Patient-Reported Dysphagia After Multimodal Therapy and Radial Forearm Free-Flap Reconstruction for OPSCC: Associations With FEES Findings, Psychological Distress, and Xerostomia.

OBJECTIVE

This study investigated whether fiberoptic endoscopic evaluation of swallowing (FEES)-derived parameters reflect patient-reported dysphagia and swallowing-related quality of life in patients with oropharyngeal squamous cell carcinoma (OPSCC) after surgery-based multimodal therapy with free-flap reconstruction. In addition, it assessed the roles of psychological distress and xerostomia in this context.

METHODS

This multicenter, cross-sectional exploratory study included 50 patients. FEES parameters comprised Penetration-Aspiration Scale (PAS) and residue scores. Patient-reported outcomes were assessed using the Sydney Swallow Questionnaire (SSQ) and MD Anderson Dysphagia Inventory (MDADI), psychological distress using the Hospital Anxiety and Depression Scale (HADS), and xerostomia using the Xerostomia Inventory (XI). Associations were examined using Spearman correlations with Benjamini-Hochberg correction and exploratory rank-transformed multiple linear regression.

RESULTS

FEES parameters showed no significant bivariate associations with SSQ or MDADI total scores after correction. HADS and XI showed moderate to strong bivariate associations with SSQ and MDADI. In exploratory multivariable analyses, HADS (β = 0.372, p = 0.012) and PAS max (β = 0.318, p = 0.006) were independently associated with SSQ, whereas XI was not (β = 0.268, p = 0.065). HADS (β = -0.339, p = 0.008), XI (β = -0.433, p < 0.001), and PAS max (β = -0.301, p = 0.003) were independently associated with MDADI.

CONCLUSION

The FEES-derived parameters only partially reflected patient-reported swallowing impairment. These findings support a multidimensional understanding of post-therapeutic dysphagia and suggest routine integration of psychosocial and symptom-oriented assessments into follow-up care in this specific patient population.

LEVEL OF EVIDENCE: 4.

TRIAL REGISTRATION: German Clinical Trials Register (DRKS) Registration Number: DRKS00038870.