Dysphagia in cancers of the lip, oral cavity, and pharynx patients: Impact on cachexia, hospitalization, and racial disparities on outcomes.

Abstract

e18045 Background: Cancers of the lip, oral cavity, and pharynx (CLOP) are frequently associated with complications arising from tumor location and treatment modalities. Dysphagia, or difficulty swallowing, is a prominent complication that significantly impacts clinical outcomes. However, the broader implications of dysphagia on CLOP patient outcomes remain underexplored. Although cachexia is well-documented in various advanced cancers, its specific association with dysphagia in CLOP patients has not been widely investigated. This study uniquely evaluates the relationship between dysphagia and cachexia in CLOP patients while also assessing key clinical outcomes, including LOS, weight loss, electrolyte and fluid imbalance, and other comorbidities. Furthermore, disparities in outcomes, particularly related to substance use disorders and racial differences, remain underexplored in this population. These comparisons are between CLOP patients with dysphagia (D-CLOP) to those without (ND-CLOP). Methods: A national inpatient database from 2021 was analyzed to identify CLOP patients and those specifically diagnosed with dysphagia. Generalized linear models were employed to assess the relationship between dysphagia and outcomes, including LOS, weight loss, fluid and electrolyte imbalance. And additionally examined history of radiation therapy (HRT), and ulcerative mucositis. Results: 56,250 CLOP patients, of whom 11,260 (19.4%) were diagnosed with dysphagia (D-CLOP). In the adjusted analysis, D-CLOP patients were associated with longer LOS (Coeff: 1.49; 95% CI: 1.34–1.66), weight loss (aOR: 2.29; 95% CI: 2.05–2.57), fluid and electrolyte imbalance (aOR: 1.44; 95% CI: 1.29–1.60), and cachexia (aOR: 1.62; 95% CI: 1.37–1.92). Additionally, D-CLOP patients were more likely to have a history of radiation therapy (HRT; aOR: 1.28; 95% CI: 1.14–1.44) and ulcerative mucositis (aOR: 1.70; 95% CI: 1.10–2.64). Among D-CLOP patients, compared with White patients, Black had higher drug dependence, aOR: 1.38 (95% CI: 1.04 - 1.83). These findings highlight the multifaceted impact of dysphagia on CLOP patients including on their clinical outcomes and hospital resource use. Conclusions: Dysphagia in CLOP patients is associated with significantly worse outcomes, including longer hospital stays, higher rates of weight loss, fluid and electrolyte imbalances, cachexia, and increased risks of ulcerative mucositis and prior radiation therapy history. The association between dysphagia and cachexia highlights a critical, understudied area with profound implications for patient outcomes. Routine dysphagia screenings, early nutritional support, and targeted strategies to manage cachexia and substance use disorders can mitigate these complications. Future research should focus on dysphagia’s systemic and sociocultural impacts to improve patient outcomes.