Patient Reported Outcomes/Quality of Life

PV QA 4 - Poster Viewing Q&A 4

TU_42_3727 - Moderate drinking is protective for swallowing function among HNC patients

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Moderate drinking is protective for swallowing function among HNC patients
P. Han1, W. Jiang2, I. Shpitser3, E. Cecil1, Z. Cheng4, M. Muse2, B. R. Page5, A. P. Kiess1, J. Maclean6, P. I. Wu7, M. Szczesniak6, I. Cook6, T. R. McNutt1, and H. Quon1; 1Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 2Johns Hopkins University, Baltimore, MD, 3Johns Hopkins University Department of Computer Science, Baltimore, MD, 4Johns Hopkins Medicine, Baltimore, MD, 5Johns Hopkins University School of Medicine, Baltimore, MD, 6University of New South Wales, Sydney, Australia, 7Department of Gastroenterology & Hepatology, St George Hospital, Sydney, Australia

Purpose/Objective(s): Using an unsupervised cluster analysis of the total scores for patients completing the validated Sydney Swallow Questionnaire (SSQ) and the MD Anderson Dysphagia Inventory (MDADI), we identified three reproducible and validated cohorts of irradiated head and neck cancer (HNC) patients. When clinically characterizing the differences between these cohorts of patients, we identified significant differences in the amount of alcohol intake as queried by the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) scale that was also co-administered with the SSQ and MDADI. To understand the nature of the association between swallow function and patient-reported baseline alcohol intake, we undertook a causal inference analysis of this study population.

Materials/Methods: We evaluated 269 HNC patients who completed assessments with no missing data. Baseline alcohol assessment, FACT-HN prior to radiotherapy (RT) and swallow function after RT assessed by the SSQ and MDADI were used. SSQ measures patient-reported physiologic swallow function in contrast to the MDADI, which measures the impact of swallow dysfunction on QoL. Five levels of alcohol intake were captured in FACT-HN Q9: “no alcohol intake”, “a little bit”, “somewhat”, “quite a bit” and “very much”. To determine if there is a causal relationship between alcohol intake and improved swallowing function, we calculated the average causal effects (ACE) for alcohol intake on SSQ (0-1700, normal range: 0-234) using three different methodologies: g-formula, inverse probability weights (IPW) and augmented inverse probability weights (AIPW). 95% CI of the ACE estimation was extracted by a bootstrap process from their empirical distributions.

Results: The mean post-RT SSQ was 299 (0-1443.5), and the mean post-RT MDADI was 75 (22-93). Compared to “no alcohol intake”, the three methods yielded consistent direction of ACE estimation, suggesting “somewhat” alcohol intake had a protective effect on swallowing function measured by SSQ. The ACE of “somewhat” alcohol intake on SSQ was -7.71 (95% CI: [-26.57, -0.05]), -168.72 (95% CI: [-269.11, -70.29]) and -41.89 (95% CI: [-41.89, -8.74]) compared to “no alcohol intake” using g-formula, IPW and AIPW separately. There was no causal effect of “a little bit” alcohol intake on improving swallowing function, compared to “no alcohol intake”. There was no causal effect of alcohol intake on swallowing function assessed by MDADI.

Conclusion: Causal inference modeling demonstrated that qualitative-reported moderate alcohol intake is moderately protective for patient-reported swallow function after RT. As individual FACT questions are unvalidated, further evaluation of these results including the use of quantity-frequency alcohol reporting is indicated to determine if baseline alcohol consumption may be an important baseline factor to consider in evaluating RT dysphagia.

Author Disclosure: P. Han: None. W. Jiang: None. I. Shpitser: None. M. Muse: None. B.R. Page: None. A.P. Kiess: None. M. Szczesniak: None. T.R. McNutt: Research Grant; Toshiba, Philips Radiation Oncology Systems, Elekta Oncology Systems. Patent/License Fees/Copyright; Sun Nuclear, Accuray-Tomotherapy. President Elect; AAPM-MAC.

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