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Background: Dysphagia is one of the most significant side effects of head and neck cancer (HNC) treatments, which increases the symptom rate after treatments. This has negative effects on patient quality of life (QoL); therefore, the evaluation of quality of life by standardized instruments is essential to patient-reported outcomes.
Objectives: The purpose of this study was to translate and validate the M.D. Anderson Dysphagia Inventory (MDADI), which is a specific QoL instrument that evaluates the impact of dysphagia on QoL in HNC patients, into the Thai language by a cross-cultural adaptation process. This subsequently determines the reliability of the Thai version of MDADI (MDADI-TH), and to verify a correlation between dysphagia severity and QoL in HNC patients.
Materials and methods: The six steps for a cross-cultural adaptation process, which include: forward translation, translation synthesis, backward translation, expert committee review, pretesting, and final proof reading were performed. Sixty-five HNC patients with dysphagia were included in this study. The patients completed the same questionnaires two weeks after first enrollment, to determine the reliability. The Reliability was determined by internal consistency (Cronbach’s alpha) and test-retest reliability. The correlation was verified between the total score of MDADI-TH and Penetration-aspiration scale, from a video-fluoroscopy swallowing study (VFSS) by independent t-test.
Results: Validation was achieved by a cross-cultural adaptation process, except for one question (E7), which was not equivalent to the original version in semantic proposition. A total of twenty-nine patients completed the same questionnaires two weeks later. The MDADI-TH subscale and total scores showed acceptable internal consistency reliability (ranging from 0.71-0.94), and test-retest reliability (ranging from 0.86-0.99). For the correlation study, a total of sixty patients were able to be examined by VFSS. The results showed that correlation between dysphagia severity and QoL was significant in total scores, the emotional subscale, and the functional subscale (p<0.05).
Conclusion: The MDADI-TH showed good reliability; therefore, the MDADI-TH can be a useful dysphagia-specific QoL instrument, for measuring QoL in Thai patients with HNC. Patients with more severity of dysphagia showed it had a compromising effect on the quality of life, especially in the emotional and functional domains.
Personal views expressed by the contributors in their articles are not necessarily those of the Journal of Associated Medical Sciences, Faculty of Associated Medical Sciences, Chiang Mai University.
Giannitto C, Preda L, Zurlo V, Funicelli L, Ansarin M, Di Pietro S, et al. Swallowing Disorders after Oral Cavity and Pharyngolaryngeal Surgery and Role of Imaging. Gastroenterol Res Pract. 2017; 2017: 1-9. doi: 10.1155/2017/7592034
Moayer R, Sinha U. Dysphagia in head and neck cancer: Crit Rev Oncol Hematol. 2015 Nov; 96(2): 372-84. doi:10.1016/j.critrevonc.2015.06.005.
Wells M, King E, Toft K, MacAulay F, Patterson J, Dougall N, et al. Development and feasibility of a Swallowing intervention Package (SiP) for patients receiving radiotherapy treatment for head and neck cancer—the SiP study protocol. Pilot Feasibility Stud. 2016 Aug; 2: 40. doi: 10.1186/s40814-016-0079-6.
Groher ME, Crary MA. Dysphagia: clinical management in adults and children. 2nd ed. St. Louis, Missouri: Elsevier; 2016.
Nguyen NP, Frank C, Moltz CC, Vos P, Smith HJ, Karlsson U, et al. Impact of dysphagia on quality of life after treatment of head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2005 Mar ; 61(3): 772-8. doi: 10.1016/j.ijrobp.2004.06.017.
Kraaijenga S, Oskam I, van der Molen L, Hamming-Vrieze O, Hilgers F, van den Brekel M. Evaluation of long term (10-years+) dysphagia and trismus in patients treated with concurrent chemo-radiotherapy for advanced head and neck cancer. Oral Oncol. 2015 Aug; 51(8): 787-94. doi: 10.1016/j.oraloncology. 2015.05.003.
Kraaijenga SA, van der Molen L, Jacobi I, Hamming-Vrieze O, Hilgers FJ, van den Brekel MW. Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises. Eur Arch Otorhinolaryngol. 2015 Nov; 272(11): 3521-31. doi: 10.1007/s00405-014-3379-6.
Gonçalves BFdT, Bastilha GR, Costa CdC, Mancopes R. Use of protocols for quality of life in dysphagia: literature review. Rev CEFAC. 2015 Aug; 17(4): 1333-40. https://doi.org/10.1590/1982-0216201517418014.
Garcia-Peris P, Paron L, Velasco C, De la Cuerda C, Camblor M, Bretón I, et al. Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: impact on quality of life. Clin Nutr. 2007 Dec; 26(6): 710-7. doi: 10.1016/j.clnu.2007.08.006.
Hey C, Lange BP, EBERLE S, ZARETSKY Y, SADER R, STÖVER T, et al. Predictability of oral and laryngopharyngeal function for aspiration and limitation of oral intake in patients after surgery for head and neck cancer. Anticancer Res. 2013 Aug; 33(8): 3347-53.
Hutcheson KA, Lewin JS, Barringer DA, Lisec A, Gunn GB, Moore MW, et al. Late dysphagia after radiotherapy-based treatment of head and neck cancer. Cancer. 2012 Dec 1; 118(23): 5793-9. doi: 10.1002/cncr.27631.
Aslan SS. Swallowing and quality of life outcomes early after radiation therapy in head and neck cancer patients. Turk J Physiother Rehabil. 2015; 26(3): 128-134. doi: 10.7603/s40680-015-0020-6
Langendijk JA, Doornaert P, Verdonck-de Leeuw IM, Leemans CR, Aaronson NK, Slotman BJ. Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol. 2008 Aug; 26(22): 3770-6. doi: 10.1200/JCO.2007.14.6647.
