Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2022, Vol. 36 ›› Issue (6): 83-88.doi: 10.6040/j.issn.1673-3770.0.2021.249

• 论著 • Previous Articles    

Application of combining fiberoptic endoscopic evaluation of swallowing technology and swallowing quality of life scale in patients with dysphagia after chemoradiotherapy for nasopharyngeal carcinoma

REN Jia1, LÜ Dan1, ZHANG Yin2, SUN Jiali3, MA Lan4, ZHENG Yitao1, YANG Jimin1, YU Lingyu1, LI Bo1   

  1. 1. Department of Otolarynology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China;
    2. Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China;
    3. Department of Otolarynology Head and Neck Surgery, The Third People's Hospital of Chengdu, Chengdu 610031, Sichuan, China;
    4. Department of Otolarynology Head and Neck Surgery, Chongqing People's Hospital, Chongqing 401121, China
  • Published:2022-12-07

Abstract: Objective to evaluate the post-chemoradiotherapy quality of life of nasopharyngeal carcinoma patients with dysphagia using the swallowing quality of life(SWAL-QOL)scale and fiberoptic endoscopic evaluation of swallowing(FEES)in order to expand the clinical applications. Methods A total of 162 nasopharyngeal carcinoma patients meeting the inclusion criteria were enrolled as the patient group in the West China Hospital from September 2019 to April 2020, who had received chemoradiotherapy and were with dysphagia problem. Additionally, 144 individuals without relevant problems were recruited as the control group. All the participants were asked to fill the SWAL-QOL scale, and 96 individuals from the patient group received further FEES examination and were graded by the Penetration-Aspiration Scale(PAS). Results Participants in patient group had significantly lower total scores(124.69±25.57)and swallowing symptoms subscale scores(58.56±9.46)than those in control group(P<0.05). In the quality of life subscale, except for the two dimensions of “fatigue” and “sleep”, the differences in other dimensions were statistically significant(P<0.05). Significant differences were presented in all other dimensions,except for “fatigue” and “sleep”. The PAS results revealed 22 patients with no penetration(22.92%), 60 patients with penetration(62.50%)and 14 patients with silent aspiration(14.58%). Significant difference was observed in the three goups, include the total scores of SWAL-QOL and the scores of 4 dimensions in the questionnaire. No significant difference was presented between groups of no penetration and penetration in the total scores of SWAL-QOL and the scores of all the dimensions in the questionnaire(P>0.05). However, significant difference was observed between groups of no penetration and silent aspiration in the total scores of SWAL-QOL and the scores of 4 dimensions in the questionnaire(P<0.05). Significant difference was observed between groups of penetration and silent aspiration in the total scores of SWAL-QOL and the scores of 2 dimensions in the questionnaire(P<0.05). Conclusion Dysphagia could affect the post- chemoradiotherapy quality of life of nasopharyngeal carcinoma patients in many aspects. Additionally, the SWAL-QOL can be used to evaluate the swallowing-related quality of life of nasopharyngeal carcinoma patients after chemoradiotherapy.

Key words: Nasopharyngeal carcinoma, Dysphagia, Swallowing quality of Life, Fiberoptic endoscopic eraluation of swallowing, Assessment

CLC Number: 

