Arabic Eating-10 Assessment Tool Validation Using Fiber-Optic Endoscopic Evaluation Of Swallowing (FEES) As An Imperfect Gold Standard: A Prospective Follow-up Cohort Study.

Abstract

Abstract Head and neck cancer treatments, such as radiotherapy, chemotherapy, and surgery, have diverse effects on patients, leading to dysphagia as a significant post-treatment issue. This study aims to validate the Arabic version of the EAT-10 questionnaire (A-EAT-10) using Fiber-Optic Endoscopic Evaluation of Swallowing (FEES) as an imperfect gold standard. Additionally, we seek to establish a correlation between A-EAT-10 and PEG tube insertion in head and neck cancer (HNC) patients.Our sample comprised 130 head and neck cancer patients with varying cancer types at King Hussein Cancer Center (KHCC). We followed these patients throughout their distinct treatment plans up to one month after their final treatment session. During follow-up visits, we administered the A-Eat-10 questionnaire to monitor dysphagia. FEES were conducted at the initial and concluding visits to compare results with A-EAT-10 scores. The results in our tests, assuming independence or dependence, demonstrated excellent agreement. A-EAT-10 exhibited outstanding predictive capabilities with an AUC ranging from 93–97%. A-EAT-10 tended to slightly overestimate dysphagia at later treatment stages by approximately 20% compared to FEES, with an RR of 1.2 (95% CI: 0.91, 1.56, p-value = 0.21), indicating statistical insignificance. In conclusion, A-EAT-10 exhibits excellent properties, making it a non-invasive, simple, and cost-effective alternative to FEES in dysphagia evaluation, and it can assist in predicting whether a patient requires PEG tube insertion before treatment initiation at first visits.