Psychometric validation of a Swallowing-related Quality-of-life Questionnaire: Head and Neck Cancer Survivors' Assessment of Mealtimes (HN-SAM)

Abstract

Background: Studies have shown that swallowing problems, a common chronic issue after radiotherapy, have negative impact on head-and-neck cancer survivors' quality of life. The proposed swallowing-related quality of life questionnaire (HN-SAM) was developed from the perspective of the survivors and based on the International Classification of Functioning, Disability and Health (ICF) framework. The current study aimed to validate the questionnaire with HNC survivors. Methods: The HN-SAM is a 35-items questionnaire divided into four sections, including: 1) current diet and health; 2) body functions and structures; 3) activities and participation; and 4) environmental factors. Eight speech therapists rated the clinical relevance of the items. 122 HNC survivors, who have completed their cancer treatment for 6 months or more, completed HN-SAM and MDADI independently. Their swallowing functions were clinically assessed and rated based on the Functional Oral Intake Scale (FOIS). Results: Strong internal consistency and good test-retest reliability were found. The HN-SAM scores were moderately negatively correlated with the FOIS ratings and MDADI scores. Significant differences were found in the HN-SAM scores between dysphagic and non-dysphagic participants. Conclusions: HN-SAM is an ICF-based swallowing-related quality of life questionnaire. Good content, criterion, construct and clinical validity were established in the current study. It is proposed that HN-SAM be tested in more languages and countries for further validation. Acknowledgements: The project was partially funded by the Seed Funding Programme for Basic Research, University of Hong Kong.