Patient-reported outcome measures used in prophylactic dysphagia intervention for head and neck cancer patients undergoing radiation therapy: a systematic review

Introduction: The primary objective of this systematic review was to identify and assess the Patient Reported Outcome Measures (PROMs) used in studies of prophylactic dysphagia intervention for patients with head and neck cancer undergoing non-surgical treatments. A secondary objective was to evaluate the quality of the PROMs used in these intervention studies and examine the articles related to their development. Method: Five databases (MEDLINE via PubMed, Web of Science, Pro-Quest, CINHAL, and SCOPUS) were searched for intervention studies on dysphagia in head and neck cancer patients, initiated before or during radiation/chemoradiation, with at least one PROM outcome. Studies on the psychometric development of identified PROMs were also analyzed separately. Result: Sixteen intervention studies met the inclusion criteria. Twenty studies on development of 17 PROMs were evaluated. The most used were: MD Anderson Dysphagia Inventory, European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and EORTC Quality of Life Head and Neck Module (EORTC-QLQ-H&N35). PROMs varied in construct and developmental characteristics, and none met criteria for all measurement domains. Conclusion: Although several studies on prophylactic dysphagia intervention during radiation therapy have reported significant improvements in the clinician-rated outcomes, the current systematic review revealed that patient-reported findings do not depict significant changes pre- and post- intervention, however a trend towards improved scores was noted that warrants further investigation. Including PROMs in research and clinical settings is important, but their growing number makes selecting the right one challenging. Users should exercise caution and understand a PROM’s developmental characteristics before use. t.