Dysphagia in Older Adults with Malignant Brain Tumors: Results of a National Study of Medicare Beneficiaries

The risk of swallowing dysfunction increases with age and is associated with underlying neurological conditions. However, the prevalence of dysphagia and its impact on outcomes among older adults with brain tumors is unknown. We aimed to determine the prevalence of dysphagia among patients ≥ 65 years with brain tumors and evaluate the relationship between dysphagia and outcomes, including healthcare utilization and survival, within this group. We hypothesized that the rates of dysphagia would be higher among those with brain cancer compared to those with solid organ cancer, and that nutrition via enteral access would not improve survival. Using a Medicare 5% limited dataset (2013–2018), we identified beneficiaries (≥ 65 years) with malignant brain tumors and measured the prevalence of dysphagia by ICD-9/10 codes. We compared outcomes and rates of dysphagia-related care among beneficiaries with primary malignant brain tumors (PMBTs) and those with solid tumors (with and without brain metastases) using current procedural terminology (CPT) codes. Beneficiaries with coexisting disorders predisposing to dysphagia were excluded. Kaplan Meier curves were used to estimate survival. Dysphagia was more prevalent among beneficiaries with PMBTs (11.0%) compared to those with solid tumors with (7.9%) and without (4.4%) brain metastases (p < 0.01). The presence of dysphagia was significantly associated with hospitalization (p < 0.01), use of gastrointestinal (GI) services (p < 0.01) and decreased survival: 75% of those with dysphagia survived 319 days post-cancer diagnosis (95% CI: 301, 332), versus 1082 days post-cancer diagnosis for those without dysphagia (95% CI: 1064, 1104) (p < 0.001). Among those with PMBTs, enteral access was not associated with an improvement in survival (p = 0.08). Dysphagia is prevalent among older adults with brain tumors (primary and metastatic) and is associated with increased mortality risk. Enteral access placement among those with PMBTs and dysphagia did not demonstrate improvement in survival.