The Role of Dysphagia on Head and Neck Cancer Patients’ Quality of Life, Functional Disabilities and Psychological Distress: Outcomes of Cancer Rehabilitation from an Observational Single-Center Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Sample
- -
- Dysphagia patients: patients who needed speech therapy to treat swallowing disorders affecting ingestion, preparation, or transport of food;
- -
- Control group 1: patients in whom no abnormalities were found regarding swallowing function or other symptoms requiring treatment by speech therapists;
- -
- Control Group 2: patients without dysphagia symptoms who needed speech therapy due to other impairments such as xerostomia, dysgeusia, dysphonia, dysglossia, dyspnoea, painful hardening of throat and muscles.
2.2. Data Collection
2.3. Ethics Approval
2.4. Outcome Assessment
2.5. Rehabilitation Therapeutic Program
2.6. Statistical Analyses
3. Results
3.1. HNC Patient Collective
3.2. Mean Baseline HRQOL Differences Between the Three Groups
3.3. Improvement During Rehabilitation Across Groups
3.4. Psychological Distress
Group | T0 | T1 | Baseline Differences Between Groups | Mean Change During Rehabilitation (Time) | Differences in Mean Changes per Group During Rehabilitation (Time × Group) | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Mean | SD | Mean | SD | p-Value | η2 | p-Value | η2 | p-Value | η2 | ||
Anxiety [0–21] | Dysphagia group | 7.3 | 4.1 | 5.1 | 4.2 | 0.146 | 0.062 | 0.015 | 0.251 | 0.328 | 0.037 |
Control Group 1 | 5.0 | 3.8 | 4.5 | 2.6 | 0.543 | 0.017 | |||||
Control Group 2 | 6.3 | 3.7 | 4.7 | 2.7 | 0.113 | 0.141 | |||||
Total | 6.2 | 4.0 | 4.8 | 3.2 | 0.005 | 0.122 | |||||
Depression [0–21] | Dysphagia group | 6.6 | 4.3 | 4.5 | 4.3 | 0.177 | 0.056 | 0.008 | 0.291 | 0.436 | 0.027 |
Control Group 1 | 4.6 | 3.2 | 3.6 | 3.3 | 0.180 | 0.080 | |||||
Control Group 2 | 6.4 | 4.5 | 4.0 | 2.4 | 0.040 | 0.225 | |||||
Total | 5.8 | 4.1 | 4.0 | 3.4 | <0.001 | 0.197 |
3.5. Multivariate Analysis
4. Discussion
4.1. Unmet Needs: Impact of Dysphagia and Speech Disorders on HRQOL and Functioning
4.2. Effects of Cancer Rehabilitation
4.3. Strengths and Limitations
4.4. Considerations for Further Research
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Total Sample | Dysphagia Patients | Control Group 1 | Control Group 2 | p-Value | |
---|---|---|---|---|---|
N (%) | N (%) | N (%) | N (%) | ||
Sex | |||||
Male | 48 (76.2) | 15 (68.2) | 20 (87.0) | 13 (72.2) | 0.301 |
Female | 15 (23.8) | 7 (31.8) | 3 (13.0) | 5 (27.8) | |
Age | |||||
Mean (SD) | 60.9 (9.2) | 59.8 (7.1) | 61.1 (9.5) | 62.1 (11.2) | 0.725 |
UICC | |||||
I | 3 (4.8) | 0 | 3 (13.0) | 0 | 0.19 |
II | 7 (11.1) | 2 (9.1) | 3 (13.0) | 2 (11.1) | |
III | 15 (23.8) | 4 (18.2) | 7 (30.4) | 4 (22.2) | |
IV | 31 (49.2) | 13 (59.1) | 7 (30.4) | 11 (61.1) | |
