Swallowing ability, nutritional status, and functioning in adults with advanced cancer excluding head, neck, and upper gastrointestinal tract: a cross-sectional study in an outpatient palliative care setting

TL;DR

This study found that swallowing difficulties in advanced cancer patients are linked to worse overall function and nutrition, even when the cancer isn't in the head, neck, or upper digestive tract.

Contribution

The study is the first to explore swallowing ability in advanced cancer patients outside head, neck, and upper GI cancers in a palliative care setting.

Findings

Most patients had normal or functional swallowing, with only one case of mild oropharyngeal dysphagia.

Poorer swallowing ability was significantly associated with lower functional performance and worse nutritional status.

Participants were mostly female, moderately undernourished, and had fair to good functional performance.

Abstract

This study sought to analyze the swallowing function of cancer patients undergoing palliative care according to the degree of functionality and nutritional status.

observational, cross-sectional study, conducted with advanced cancer patients outside the head and neck and upper gastrointestinal tract, in an outpatient palliative care setting at a Brazilian oncology center, conducted between March 2022 and August 2023. In the first stage, sociodemographic, clinical, functional, and nutritional data were collected. Subsequently, a speech therapy assessment was performed to classify swallowing disorders and feeding route associated with swallowing ability. Descriptive, univariate, and multivariate analyses were conducted using logistic regression.

39 individuals participated in the study, the majority were female, with functional performance between fair and good, moderately undernourished. Regarding the assessment of swallowing abilities, the sample mostly exhibited fully functional swallowing, followed by functional swallowing with occasional minimal cues, additional time, or avoidance of specific foods. As for the classification of swallowing, most participants had either normal swallowing or functional swallowing, with only one patient presenting mild oropharyngeal dysphagia. Multivariate analysis revealed a significant association between a decline in swallowing ability and poorer functional performance and nutritional status.

Poorer swallowing ability in patients with advanced cancer, excluding those with head, neck, and upper gastrointestinal tract cancers, was associated with lower global functionality and nutritional status.

Analisar a função de deglutição de pacientes oncológicos em cuidados paliativos segundo a funcionalidade e o estado nutricional.

Estudo observacional, do tipo transversal, com pacientes com câncer avançado excluindo cabeça, pescoço e trato gastrointestinal superior, em cuidados paliativos ambulatorial de um centro oncológico brasileiro, realizado entre março de 2022 e agosto de 2023. Foram obtidos dados sociodemográficos, clínicos, funcionais e nutricionais. A avaliação fonoaudiológica classificou a habilidade de deglutição e a via de alimentação por meio dos protocolos PARD e FOIS, respectivamente. Foram realizadas análise descritiva, uni e multivariada por meio de regressão logística.

39 indivíduos participaram do estudo, a maioria do sexo feminino, performance funcional entre regular a boa e moderadamente desnutridos. Na avaliação das habilidades de deglutição, os pacientes, majoritariamente, foram classificados com deglutição plenamente funcional, seguida de deglutição funcional com necessidades raras de mínimas pistas, tempo adicional ou evitar alimentos específicos. Quanto à classificação da deglutição, a maioria dos participantes apresentou deglutição normal ou deglutição funcional e apenas um paciente apresentou disfagia orofaríngea leve. A análise multivariada revelou associação significativa entre pior habilidade de deglutição e desempenho funcional e estado nutricional inferiores.

Habilidade de deglutição prejudicada em pacientes com câncer avançado que não abarcam a região de cabeça, pescoço e trato gastrointestinal superior foi associada a uma funcionalidade global e estado nutricional inferiores.

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