Carr AJ, Higginson IJ. Are quality of life measures patient centred? BMJ. 2001 Jun 2; 322(7298): 1357-60. doi: 10.1136/bmj.322.7298.1357.
Kazi R, Sayed S, Dwivedi R. Clinical importance of quality of life measures in head and neck cancer. Indian J Cancer. Jul-Sep 2010; 47(3): 237-8. doi: 10.4103/0019-509X.64705.
Trevittaya P. Concepts of quality of life. J Assoc Med Sci. 2016; 49(2): 171.
Timmerman AA, Speyer R, Heijnen BJ, Klijn-Zwijnenberg IR. Psychometric characteristics of health-related quality-of-life questionnaires in oropharyngeal dysphagia. Dysphagia. 2014 Apr; 29(2): 183-98. doi: 10.1007/s00455-013-9511-8.
Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin J, et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the MD Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg. 2001 Jul; 127(7): 870-6.
Speyer R, Kertscher B, Cordier R. Functional health status in oropharyngeal dysphagia. J Gastroenterol Hepatol Res. 2014; 3(5): 1043-8.
Orlandoni P, Jukic P. Health-related quality of life and functional health status questionnaires in oropharyngeal dysphagia. J Aging Res Clin Pract. 2016; 5(1): 31-7. doi: 10.14283/jarcp.2016.87
Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000 Dec; 25(24): 3186-91. doi: 10.1097/00007632-200012150-00014.
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 Dec; 46(12): 1417-32. doi: 10.1016/0895-4356(93)90142-n.
Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia Spring 1996;11(2):93-8. doi: 10.1007/BF00417897.
Tavakol M, Dennick R. Making sense of Cronbach's alpha. Int J Med Educ. 2011; 2: 53–55. doi: 10.5116/ijme.4dfb.8dfd
Robins, R. W., Fraley, R. C., & Krueger, R. F. Handbook of research methods in personality psychology. New York: The Guilford Press; 2007
Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016 Jun; 15(2): 155-63. doi: 10.1016/j.jcm.2016.02.012.
Taber KS. The use of Cronbach’s alpha when developing and reporting research instruments in science education. J Chiropr Med. 2016 Jun; 15(2): 155-63. doi: 10.1016/j.jcm.2016.02.012.
Andrade MS, Gonçalves AN, Guedes RLV, Barcelos CB, Slobodticov LDAS, Lopes SAC, et al. Correlation between swallowing-related quality of life and videofluoroscopy after head and neck cancer treatment. Codas. 2017 Mar; 29(1): e20150175. doi: 10.1590/2317-1782/20172015175.
Hutcheson KA, Barrow MP, Lisec A, Barringer DA, Gries K, Lewin JS. What is a clinically relevant difference in MDADI scores between groups of head and neck cancer patients? Laryngoscope. 2016 May; 126(5): 1108-13. doi: 10.1002/lary.25778.
Meyer TK, Pisegna JM, Krisciunas GP, Pauloski BR, Langmore SE. Residue influences quality of life independently of penetration and aspiration in head and neck cancer survivors. Laryngoscope. 2017 Jul; 127(7): 1615-1621. doi: 10.1002/lary.26387.
Molfenter SM, Steele CM. The relationship between residue and aspiration on the subsequent swallow: an application of the normalized residue ratio scale. Dysphagia. 2013 Dec; 28(4): 494-500. doi: 10.1007/s00455-013-9459-8
Pauloski BR. Rehabilitation of dysphagia following head and neck cancer. Phys Med Rehabil Clin N Am. 2008 Nov; 19(4): 889-928, x. doi: 10.1016/j.pmr.2008.05.010.
Knigge MA, Thibeault S. Relationship between tongue base region pressures and vallecular clearance. Dysphagia. 2016 Jun; 31(3): 391-7. doi: 10.1007/s00455-015-9688-0.
Murphy BA, Ridner S, Wells N, Dietrich M. Quality of life research in head and neck cancer: a review of the current state of the science. Crit Rev Oncol Hematol. 2007 Jun;62(3):251-67. doi: 10.1016/j.critrevonc.2006.07.005.
Terrell JE, Ronis DL, Fowler KE, Bradford CR, Chepeha DB, Prince ME, et al. Clinical predictors of quality of life in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 2004 Apr;130(4):401-8. doi: 10.1001/archotol.130.4.401.
Murphy BA, Gilbert J. Dysphagia in head and neck cancer patients treated with radiation: assessment, sequelae, and rehabilitation. Semin Radiat Oncol. 2009 Jan;19(1):35-42. doi: 10.1016/j.semradonc.2008.09.007.
Pauloski BR. Rehabilitation of dysphagia following head and neck cancer. Phys Med Rehabil Clin N Am. 2008 Nov; 19(4): 889–928. doi: 10.1016/j.pmr.2008.05.010
Denaro N, Merlano MC, Russi EG. Dysphagia in head and neck cancer patients: pretreatment evaluation, predictive factors, and assessment during radio-chemotherapy, recommendations. Clin Exp Otorhinolaryngol. 2013 Sep; 6(3): 117–126. doi: 10.3342/ceo.2013.6.3.117
Nascimento, M. L., Farias, A. B., Carvalho, A. T., et al. (2019). Impact of xerostomia on the quality of life of patients submitted to head and neck radiotherapy. Medicina oral, patologia oral y cirugia bucal, 24(6), e770–e775. https://doi.org/10.4317/medoral.23131