Swallowing Outcomes for Head and Neck Cancer Patients With Sarcopenia

Introduction: Sarcopenia, characterized by decreased skeletal muscle mass, is associated with worse oncologic outcomes in Head and Neck Cancer (HNC) patients. However, the effect of sarcopenia on swallowing outcomes following HNC treatment is unknown. This study aims to investigate the association of sarcopenia and dysphagia in patients treated for head and neck cancer.

Methods: This is a retrospective review of HNC patients treated at a single tertiary care institution ( Jan 2022 - Jan 2023). Sarcopenia was measured with pre-treatment skeletal muscle index (SMI) calculated using cross-sectional imaging at the 3rd cervical vertebra. Presence of feeding tube, patient-reported dysphagia, and swallowing function were assessed before and after treatment with the Functional Oral Intake Scale (FOIS), Eating Assessment Tool-10 (EAT-10), and Penetration Aspiration Scale (PAS), respectively. Chi-squared analysis determined the relationship between sarcopenia and dysphagia, feeding tube dependence, and aspiration. Multivariate logistic regression analysis identified independent predictors of adverse sequelae.

Results: 112 patients were included, 84 males and 28 females. A total of 69 (61.6%) had sarcopenia. Sarcopenia was significantly associated with elevated risk of pretreatment dysphagia (OR = 2.71, [95% CI, 1.12-6.79]; p< 0.05). Multivariate logistic regression demonstrated that sarcopenia (OR = 10.79, [95% CI, 1.53-228.27]; p< 0.05) and high tumor stage (OR = 6.41, [95% CI, 1.36-42.22]; p< 0.05) were independent predictors for aspiration following treatment for HNC.

Conclusions: Our data indicates that patients with sarcopenia had higher rates of dysphagia before treatment and were more likely to develop aspiration due to treatment. Based on these findings, sarcopenia may be useful for identifying patients at risk of swallowing dysfunction.