  • R856.76
[1] 王涛, 王继英. 早期吞咽功能训练对鼻咽癌放疗患者功能恢复及生活质量的影响[J]. 中国肿瘤临床与康复, 2016, 23(2): 251-254. doi:10.13455/j.cnki.cjcor.2016.02.35. WANG Tao, WANG Jiying. Effect of early swallowing function training on functional recovery and quality of life for patients with nasopharyngeal carcinoma treated by radiotherapy[J]. Chinese Journal of Clinical Oncology and Rehabilitation, 2016, 23(2): 251-254. doi:10.13455/j.cnki.cjcor.2016.02.35.
[2] 中华医学会神经外科学分会, 中国神经外科重症管理协作组. 抗栓药物治疗中颅内出血患者神经外科围手术期管理中国专家共识(2018版)[J]. 中华医学杂志, 2018, 98(21): 1640-1645. doi:10.3760/cma.j.issn.0376-2491.2018.21.004.
[3] 谭嘉升, 丘卫红, 刘中良, 等. 中文版吞咽生命质量量表信度和效度的研究[J]. 中华物理医学与康复杂志, 2016, 38(9): 669-673. doi:10.3760/cma.j.issn.0254-1424.2016.09.006. TAN Jiasheng, QIU Weihong, LIU Zhongliang, et al. The reliability and validity of the Chinese version of swallowing quality of life questionnaire[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2016, 38(9): 669-673. doi:10.3760/cma.j.issn.0254-1424.2016.09.006.
[4] Rosenbek JC, Robbins JA, Roecker EB, et al. A penetration-aspiration scale[J]. Dysphagia, 1996, 11(2): 93-98. doi:10.1007/BF00417897.
[5] Eisbruch A, Schwartz M, Rasch C, et al. Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? [J]. Int J Radiat Oncol Biol Phys, 2004, 60(5): 1425-1439. doi:10.1016/j.ijrobp.2004.05.050.
[6] 邱丽燕, 杨丽, 廖婷婷, 等. 鼻咽癌出院5年患者症状困扰现状及其影响因素分析[J]. 中国护理管理, 2020, 20(9): 1334-1339. doi:10.3969/j.issn.1672-1756.2020.09.011. QIU Liyan, YANG Li, LIAO Tingting, et al. Symptom distress and its influencing factors of patients with nasopharyngeal carcinoma after 5 years of discharge[J]. Chinese Nursing Management, 2020, 20(9): 1334-1339. doi:10.3969/j.issn.1672-1756.2020.09.011.
[7] Vanderwegen J, van Nuffelen G, de Bodt M. The validation and psychometric properties of the Dutch version of the Swallowing Quality-of-Life Questionnaire(DSWAL-QOL)[J]. Dysphagia, 2013, 28(1): 11-23. doi:10.1007/s00455-012-9408-y.
[8] 刘诗丹, 陈启波, 李荣祝, 等. 鼻咽癌患者放疗后吞咽障碍的发生与治疗研究进展[J]. 中华物理医学与康复杂志, 2018, 40(3): 234-236. doi:10.3760/cma.j.issn.0254-1424.2018.03.020.
[9] Keage MJ, Delatycki MB, Gupta I, et al. Dysphagia in friedreich Ataxia[J]. Dysphagia, 1993, 32(5): 626-635. doi:10.1007/s00455-017-9804-4.
[10] 余意, 陈冬平, 邝燕好, 等. 鼻咽癌放射性龋齿发病规律及相关因素分析[J]. 中华肿瘤防治杂志, 2017, 24(6): 379-382. doi:10.16073/j.cnki.cjcpt.2017.06.005. YU Yi, CHEN Dongping, KUANG Yanhao, et al. Occurrence dynamics and analysis of influencing factors of radiation caries for the patients with nasopharyngeal carcinoma[J]. Chinese Journal of Cancer Prevention and Treatment, 2017, 24(6): 379-382. doi:10.16073/j.cnki.cjcpt.2017.06.005.
[11] 廖朝晖, 邓淑琴. 鼻咽癌患者放射治疗前后睡眠质量变化规律的调查分析[J]. 齐鲁护理杂志, 2015, 21(11): 74-75. doi:10.3969/j.issn.1006-7256.2015.11.032.
[12] 邓湘琴, 梁慧, 林宏远, 等. 恶性肿瘤患者失眠发生的特征及对生命质量影响的临床调查[J]. 世界睡眠医学杂志, 2020, 7(1): 11-13. doi:10.3969/j.issn.2095-7130.2020.01.004. DENG Xiangqin, LIANG Hui, LIN Hongyuan, et al. Clinical investigation on the occurrence and characteristics of insomnia and its effect on quality of life in patients with malignant tumor[J]. World Journal of Sleep Medicine, 2020, 7(1): 11-13. doi:10.3969/j.issn.2095-7130.2020.01.004.
[13] 廖婷婷, 杨丽, 邱丽燕, 等. 鼻咽癌出院患者放疗毒副反应变化趋势研究[J]. 中国全科医学, 2020, 23(26): 3330-3336. doi:10.12114/j.issn.1007-9572.2020.00.182. LIAO Tingting, YANG Li, QIU Liyan, et al. Changes in trends of toxic side effects of radiotherapy in discharged patients with nasopharyngeal carcinoma[J]. Chinese General Practice, 2020, 23(26): 3330-3336. doi:10.12114/j.issn.1007-9572.2020.00.182.
[14] Rogus-Pulia NM, Gangnon R, Kind A, et al. A pilot study of perceived mouth dryness, perceived swallowing effort, and saliva substitute effects in healthy adults across the age range[J]. Dysphagia,2018, 33(2): 200-205. doi:10.1007/s00455-017-9846-7.
[15] Van der Graaff M, Kuiper T, Zwinderman A, et al. Clinical identification of dysarthria types among neurologists, residents in neurology and speech therapists[J]. Eur Neurol, 2009, 61(5): 295-300. doi:10.1159/000206855.
[16] Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure[J]. Dysphagia, 1988, 2(4): 216-219. doi:10.1007/BF02414429.
[17] 吕丹, 任佳, 王海洋, 等. 纤维内镜检查在吞咽功能评估中的应用进展[J]. 中华物理医学与康复杂志, 2020, 42(7): 656-659. doi:10.3760/cma.j.issn.0254-1424.2020.07.018.