Missing | 7 (11.1) | 3 (13.6) | 3 (13.0) | 1 (5.6) | |
Recurrent Disease | |||||
Yes | 8 (12.7) | 3 (13.6) | 3 (13.0) | 2 (11.1) | 0.97 |
No | 55 (87.3) | 19 (86.4) | 20 (87.0) | 16 (88.9) |
Group | T0 | T1 | Baseline (T0) Differences Between Groups | Mean Changes (T1–T0) During Rehabilitation (Time) | Differences in Mean Changes per Group During Rehabilitation (Time × Group) | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Mean | SD | Mean | SD | p-Value | η2 | p-Value | η2 | p-Value | η2 | ||
Global health/QOL [0–100] | Dysphagia group | 48.1 | 17.2 | 62.5 | 20.4 | 0.002 a,c | 0.184 | 0.002 | 0.361 | 0.076 a,c | 0.082 |
Control Group 1 | 67.0 | 19.4 | 68.8 | 15.9 | 0.648 | 0.010 | |||||
Control Group 2 | 50.5 | 19.5 | 63.0 | 18.8 | 0.018 | 0.287 | |||||
Total | 55.7 | 20.3 | 64.9 | 18.3 | <0.001 | 0.200 | |||||
Physical functioning [0–100] | Dysphagia group | 62.1 | 23.1 | 66.7 | 24.4 | 0.030 a | 0.110 | 0.252 | 0.062 | 0.317 a | 0.038 |
Control Group 1 | 79.1 | 19.6 | 78.8 | 22.3 | 0.927 | 0.000 | |||||
Control Group 2 | 69.6 | 20.0 | 77.4 | 21.1 | 0.087 | 0.162 | |||||
Total | 70.5 | 21.9 | 74.2 | 23.0 | 0.068 | 0.054 | |||||
Role functioning [0–100] | Dysphagia group | 58.3 | 29.4 | 68.2 | 29.1 | 0.068 | 0.086 | 0.067 | 0.151 | 0.027 c | 0.114 |
Control Group 1 | 68.8 | 24.3 | 71.0 | 26.7 | 0.657 | 0.009 | |||||
Control Group 2 | 50.0 | 21.4 | 71.3 | 21.2 | <0.001 | 0.625 | |||||
Total | 59.8 | 26.2 | 70.1 | 25.8 | <0.001 | 0.211 | |||||
Social functioning [0–100] | Dysphagia group | 51.5 | 30.4 | 75.8 | 29.9 | 0.001 a,c | 0.197 | 0.004 | 0.337 | 0.204 a,c | 0.052 |
Control Group 1 | 71.7 | 24.8 | 84.1 | 17.0 | 0.035 | 0.188 | |||||
Control Group 2 | 40.7 | 23.0 | 67.6 | 28.9 | <0.001 | 0.658 | |||||
Total | 55.8 | 29.0 | 76.5 | 26.0 | <0.001 | 0.371 | |||||
Emotional functioning [0–100] | Dysphagia group | 50.0 | 29.7 | 75.8 | 28.2 | 0.024 a | 0.117 | <0.001 | 0.525 | 0.135 a | 0.065 |
Control Group 1 | 71.4 | 23.4 | 83.3 | 16.3 | 0.007 | 0.284 | |||||
Control Group 2 | 57.9 | 23.1 | 76.4 | 17.9 | 0.004 | 0.393 | |||||
Total | 60.1 | 26.9 | 78.7 | 21.5 | <0.001 | 0.414 | |||||
Cognitive functioning [0–100] | Dysphagia group | 66.7 | 30.9 | 72.0 | 31.9 | 0.101 | 0.074 | 0.390 | 0.035 | 0.601 | 0.017 |
Control Group 1 | 80.4 | 17.9 | 79.7 | 21.9 | 0.840 | 0.002 | |||||
Control Group 2 | 80.6 | 20.8 | 79.6 | 25.9 | 0.859 | 0.002 | |||||
Total | 75.7 | 24.5 | 77.0 | 26.7 | 0.675 | 0.003 | |||||
Total functioning scale score [0–100] | Dysphagia group | 57.7 | 23.7 | 71.7 | 23.5 | 0.011 a,c | 0.141 | <0.001 | 0.427 | 0.054 a,c | 0.093 |
Control Group 1 | 74.3 | 17.1 | 79.4 | 16.6 | 0.080 | 0.133 | |||||
Control Group 2 | 59.8 | 15.1 | 74.5 | 16.7 | <0.001 | 0.604 | |||||
Total | 64.4 | 20.4 | 75.3 | 19.3 | <0.001 | 0.393 |
