Pharyngeal Dysphagia in Cancer: Characterizing Functional and Physiological Swallow Targets Across 12 Cancer Types

Dysphagia is common across cancer populations, yet it remains poorly characterized outside of head and neck (HN) cancer. Defining swallowing profiles in diverse cancer groups is essential to guide targeted supportive care and rehabilitation. We analyzed 10,677 MBSs from 6,423 adult cancer patients referred for dysphagia assessment (2016-2021) across 12 cancer diagnoses, at a designated comprehensive cancer center. Swallowing safety and efficiency were graded using the DIGEST scale. Multivariable mixed-effects ordinal logistic regression assessed differences in DIGEST impairment (≥ 1) across diagnoses. In a subset of 704 studies, physiologic impairments were examined with the MBSImP and correlated with DIGEST outcomes. Dysphagia frequency varied significantly across cancer types for overall, safety, and efficiency domains (all p < 0.05). Overall dysphagia (DIGEST ≥ 1) was most frequent in patients with multiple cancers including HN (71%) and gastrointestinal (64%) and lowest in breast and endocrine/thyroid cancers. Safety impairments were highest in patients with multiple cancers including HN (59%), gastrointestinal (52%), and CNS (51%), while efficiency deficits predominated in patients with multiple cancers including HN (54%), HN alone (46%), CNS and multiple non-HN cancers (both 44%). Pharyngeal swallow initiation, anterior hyoid excursion, and laryngeal vestibular closure were the most frequently impaired physiologic components. Correlations between MBSImP and DIGEST varied across cancer types. Swallowing impairment profiles differ substantially by cancer type, and link to distinct physiologic targets. These findings support developing cancer-specific dysphagia pathways and integrating physiologic and functional metrics to optimize rehabilitation.