[18] 强笔, 田兴德, 汪华, 等. 纤维内镜检查在吞咽障碍评估中的应用研究[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(5): 385-388. doi:10.3760/cma.j.issn.1673-0860.2009.05.010. QIANG Bi, TIAN Xingde, WANG Hua, et al. Application of fibreoptic endoscope in evaluation of swallowing[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2009, 44(5): 385-388. doi:10.3760/cma.j.issn.1673-0860.2009.05.010.
[19] 陈丽珊, 周惠嫦, 张盘德, 等. 食团体积与鼻咽癌吞咽障碍患者的舌骨位移相关性[J]. 中华物理医学与康复杂志, 2019, 41(12): 894-899. doi:10.3760/cma.j.issn.0254-1424.2019.12.003. CHEN Lishan, ZHOUHuichang, ZHANG Pande, et al. The relationship between bolus volume and hyoid displacement in dysphagia patients with nasopharyngeal carcinoma after radiation therapy[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2019, 41(12): 894-899. doi:10.3760/cma.j.issn.0254-1424.2019.12.003.
[20] Hey C, Pluschinski P, Zaretsky Y, et al. Penetration-aspiration scale according to rosenbek. validation of the German version for endoscopic dysphagia diagnostics[J]. HNO, 2014, 62(4): 276-281. doi:10.1007/s00106-013-2815-z.
[21] Crary MA, Humphrey JL, Carnaby-Mann G, et al. Dysphagia, nutrition, and hydration in ischemic stroke patients at admission and discharge from acute care[J]. Dysphagia, 2013, 28(1): 69-76. doi:10.1007/s00455-012-9414-0.
[1] SONG Qing, WANG Xiaoyong, JIA Chuanliang, MOU Yakui, SONG Xicheng. Dysphagia due to left atrial enlargement: a case report and literature review [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(2): 64-67.
[2] HUA Hongli, LI Song,TAO Zezhang. Research progress of artificial intelligence in the diagnosis and treatment of nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(2): 113-119.
[3] ZHOU Yuxiang,MIAO Beiping, LU Yongtian. Treatment progress of endoscopic surgery for first diagnosed nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 108-112.
[4] ZHANG Kaiting, LIU Jie, XU Zhenju, ZHANG Xiaoxue, CAO Songli, HAN Min. Evaluation of voice and mental state in patients with functional dysphonia [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(3): 37-41.
[5] WANG Zhongwei, YANG Lin, GUO Ya, SUN Bin, WANG Yali, MA Xiulong, REN Hongtao, BAO Xing. Analysis of the relationship between miR-429 and miR-200C expression and prognosis in patients with nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(3): 81-86.
[6] SUN Xiaohan, LI Na, CHEN Kaixuan, CHEN Min, YAN Shu, CHE Fei. Application of the ROE scale to the evaluation of the quality of life of patients with external nose deformity and nasal septum deviation before and after surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(3): 87-91.
[7] ZHANG Yitong, LIU Haiqin,REN Xiaoyong. Cognitive and behavioral dysfunction related to obstructive sleep apnea in children: current status, problems, and prospects [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 119-124.
[8] TAN Yufang, YI Tianhua. Clinical characteristics and prognosis of sudden sensorineural hearing loss in post-irradiated nasopharyngeal carcinoma survivors: a report of 18 cases [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(1): 35-39.
[9] FAN Li, LI Yue, XU Ximing. Changes in and prognostic value of the inflammatory index before and after concurrent chemoradiotherapy for nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(6): 36-41.
[10] This study was conducted to explore the preoperative risk factors for postoperative adhesion in patients with chronic rhinosinusitis(CRS)undergoing functional endoscopic sinus surgery(FESS), and to construct a risk score model to evaluate their predictive effect. MethodsA retrospective study was conducted on 323 patients with CRS who underwent FESS at our hospital between January 2015 and June 2018. The risk factors for postoperative adhesion were screened using a multivariate logistic regression analysis. The risk score was assigned according to the odds ratio(OR)value, and a receiver operating characteristic(ROC)curve was drawn to evaluate the predictive effect. ResultsPostoperative adhesion occurred in 35 patients(10.8%). The logistic regression results showed that concha bullosa, primary FESS, operative experience less than 10 years, and a history of middle turbinate resection were independent risk factors for postoperative adhesion in FESS. The OR values were 1.12(95% CI: 1.06-1.18), 3.87(95% CI: 2.23-5.51), 3.19(95% CI: 2.07-4.31), and 2.24(95% CI:1.95-2.53), respectively. The risk score model assigned 1 point for vesicular middle turbinate, 4 points for