Group | T0 | T1 | Baseline (T0) Differences Between Groups | Mean Changes During Rehabilitation (Time) | Differences in Mean Changes per Group During Rehabilitation (Time × Group) | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Mean | SD | Mean | SD | p-Value | η2 | p-Value | η2 | p-value | η2 | ||
Fatigue [0–100] | Dysphagia group | 61.6 | 26.3 | 38.9 | 26.1 | 0.071 | 0.084 | 0.002 | 0.370 | 0.222 a | 0.049 |
Control Group 1 | 44.0 | 28.9 | 33.8 | 22.8 | 0.013 | 0.249 | |||||
Control Group 2 | 51.2 | 17.9 | 33.3 | 20.5 | 0.004 | 0.399 | |||||
Total | 52.2 | 26.0 | 35.4 | 23.2 | <0.001 | 0.336 | |||||
Nausea/ vomiting [0–100] | Dysphagia group | 13.6 | 16.0 | 8.3 | 17.6 | 0.290 | 0.040 | 0.296 | 0.052 | 0.813 | 0.007 |
Control Group 1 | 6.5 | 9.7 | 2.9 | 9.6 | 0.203 | 0.072 | |||||
Control Group 2 | 9.3 | 19.2 | 1.9 | 5.4 | 0.104 | 0.148 | |||||
Total | 9.8 | 15.2 | 4.5 | 12.4 | 0.025 | 0.081 | |||||
Pain (0–100) | Dysphagia group | 53.0 | 28.0 | 44.7 | 31.9 | 0.160 | 0.059 | 0.185 | 0.082 | 0.314 | 0.038 |
Control Group 1 | 39.1 | 27.3 | 40.6 | 30.9 | 0.780 | 0.004 | |||||
Control Group 2 | 38.9 | 26.2 | 29.6 | 23.3 | 0.096 | 0.154 | |||||
Total | 43.9 | 27.6 | 38.9 | 29.5 | 0.100 | 0.044 | |||||
Dysphagia patient dyspnoea (0–100) | Dysphagia group | 25.8 | 32.4 | 30.3 | 32.4 | 0.450 | 0.026 | 0.378 | 0.037 | 0.149 | 0.062 |
Control Group 1 | 33.3 | 37.6 | 31.9 | 32.5 | 0.803 | 0.003 | |||||
Control Group 2 | 38.9 | 26.2 | 27.8 | 28.6 | 0.055 | 0.200 | |||||
Total | 32.3 | 32.8 | 30.2 | 30.9 | 0.401 | 0.012 | |||||
Sleep disturbances [0–100] | Dysphagia group | 47.0 | 33.6 | 24.2 | 29.4 | 0.477 | 0.024 | 0.006 | 0.310 | 0.034 a,c | 0.106 |
Control Group 1 | 36.2 | 30.0 | 37.7 | 33.8 | 0.847 | 0.002 | |||||
Control Group 2 | 46.3 | 34.6 | 27.8 | 30.8 | 0.004 | 0.397 | |||||
Total | 42.9 | 32.5 | 30.2 | 31.5 | 0.002 | 0.149 | |||||
Appetite loss [0–100] | Dysphagia group | 40.9 | 34.0 | 25.8 | 29.0 | 0.438 | 0.027 | 0.047 | 0.175 | 0.866 | 0.005 |
Control Group 1 | 31.9 | 35.5 | 20.3 | 32.9 | 0.073 | 0.139 | |||||
Control Group 2 | 46.3 | 39.8 | 29.6 | 37.7 | 0.035 | 0.237 | |||||
Total | 39.2 | 36.2 | 24.9 | 32.8 | <0.001 | 0.181 | |||||
Constipation (0–100) | Dysphagia group | 15.2 | 24.6 | 15.2 | 24.6 | 0.783 | 0.008 | 1.000 | 0.000 | 0.557 | 0.019 |
Control Group 1 | 13.0 | 19.4 | 10.1 | 23.4 | 0.492 | 0.022 | |||||
Control Group 2 | 18.5 | 30.7 | 11.1 | 19.8 | 0.104 | 0.148 | |||||
Total | 15.3 | 24.6 | 12.2 | 22.6 | 0.212 | 0.026 | |||||
Diarrhea (0–100) | Dysphagia group | 12.1 | 24.2 | 9.1 | 23.4 | 0.507 | 0.022 | 0.680 | 0.008 | 0.940 | 0.002 |
Control Group 1 | 4.3 | 20.9 | 2.9 | 13.9 | 0.328 | 0.043 | |||||
Control Group 2 | 9.3 | 22.3 | 5.6 | 17.1 | 0.163 | 0.111 | |||||
Total | 8.5 | 22.4 | 5.8 | 18.5 | 0.317 | 0.017 | |||||
