
  18. 18.
    Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. 2nd ed. Oxford: Oxford University Press; 1989.Google Scholar
  19. 19.
    Deyo RA, Diehr P, Patrick DL. Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation. Control Clin Trials. 1991;12(suppl):142S–58S.PubMedCrossRefGoogle Scholar
  20. 20.
    Chen PH, Golub JS, Hapner ER, Johns MM III. Prevalence of perceived dysphagia and quality-of-life impairment in a geriatric population. Dysphagia. 2009;24:1–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Rogers SN, Laher H, Overend L, Lowe D. Importance-rating using the University of Washington quality-of-life questionnaire in patients treated by primary surgery for oral and oropharyngeal cancer. J Craniomaxillofac Surg. 2002;30:125–32.PubMedCrossRefGoogle Scholar
  22. 22.
    Bandeira AKC, Azevedo EH, Vartanian JG, Nishimoto IN, Kowalski LP, Carrara-de Angelis E. Quality of life related to swallowing after tongue cancer treatment. Dysphagia. 2008;23(2):183–92.CrossRefGoogle Scholar
  23. 23.
    Gliklich RE, Goldsmith TA, Funk GF. Are head and neck specific quality of life measures necessary? Head Neck. 1997;19:474–80.PubMedCrossRefGoogle Scholar
  24. 24.
    Bland JM, Altman DG. Cronbach’s alpha. Br Med J. 1997;314:572.CrossRefGoogle Scholar
  25. 25.
    Menezes PR, Nascimento AF. Validade e confiabilidade das escalas de avaliação em psiquiatria. In: Gorenstein C, Andrade LHSG, Zuardi AW (organizadores). Escalas de avaliação clínica em Psiquiatria e psicofarmacologia. São Paulo: Lemos Editorial; 2000. p. 23–8.Google Scholar
  26. 26.
    Schindler A, Borghi E, Tiddia C, Ginocchio D, Felisati G, Ottaviani F. Adaptation and validation of the Italian MD Anderson dysphagia inventory (MDADI). Rev Laryngol Otol Rhinol. 2008;129:97–100.Google Scholar
  27. 27.
    Braz DSA, Ribas MM, Dedivitis RA, Nishimoto IN, Barros APB. Quality of life and depression in patients undergoing total and partial laryngectomy. Clinics. 2005;60:135–42.PubMedCrossRefGoogle Scholar
  28. 28.
    Goguen LA, Posner MR, Norris CM, Tishler RB, Wirth LJ, Annino DJ, Gagne A, Sullivan CA, Sammartino DE, Haddad RI. Dysphagia after sequential chemoradiation therapy for advanced head and neck cancer. Otolaryngol Head Neck Surg. 2006;134:916–22.PubMedCrossRefGoogle Scholar
  29. 29.
    Gaziano JE. Evaluation and management of oropharyngeal dysphagia in head and neck cancer. Cancer Control. 2002;9:400–9.PubMedGoogle Scholar
  30. 30.
    Nguyen NP, Frank C, Moltz CC, Vos P, Smith HJ, Karlsson U, Dutta S, Midyett A, Barloon J, Sallah S. Impact of dysphagia on quality of life after treatment of head and neck cancer. Int J Radiat Oncol Biol Phys. 2005;61:772–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Nguyen NP, Frank C, Moltz CC, Vos P, Smith HJ, Nguyen PD, Martinez T, Karlsson U, Dutta S, Lemanski C, Nguyen LM, Sallah S. Analysis of factors influencing aspiration risk following chemoradiation for oropharyngeal cancer. Br J Radiol. 2009;82:675–80.PubMedCrossRefGoogle Scholar
  32. 32.
    Carrara-de Angelis E, Mourão LF, Furia CLB. Avaliação e tratamento das disfagias após o tratamento do câncer de cabeça e pescoço. In: Carrara-de Angelis E, Furia CLB, Mourão LF, Kowalski LP, editors. A atuação da fonoaudiologia no câncer de cabeça e pescoço. São Paulo: Editora Lovise, 2000; p. 155–62.Google Scholar
  33. 33.
    Logemann JA, Rademaker AW, Pauloski BR, Lazarus CL, Mittal BB, Brockstein B, MacCracken E, Haraf DJ, Vokes EE, Newman LA, Liu D. Site of disease and treatment protocol as correlates of swallowing function in patients with head and neck cancer treated with chemoradiation. Head Neck. 2006;28:64–73.PubMedCrossRefGoogle Scholar
  34. 34.
    Teguh DN, Levendang PC, Noever I, van Rooij P, Voet P, van der Est H, Sipkema D, Sewnaik A, de Jong RJB, de la Bije D, Schmitz PI. Treatment techniques and site considerations regarding dysphagia-related quality of life in cancer of the oropharynx and nasopharynx. Int J Radiat Oncol Biol Phys. 2008;72:1119–27.PubMedCrossRefGoogle Scholar
  35. 35.
    Keereweer S, Kerrebijn JD, Al-Mamgani A, Sewnaik A, de Jong RJ, van Meerten E. Chemoradiation for advanced hypopharyngeal carcinoma: a retrospective study on efficacy, morbidity and quality of life. Eur Arch Otorhinolaryngol. 2012;269(3):939–46.PubMedCrossRefGoogle Scholar
  36. 36.
    Maclean J, Cotton S, Perry A. Dysphagia following a total laryngectomy: the effect on quality of life, functioning, and psychological well-being. Dysphagia. 2009;24:314–21.PubMedCrossRefGoogle Scholar
  37. 37.
    Pillon J, Gonçalves MI, De Biase NG. Changes in eating habits following total and frontolateral laryngectomy. Sao Paulo Med J. 2004;122:195–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Campbell BH, Spinelli K, Marbella AM, Myers KB, Kuhn JC, Layde PM. Aspiration, weight loss, and quality of life in head and neck cancer survivors. Arch Otolaryngol Head Neck Surg. 2004;130:1100–3.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Renata Lígia Vieira Guedes
    • 1
  • Elisabete Carrara-de Angelis
    • 1
  • Amy Y. Chen
    • 2
  • Luiz Paulo Kowalski
    • 3
  • José Guilherme Vartanian
    • 3
    Email author
  1. 1.Voice, Speech and Swallowing Rehabilitation DepartmentA. C. Camargo HospitalSão PauloBrazil
  2. 2.Otolaryngology Head and Neck Surgery DepartmentEmory University HospitalAtlantaUSA
  3. 3.Head and Neck Surgery and Otorhinolaryngology DepartmentA. C. Camargo HospitalSão PauloBrazil

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