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Swallowing functional outcomes and nutritional status in head and neck cancer radiotherapy: longitudinal study
  1. Yujie Wang1,
  2. Lichuan Zhang1,
  3. Shuai Jin1,
  4. Hongmei Li2,
  5. Liqing Gong3,
  6. Yanli Wang3,
  7. Sanli Jin1,
  8. Yiwei Cao1,
  9. Yian Shih1 and
  10. Qian Lu1
  1. 1 Division of Medical and Surgical Nursing, Peking University School of Nursing, Beijing, China
  2. 2 Division of Surgical Nursing, Shanxi Hospital of Integrated Traditional and Western Medicine, Taiyuan, China
  3. 3 Division of Clinical Nutrition, Beijing Cancer Hospital, Beijing, China
  1. Correspondence to Dr Qian Lu, Peking University School of Nursing, Beijing 100191, China; luqian{at}


Objective To explore the relationships between swallowing functional outcomes and nutritional status in patients with head and neck cancer undergoing radiotherapy (RT).

Methods This longitudinal study included 122 patients. Data were collected at three time points: baseline (T1), the third week of RT (T2) and the completion of RT (T3). The Common Terminology Criteria for Adverse Events was used to assess the symptom of dysphagia and other toxicities; the MD Anderson Dysphagia Inventory (MDADI) was used to assess the patient-perceived swallowing functional outcomes; the nutritional status was evaluated by the weight ratio and the Patient-Generated Subjective Global Assessment (PG-SGA). The generalised estimating equation (GEE) was used to measure the correlation of MDADI with the weight ratio or PG-SGA and also to analyse the influential factors of swallowing functional outcomes.

Results The participants’ acute dysphagia rates were 5.7% at T1, 69.7% at T2 and 77.9% at T3. The swallowing functional outcomes worsen over RT (p<0.001) and were associated with weight ratio (β=0.032, p=0.008) and PG-SGA (β=−0.115, p<0.001). GEE models showed that patients with cancer of the pharynx region, advanced stage, chemoradiotherapy and high RT dose perceived worse swallowing functional outcomes. Oral mucositis, pharynx mucositis and salivary gland inflammation were positively correlated with swallowing functional outcomes, and the pharynx mucositis presented the highest absolute value of β.

Conclusion The swallowing functional outcomes were negatively correlated with nutritional status. Healthcare professionals should identify early on the population at higher risk and focus on multiple toxicities, especially the management of pharynx mucositis, to improve nutritional status.

  • head and neck
  • dysphagia
  • clinical assessment
  • clinical decisions

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  • Contributors YuW: data analysis and interpretation of data. LZ, ShJ, HL, LG and YaW: acquisition of data. SaJ, YC and YS: editing and proofreading. QL: supervision.

  • Funding National Key Research and Development Project: ZDZX2017ZL-04.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study obtained ethical approval from the university (ethics review approval number IRB00001052-17002). Each participant was aware of the purpose and content of the study by oral examination from the researcher before the investigation according to the principles of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.