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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
Amy Y. Chen, MD, MPH;
Ralph Frankowski, PhD;
Julie Bishop-Leone, MA, CCC-SLP;
Tiffany Hebert, MCD, CCC-SLP;
Stacy Leyk, MA, CCC-SLP;
Jan Lewin, PhD;
Helmuth Goepfert, MD
Arch Otolaryngol Head Neck Surg. 2001;127:870-876.
Objective To design a reliable and validated self-administered questionnaire 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 design.
The M. D. Anderson Dysphagia Inventory (MDADI) included global, emotional,
functional, and physical subscales. One hundred consecutive adult patients
with a neoplasm of the upper aerodigestive tract who underwent evaluation
by our Speech Pathology team completed the MDADI and the Medical Outcomes
Study 36-Item Short Form Health Survey (SF-36). Speech pathologists completed
the Performance Status Scale for each patient. Validity and reliability properties
were calculated. Analysis of variance was used to assess how well the MDADI
discriminated between groups of patients.
Results The internal consistency reliability of the MDADI was calculated using
the Cronbach  coefficient. The Cronbach coefficients of the
MDADI subscales ranged from 0.85 to 0.93. Test-retest reliability coefficients
of the subscales ranged from 0.69 to 0.88. Spearman correlation coefficients
between the MDADI subscales and the SF-36 subscales demonstrated construct
validity. Patients with primary tumors of the oral cavity and oropharynx had
significantly greater swallowing disability with an adverse impact on their
QOL compared with patients with primary tumors of the larynx and hypopharynx
(P<.001). Patients with a malignant lesion also
had significantly greater disability than patients with a benign lesion (P<.001).
Conclusions The MDADI is the first validated and reliable self-administered questionnaire
designed specifically for evaluating the impact of dysphagia on the QOL of
patients with head and neck cancer. Standardized questionnaires that measure
patients' QOL offer a means for demonstrating treatment impact and improving
medical care. The development and validation of the MDADI and its use in prospective
clinical trials allow for better understanding of the impact of treatment
of head and neck cancer on swallowing and of swallowing difficulty on patients'
QOL.
From the Department of Head and Neck Surgery, University of Texas M.
D. Anderson Cancer Center (Drs Chen, Lewin, and Goepfert and Mss Bishop-Leone,
Hebert, and Leyk), and the Department of Biometry, University of Texas School
of Public Health (Dr Frankowski), Houston.
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