Evaluation of the limitations of using the University of Washington Quality of Life swallowing domain alone to screen patients in the routine clinical setting

A broad patient-completed screening tool in routine clinical practice in head and neck oncology has merit, but clinicians should be awarethat its simplicity could lead to some patients and the detail of their problems being missed. The purpose of this study was to compare theUniversity of Washington Quality of Life (UWQoL) swallowing domain with the MD Anderson Dysphagia Inventory (MDADI) in relationto the need for interventions for swallowing around one year after treatment. The group comprised 112 consecutively referred patients tospeech and language therapy between January 2007 and August 2009 after primary operation for previously untreated oral and oropharyngealsquamous cell carcinoma (SCC). A total of 78 patients completed questionnaires (median time of assessment 11.7 months, IQR 6.1–12.2).There were significant (p < 0.001) and moderately strong correlations (rs= 0.51–0.62) between the UWQoL swallowing domain score andMDADI subscales and total scores, and also with individual MDADI questions: taking a great deal of effort (rs= 0.71); being upset (rs= 0.61);and not going out (rs= 0.62) were the strongest in regard to swallowing. Use of a gastrostomy tube was associated with worse UWQoL andMDADI scores. In conclusion, patients who score 100 on the UWQoL do not require swallowing to be evaluated further. Those who score70 could benefit from the detailed MDADI to help to clarify the specific problem and the impact it has before being referred to speech andlanguage therapy. Those who score less than 70 should be brought to the attention of speech and language therapists to confirm that appropriatesupport and intervention are in place.