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Long-term Functional Outcomes and Patient Perspective Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

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Abstract

With no long-term data available in published research to date, this study presents details of the swallowing outcomes as well as barriers to and facilitators of oral intake and weight maintenance at 2 years after altered fractionation radiotherapy with concomitant boost (AFRT-CB). Twelve patients with T1–T3 oropharyngeal cancer who received AFRT-CB were assessed at baseline, 6 months, and 2 years post-treatment for levels of dysphagia and salivary toxicity, food and fluid tolerance, functional swallowing outcomes, patient-reported function, and weight. At 2 years, participants were also interviewed to explore barriers and facilitators of oral intake. Outcomes were significantly worse at 2 years when compared to baseline for late toxicity, functional swallowing, and patient-rated physical aspects of swallowing. Most patients (83%) tolerated a full diet pretreatment, but the rate fell to 42% (remainder tolerated soft diets) at 2 years. Multiple barriers to oral intake that impacted on activity and participation levels were identified. Participants lost 11 kg from baseline to 2 years, which was not regained between 6 months and 2 years. Global, social, and emotional domains of patient-reported function returned to pretreatment levels. At 2 years post AFRT-CB, worsening salivary and dysphagia toxicity, declining functional swallowing, and multiple reported ongoing barriers to oral intake had a negative impact on participants’ activity and participation levels relating to eating. These ongoing deficits contributed to significant deterioration in physical swallowing functioning determined by the MDADI. In contrast, patients perceived their broader functioning had improved at 2 years, suggesting long-term adjustment to ongoing swallowing deficits.

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Acknowledgment

Funding for this research was obtained as PhD scholarships through the Cancer Council Queensland and Cancer Collaborative Group, Princess Alexandra Hospital.

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Authors and Affiliations

  1. Division of Speech Pathology and Speech Pathology Department, The University of Queensland and Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia

    Bena Cartmill

  2. Griffith Health Institute and Metro North Health Service District, Griffith University and Queensland Health, Mt Gravatt, Brisbane, QLD, 4111, Australia

    Petrea Cornwell

  3. Division of Speech Pathology and Centre for Functioning and Health Research, The University of Queensland and Queensland Health, Buranda, Brisbane, QLD 4102, Australia

    Elizabeth Ward

  4. Dietetics Department, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia

    Wendy Davidson

  5. Radiation Oncology Department and School of Medicine, Princess Alexandra Hospital and The University of Queensland, Woolloongabba, Brisbane, QLD, 4102, Australia

    Sandro Porceddu

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  1. Bena Cartmill
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Correspondence to Bena Cartmill.

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Cartmill, B., Cornwell, P., Ward, E. et al. Long-term Functional Outcomes and Patient Perspective Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer. Dysphagia 27, 481–490 (2012). https://doi.org/10.1007/s00455-012-9394-0

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