Disparities in Swallowing Care for Dysphagia After Head and Neck Cancer

Introduction: Dysphagia is a common and debilitating sequela of head and neck cancer (HNC) treatment. Evaluation by a speech-language pathologist (SLP) is essential, but the extent to which patients access SLP services is unclear. This study sought to examine the rate of SLP services for patients diagnosed with dysphagia after HNC and to assess for disparities among demographic groups.

Methods: We performed a retrospective cohort study using a large global health database (TriNetX) to search international classification of disease (ICD) and current procedural terminology (CPT) codes. Patients diagnosed with oral, oropharyngeal, laryngeal, or nasopharyngeal cancer from 1/1/04-1/19/24 and a subsequent new diagnosis of dysphagia (ICD-10 R13.1*) were identified. Two cohorts were examined: HNC patients with dysphagia who (1) received SLP services related to swallowing and (2) those who did not. Chi-square analyses assessed the relationship between various demographic factors and the likelihood of SLP services.

Results: Of 239,604 HNC patients, 68,571 (28.6%) were diagnosed with new dysphagia. Of HNC patients with dysphagia, 27,500 (40.1%) had evidence of SLP services, and 41,071 (59.9%) did not. The mean ± SD time from dysphagia diagnosis to the first SLP service was 175.55±536.7 days. Females were significantly less likely than males to receive SLP services (39.5% vs. 40.8%, p=.004). Hispanic patients were also significantly less likely to receive SLP services than non-Hispanic patients (34.5% vs. 44.1%, p<.0001). There were no significant differences in SLP services for non-White patients compared to White patients (40.7% vs. 41.7%, p=.06).

Conclusions: The results reveal a substantial deficit in swallowing care among HNC patients diagnosed with dysphagia. Although there were significant differences in SLP services related to sex and ethnicity, the proportions are relatively similar across groups. Therefore, there is an overarching need irrespective of demographics for increased utilization of SLP services for the effective management of dysphagia in HNC patients.