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An investigation of the prevalence of swallowing difficulties and impact on quality of life in patients with advanced lung cancer

Abstract

Background

Dysphagia can occur in advanced lung cancer due to direct tumour invasion or nerve compression. Anti-cancer treatments and co-morbid conditions may also cause or compound dysphagic symptoms. Speech and language therapy (SLT), medical and surgical interventions are available to address dysphagic symptoms in patients with lung cancer, however, management options are not described in national guidelines. Given the potentially short prognoses for patients with lung cancer, the aim of care should be to reduce symptom burden and maximise quality of life (QOL). Central to that aim is the identification and treatment of swallowing difficulties.

Purpose

This study sought to identify the prevalence and impact of dysphagia on QOL in patients with advanced lung cancer.

Methods

A single-site, prospective, exploratory study was undertaken. Previously validated patient-reported outcome measures of swallowing were used to identify the presence and impact of dysphagia on QOL: EAT-10 assessment and the SWAL-QOL assessment.

Results

Seventy-two participants were recruited with 18.1% identified as having dysphagia on completion of the EAT-10 assessment. On further evaluation using the SWAL-QOL, compromised quality of life was noted with increased fatigue and meal time duration, difficulties with food selection and reduced eating desire. Frequent throat clearing, coughing and perceived pharyngeal stasis were reported.

Conclusions

Dysphagia is a potential symptom in advanced lung cancer which may impact QOL. Patients, carers and healthcare professionals should be aware of this so that early referral to SLT can be expedited. More robust prevalence and interventional studies are required to inform optimal management of this distressing condition.

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Acknowledgements

Miss Grainne Brady, Dr. Mary O′ Brien, Dr. Justin Roe and Dr. Clare Shaw acknowledge support from the National Institute for Health Research (NIHR) and the Royal Marsden/Institute of Cancer Research Biomedical Research Centre.

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Correspondence to Grainne C. Brady.

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Conflict of interest

Miss Brady received funding to complete a Masters of Research degree at Kingston and St. George’s University of London from the National Institute for Health Research (NIHR). The research was carried out as part of the academic programme of study. Miss Brady, Dr. Roe, Dr. Shaw and Dr. O′ Brien are employed by the Royal Marsden NHS Foundation Trust. Dr. Roe is also employed by Imperial College Healthcare NHS Trust. Professor Boaz is employed by Kingston and St George’s University of London. The authors have no other relevant financial or non-financial relationships to disclose. As sponsor for this research project, St George’s University of London have full control of all primary data and with their permission, primary data can be disclosed.

Ethical approval

An application to the National Research Ethics Committee (REC) was submitted in July 2015 and a favourable opinion was granted following proportionate review at meeting dated 15th July 2015. Subsequent approval was granted from the NHS trust host site Research and Development Department in September 2015.

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Brady, G.C., Roe, J.W.G., O’ Brien, M. et al. An investigation of the prevalence of swallowing difficulties and impact on quality of life in patients with advanced lung cancer. Support Care Cancer 26, 515–519 (2018). https://doi.org/10.1007/s00520-017-3858-6

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Keywords

  • Lung cancer
  • Dysphagia
  • End of life care
  • Quality of life
  • Rehabilitation