The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer - The M. D. Anderson dysphagia inventory

Objective: To design. a reliable and validated self-administered questionna ire whose purpose is to assess dysphagia's effects on the quality of life ( QOL) of patients with head and neck cancer. Design: Cross-sectional survey study. Methods: Focus groups were convened for questionnaire development and desig n. The M. D. Anderson Dysphagia Inventory (MDADI) included global, emotiona l, functional, and physical subscales. One hundred consecutive adult patien ts with a neoplasm of the upper aerodigestive tract who underwent evaluatio n by our Speech Pathology team completed the MDADI and the Medical Outcomes Study 36-Item Short Form Hearth Survey (SF-36). Speech pathologists comple ted the Performance Status Scale for each patient. Validity and reliability properties were calculated. Analysis of variance was used to assess how we ll the MDADI discriminated between groups of patients. Results: The internal, consistency reliability of the MDADI was calculated using the Cronbach or coefficient. The Cronbach alpha coefficients of the M DADI sub-scales ranged from 0.85 to 0.93. Test-retest reliability coefficie nts of the subscales ranged from 0.69 to 0.88. Spearman correlation coeffic ients between the MDADI subscales and the SF-36 subscales demonstrated cons truct validity. Patients with primary tumors of the oral cavity and orophar ynx had significantly greater swallowing disability with an adverse impact an their QOL compared with patients with primary tumors of the larynx and h ypopharynx (P < .001). Patients with a malignant lesion also had significan tly greater disability than patients with a benign lesion (P < .001). Conclusions: The MDADI is the first validated and reliable self-administere d questionnaire designed specifically for evaluating the impact of dysphagi a on the QOL of patients with head and neck cancer. Standardized questionna ires that measure patients' QOL offer a means for demonstrating treatment i mpact and improving medical care. The development and validation of the MDA DI and its use in prospective clinical trials allow for better understandin g of the impact of treatment of head and neck cancer on swallowing and of s wallowing difficulty on patients' QOL.