Financial impact (0–100) | Dysphagia group | 27.3 | 31.9 | 22.7 | 29.8 | 0.560 | 0.019 | 0.378 | 0.037 | 0.662 | 0.014 |
Control Group 1 | 20.3 | 26.1 | 11.6 | 19.1 | 0.056 | 0.157 | |||||
Control Group 2 | 18.5 | 23.5 | 16.7 | 23.6 | 0.790 | 0.004 | |||||
Total | 22.2 | 27.4 | 16.9 | 24.6 | 0.108 | 0.042 | |||||
Total symptom scales score (0–100) | Dysphagia group | 32.9 | 18.4 | 24.4 | 20.1 | 0.318 | 0.038 | 0.041 | 0.184 | 0.353 | 0.034 |
Control Group 1 | 25.4 | 17.1 | 21.3 | 13.9 | 0.120 | 0.106 | |||||
Control Group 2 | 30.8 | 14.9 | 20.4 | 14.3 | 0.001 | 0.476 | |||||
Total | 29.6 | 17.0 | 22.1 | 16.3 | <0.001 | 0.227 |
Mean Change During Rehabilitation (Time, η2) | Differences Between Groups (η2) | Mean Change During Rehabilitation per Group (Time × Group, η2) | |
---|---|---|---|
HADS Anxiety | 0.122 ** | 0.041 | 0.037 |
HADS Depression | 0.197 *** | 0.042 | 0.027 |
QLQ Functioning scales | 0.393 *** | 0.088 | 0.093 |
QLQ Symptom scales | 0.227 *** | 0.023 | 0.034 |
QLQ Global health status | 0.200 *** | 0.124 * | 0.082 |
Multivariate | 0.421 *** | 0.123 | 0.075 |
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Matko, Š.; Knauseder, C.; Riedl, D.; Grote, V.; Fischer, M.J.; Vorbach, S.M.; Pfaller-Frank, K.; Frank, W.; Licht, T. The Role of Dysphagia on Head and Neck Cancer Patients’ Quality of Life, Functional Disabilities and Psychological Distress: Outcomes of Cancer Rehabilitation from an Observational Single-Center Study. Curr. Oncol. 2025, 32, 220. https://doi.org/10.3390/curroncol32040220
Matko Š, Knauseder C, Riedl D, Grote V, Fischer MJ, Vorbach SM, Pfaller-Frank K, Frank W, Licht T. The Role of Dysphagia on Head and Neck Cancer Patients’ Quality of Life, Functional Disabilities and Psychological Distress: Outcomes of Cancer Rehabilitation from an Observational Single-Center Study. Current Oncology. 2025; 32(4):220. https://doi.org/10.3390/curroncol32040220
Chicago/Turabian StyleMatko, Špela, Christina Knauseder, David Riedl, Vincent Grote, Michael J. Fischer, Samuel Moritz Vorbach, Karin Pfaller-Frank, Wilhelm Frank, and Thomas Licht. 2025. "The Role of Dysphagia on Head and Neck Cancer Patients’ Quality of Life, Functional Disabilities and Psychological Distress: Outcomes of Cancer Rehabilitation from an Observational Single-Center Study" Current Oncology 32, no. 4: 220. https://doi.org/10.3390/curroncol32040220
APA StyleMatko, Š., Knauseder, C., Riedl, D., Grote, V., Fischer, M. J., Vorbach, S. M., Pfaller-Frank, K., Frank, W., & Licht, T. (2025). The Role of Dysphagia on Head and Neck Cancer Patients’ Quality of Life, Functional Disabilities and Psychological Distress: Outcomes of Cancer Rehabilitation from an Observational Single-Center Study. Current Oncology, 32(4), 220. https://doi.org/10.3390/curroncol32040220