Considering the hypothesis that the presence of dysphagia increases the chances that the patient diagnosed and treated for HNC will present a reduction in their QoL, this study detected a composite mean of 53.29 in the MDADI, reflecting a mean reduction in the QoL due to swallowing changes in majority of studied patients, that is, the majority of patients reported that their swallowing limits their daily activities.
The composite MDADI mean scores in this study was considerably lower than 63.36 reported in Brazil [42], 64.06 and 67 and reported in USA [1, 43] and 67.08 reported in Taiwan [27] indicating the severity of this problem in Ethiopia. The variation may be due to the fact that patients in Ethiopia lack access to early treatment and support since there is a single cancer center in the country that provide comprehensive cancer care.
Similar to previous studies that reported patient-related factors such as, gender [16, 19, 20] and financial burden [18, 44, 45], tumor-related factors such as advanced tumor stage[21–23], location of HNC [25–29] and type of treatment [15, 25, 30] ,this study also identified that female sex, low income (who can’t cover their medical expenses), suffering from laryngeal/ hypo pharyngeal cancer, suffering from advanced tumor are key determinants of poor QoL related to swallowing problems in HNC patients. These results have direct implications at improving the care of HNC patients by highlighting the need to incorporate swallowing function in the assessment and clinical management of patients.
In contrast, unlike previous studies that reported factors such as, age[16, 18, 19], marital status [46], and smoking [16–18] and deterioration in swallowing function through time [17, 37, 38], no associations were observed between age, smoking habit, marital status, time since diagnosis and type of carcinoma in this study.
Female cancer patients in this study experienced poor swallowing related QoL consistent with earlier studies[16, 19, 20]. Women were more emotionally distressed, frustrated, embarrassed and depressed due to the inability to enjoy mealtime [20] compared with male counterparts.
In this study, low - income patients scored lower MDADI scores in most of the domains which is consistent with the previous studies that linked financial burden from cancer with poor QoL [18, 44, 45].
Our results were consistent with prior studies that identified the negative impact of stage and location of cancer on swallowing related QoL. It is interesting to note that worse MDADI scores among patients with advanced tumor stages and that had laryngeal/ hypo pharyngeal tumors observed in prior studies [17, 21–29] were consistent with the risk observed for poorer QoL scores in our population. Patients that had oral cavity/ oropharyngeal tumor and at initial tumor stages had better MDADI scores compared to patients with laryngeal/ hypo pharyngeal and an advanced stage cancer emphasizing the need to rigorously address swallowing function in such cancer patients.
Unlike the finding of studies done in Spain, Brazil and USA, [2, 23, 47, 48], those patients received a multi-modality treatment were found to have a better scores compared to those with single modality treatment. This difference might be related to the fact that those patients with advanced stage cancer were less likely to had surgery and radiotherapy and any form of combination therapy due to their condition. Therefore, future studies should separately address the effect of therapy on swallowing problems for patients with early and advanced stage HNC patients in Ethiopia. As the burden of swallowing problems in HNC patients was established, it is crucial to incorporate swallowing function in routine cancer therapy protocols to mitigate the effect of dysphagia on QoL.