Patient-reported swallowing burden and FEES findings in disease-free oropharyngeal cancer survivors after chemoradiotherapy.

PURPOSE: Oropharyngeal dysphagia is a frequent long-term sequela in survivors of oropharyngeal cancer treated with chemoradiotherapy (CRT), with significant impact on quality of life (QoL). Flexible endoscopic evaluation of swallowing (FEES) provides objective information on swallowing physiology, whereas patient-reported outcome measures (PROMs) capture perceived dysphagia burden. This study explored how FEES findings and PROMs provide complementary information regarding dysphagia in disease-free survivors treated with CRT.

METHODS

A cross-sectional study was conducted in 38 disease-free survivors of oropharyngeal cancer treated with CRT. Swallowing was assessed using FEES, including measures of swallowing safety, efficiency and temporal physiology. Swallowing-related QoL and symptom burden were assessed using the EORTC QLQ-C30, EORTC QLQ-H&N43, and SWAL-QOL questionnaires. Associations between objective and subjective outcomes were explored using correlation and comparative analyses.

RESULTS

FEES identified frequent swallowing impairments, particularly pharyngeal residue, increased number of swallows for solid consistencies and penetration-aspiration events. PROMs also revealed substantial dysphagia-related burden, with the SWAL-QOL identifying the highest proportion of altered results. Associations between FEES findings and QoL domains were observed; however, no consistent one-to-one relationship between physiological impairment and patient-reported burden was identified.

CONCLUSION

FEES and PROMs capture complementary dimensions of dysphagia in disease-free survivors of oropharyngeal cancer after CRT. FEES identifies physiological swallowing impairments, whereas PROMs reflect the functional and psychosocial impact of dysphagia. Combined use of instrumental and patient-reported assessments may improve supportive care and long-term follow-up in this population.