How Can Physicians Identify Dysphagia in Patients with Head and Neck Cancer?

Objective The investigators sought to determine the most sensitive indicator for identifying a swallowing problem in patients with HNC who are treated with radiotherapy—patient‐report of dysphagia or diet level consumed. Method Data were taken from 113 HNC patients. Prevalence of dysphagia was determined by patient report and diet level, then broken out by gender and age. A web‐based survey of clinical practice included 759 SLPs who work with HNC patients. Referral patterns and time of first intervention were queried. Results Over the first year, prevalence of dysphagia was 8% to 20% higher (worse) by diet restriction than by report of a swallowing problem. Men reported a worse swallowing problem and more diet restrictions than did women ( P =. 057). Patients younger than 60 years reported worse diet levels and diet restrictions than did older patients (ns). The survey found that 70.6% of SLPs reported no institutional policy, with referrals made on a case by case basis. The prevalent trend (nearly 50%) was for patients to be referred only when a dysphagia presented. Conclusion Since most MDs do not refer to SLPs for dysphagia unless the patient reports a problem, it is critical to query the patient carefully. Patients tend to underreport a problem compared to diet level, thus physicians should ask specifically about diet in order to maximize sensitivity. A standardized diet scale is recommended.