first time FESS, 3 points for operative experience less than 10 years, and 2 points for middle turbinate resection. The ROC curve analysis showed that the area under the curve(AUC)was 0.784(95% CI: 0.672-0.896, P<0.05). When 4 points were selected as the cut-off point, the Jordan index was the largest, with a sensitivity of 75.1% and a specificity of 73.6%. ConclusionThe incidence of postoperative adhesion in 323 patients with CRS who underwent FESS was 10.8%. The risk score model has certain reference value for predicting high-risk postoperative adhesion.. Potential risk factors and evaluation of a predictive risk score model for postoperative adhesion in functional endoscopic sinus surgeryCHEN Dong1, YU Hong2, LI Yang1, HUANG Qiang1, FANG Min1 1. Department of Otolaryngology, Jiangyou Peoples Hospital, Jiangyou 621700, Sichuan, China; 2. Department of Pathology, Jiangyou Peoples Hospital, Jiangyou 621700, Sichuan, ChinaAbstract:Objective〓 [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 87-91.
[11] The objective of this study was to analyze the effects and possible regulatory mechanisms that Notch receptors could have on cisplatin resistance, observed in nasopharyngeal carcinoma. MethodsWestern blot analysis was used for the detection of Notch receptor expression in nasopharyngeal carcinoma cells and cisplatin-resistant nasopharyngeal carcinoma cells(5-8F, 5-8F/CDDP). Flow cytometry was used to investigate how the combined treatment with 10 μM CDDP and different concentrations of γ-secretase inhibitor(DAPT)could affect apoptosis in 5-8F/CDDP cells. Flow cytometry was also used for the detection of cell cycle stages in DAPT-treated 5-8F / CDDP cells. Finally, western blotting was also used for the detection of drug resistance-related protein expression. All experiments were followed by statistical data analysis. ResultsWe observed significantly higher Notch1 and Notch4 receptor expression in 5-8F/CDDP cells than in 5-8F cells(P=0.003, P=0.004). Furthermore, we described that Notch signaling was inhibited by DAPT in 5-8F/CDDP cells, followed by a significant increase in the apoptosis rate and decrease in cell proliferation, induced by cisplatin in a dose-dependent manner(P<0.05). Moreover, after inhibiting the Notch signaling pathway in 5-8F/CDDP cells, DAPT treatment significantly decreased the expression of Cyclin E and CDK-2, proteins involved in cell cycle regulation, and contributed to blocking the cells in the G1/S phase(P<0.05). At the same time, the expression levels of both the EMT-related protein Slug and the DNA excision repair protein ERCC1 significantly decreased, while that of E-Cadherin was up-regulated. ConclusionUp-regulated expression of Notch1 and Notch4 receptors is associated with cisplatin resistance in nasopharyngeal carcinoma cells. The inactivation of the Notch signaling pathway might thus have the potential to enhance the efficiency of cisplatin chemotherapy in drug-resistant nasopharyngeal carcinoma cells by inhibiting EMT rather than blocking the G1/S cell cycle phase.. Cisplatin resistance in nasopharyngeal carcinoma cells is affected by Notch receptors through the regulation of epithelial-mesenchymal transition rather than cell cycle controlHAN Jibo, ZOU You, YANG Rui, TAO Zezhang Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, ChinaAbstract:Objective〓 [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 105-110.
[12] CHEN Xuesong, FU Weiwei, LIU Jiangtao. The prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in intensity modulated radiation therapy for nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 50-53.
[13] ZHANG Jianli, CHEN Weixiong, CHEN Ruikai, KUANG Debing, PANG Yishi. Evaluation of the effect of fiberoptic endoscopic evaluation of swallowing on long-term survivor with nasopharyngeal cancer [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(6): 56-59.
[14] Lin LI,Heng ZHANG,Yufei XIAN,Xiaoli SHENG. Expression and biological function of long chain non-coding cytoskeleton regulator RNA in nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 69-72.
[15] Wenjin WAN,Yujie YAN,Na LI,Renyu GUO,Hui YUAN. Comprehensive intervention on xerostomia after functional endoscopic sinus surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 134-137.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!