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Upplevda sväljningssvårigheter vid cancer i struphuvud och nedre svalg: En studie baserad på patientrapportering efter cancerbehandling med inriktning på livskvalitet och logopedens insatser
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
2012 (Swedish)Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
Abstract [sv]

Cancer i huvud- och halsregionen och dess behandling har setts leda till svårigheter att svälja hos cirka 40 % av patienterna. Sväljningssvårigheterna har visats vara svårast vid larynx- och hypofarynxcancer. Sväljningssvårigheter påverkar livskvaliteten negativt enligt flera studier. Logopeden har en central roll i rehabilitering och behandling vid sväljningsvårigheter hos dessa patienter. Mätningar av sväljningssvårigheter med subjektiva eller objektiva mått stämmer inte alltid överens. Många studier är objektivt inriktade. Det är viktigt att även lyfta fram patientens egen upplevelse av sväljningen. Syftet med föreliggande studie var att kartlägga förekomst av upplevda sväljningssvårigheter hos patienter behandlade för larynx- och hypofarynxcancer samt att sätta dessa i relation till livskvalitet. Vidare ämnade studien sammanställa patienters rapportering av logopedinsatser. I studien användes de två självskattningsformulären MDADI och EAT-10 samt ett frågeformulär, utformat av projektansvariga, som material. Formulären skickades till 92 patienter som behandlats för larynx- och hypofarynxcancer vid Akademiska sjukhuset i Uppsala mellan åren 2000 och 2009. 41 patienter inkluderades i studien. EAT- 10 uteslöts ur analysen på grund av att få formulär samlades in. Resultatet visade att 44 % av de medverkande upplevde sväljningssvårigheter. Förekomst av upplevda sväljningssvårigheter var högre i gruppen med hypofarynxcancer än i gruppen med larynxcancer. En signifikant skillnad (p = 0,006) fanns i förekomst av sväljningssvårigheter mellan de högre och lägre tumörstadierna. Kombinationsbehandlingen kirurgi följt av strålning visade en högre förekomst av sväljningssvårigheter än övriga behandlingsformer. Medianvärdet av totalpoängen i MDADI (20= låg funktionalitet, 100 = hög funktionalitet) var 69,5/100 i hypofarynxcancergruppen och 96/100 i gruppen med larynxcancer och spridningen var stor (23-100). Lägre sväljningsrelaterad livskvalitet korrelerade med högre tumörstadium (rho = -0,65, p<0,001). 18 patienter hade haft kontakt med logoped och den vanligaste anledningen var rådgivning. Sex medverkande med sväljningssvårigheter som ej erbjudits logopedkontakt, hade önskat kontakt med logoped. De slutsatser som kan dras utifrån resultaten är att de upplevda sväljningssvårigheterna förekom i störst utsträckning och hade störst negativ påverkan på den sväljningsrelaterade livskvaliteten hos de som behandlats för högre tumörstadium samt hypofarynxcancer. Framtida forskning skulle förslagsvis kunna fokusera på sväljningsrelaterad livskvalitet i relation till logopedens insatser. 

Abstract [en]

Cancer in the head and neck region and its treatment has been seen to lead to difficulties in swallowing in around 40 % of the patients. The swallowing difficulties have been shown to be most severe in laryngeal and hypopharyngeal cancer. Swallowing difficulties affect the quality of life according to several studies. The Speech and Language Pathologist (SLP) plays a central role in rehabilitation and treatment of swallowing difficulties in these patients. Measurements of swallowing difficulties with subjective or objective measures do not always agree. Many studies have an objective approach. It is important to also take into account the patient’s own experience of the swallowing. The purpose of this study was to survey the prevalence of patient-reported swallowing difficulties in patients treated for laryngeal and hypopharyngeal cancer and to put the difficulties in relation to quality of life. Further the study intended to compile patient reports of the work of the SLP. In the study the two forms based on individual reports, MDADI and EAT-10 and one questionnaire, constructed by the leaders of the project, was used as material. The forms were sent to 92 patients who had been treated for laryngeal or hypopharyngeal cancer at Akademiska sjukhuset in Uppsala between the years 2000 and 2009. 41 patients were included in the study. EAT-10 was excluded from the analysis due to that few forms were collected. The result showed that 44 % of the participants reported swallowing difficulties. The prevalence of patient-reported swallowing difficulties was higher in the group with hypopharyngeal cancer than in the group with laryngeal cancer. A statistically significant difference (p= 0,006) was found in prevalence of swallowing difficulties between the higher and the lower tumour stages. The combined treatment modality, surgery followed by radiation therapy, showed a greater prevalence of swallowing difficulties than other treatment modalities. The median of the score in total in MDADI (20= low functionality, 100= high functionality) was 69, 5/100 in the hypopharyngeal cancer group and 96/100 in the laryngeal cancer group and the spread of the total score was wide (23-100). Lower swallowing- related quality of life was correlated with a more advanced tumour stage (rho -0, 65, p<0,001).18 participants have had contact with a SLP and the most common reason was counselling. Six participants with swallowing difficulties who had not been offered contact with a SLP wanted it. The conclusions that can be drawn from the results is that the prevalence of patient-reported swallowing difficulties was greatest and had greatest impact on swallowing- related quality of life in patients treated for more advanced tumour stages and hypopharyngeal cancer. Future research could, as a suggestion, focus on quality of life in relation to the work of the SLPs. 

Place, publisher, year, edition, pages
2012. , 54 p.
Series
Examensarbete i logopedi, 066
Keyword [en]
(subjective) swallowing difficulties, dysphagia, quality of life, laryngeal cancer, hypopharyngeal cancer, speech and language pathologist (SLP)
Keyword [sv]
(upplevda) sväljningssvårigheter, dysfagi, livskvalitet, larynxcancer, hypofarynxcancer, logoped
National Category
Other Medical Sciences not elsewhere specified
Identifiers
URN: urn:nbn:se:uu:diva-191910OAI: oai:DiVA.org:uu-191910DiVA: diva2:589096
Subject / course
Speech and Language Pathology
Educational program
Degree of Master of Science in Speech and Language Pathology
Uppsok
Medicine
Supervisors
Examiners
Available from: 2013-01-17 Created: 2013-01-15 Last updated: 2013-01-17Bibliographically approved

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