{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:22:25Z","timestamp":1790295745418,"version":"4.1.0"},"reference-count":20,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:sec id=\"ab-ooi260015-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Hypoglossal (CN XII) neuropathy is a debilitating latent toxic effect in survivors of oropharyngeal cancer (OPC), which is often underdiagnosed due to its delayed onset and subtle early signs and symptoms. There is no established patient-reported outcome tool to aid early detection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi260015-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate selected MD Anderson Symptom Inventory\u2013Head and Neck (MDASI-HN) symptom items for predicting CN XII neuropathy risk and derive a composite symptom-based nerve score (MDASI-HN-NERVE) with an optimal threshold for early risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi260015-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This retrospective analysis used data from a prospective cohort study of 1297 patients with OPC who were treated with curative intent at MD Anderson Cancer Center between March 2015 and December 2023. Eligible patients completed symptom assessments at baseline and regular follow-up intervals for up to 5 years. CN XII neuropathy status was classified based on documented clinical signs through a structured health record review. Data were analyzed in June 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi260015-7\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Symptom trajectories of 6 MDASI-HN items (chewing\/swallowing, choking, speech\/voice, mucus, fatigue, and dry mouth) were analyzed using spaghetti plots and piecewise linear mixed-effects models. A MDASI-HN-NERVE score was derived from these items to quantify CN XII neuropathy\u2013associated symptom burden. Time-dependent Cox models and Kaplan-Meier analyses were used to assess the risk of developing CN XII neuropathy, and optimal cut-off values were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi260015-8\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1297 participants, 141 (10.9%) were female and 1156 (89.1%) were male; the mean (SD) age was 65.9 (9.2) years. Higher MDASI-HN-NERVE scores were associated with an increased risk of CN XII neuropathy (hazard ratio, 1.35; 95% CI, 1.18-1.54). An optimal threshold of 3.4 at baseline and 3.5 at 3 to 6 months posttreatment distinguished high-risk vs low-risk groups with significantly different CN XII neuropathy\u2013free survival. Single-item MDASI speech\/voice scores at baseline and 3 to 6 months also discriminated latent CN XII neuropathy risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi260015-9\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>The results of this cohort study suggest that MDASI-HN speech\/voice symptoms and the MDASI-HN-NERVE score may provide a practical, patient-centered approach to aid early detection and monitoring of CN XII neuropathy risk. These findings provide early evidence to support the clinical use of MDASI-HN\u2013based surveillance in oropharyngeal cancer survivorship care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaoto.2026.0518","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T15:30:22Z","timestamp":1776958222000},"page":"586","source":"Crossref","is-referenced-by-count":1,"title":["MDASI-HN Symptom Profiling for Early-Risk Stratification of Hypoglossal Neuropathy in Survivors of Oropharyngeal Cancer"],"prefix":"10.1001","volume":"152","author":[{"given":"Wenye","family":"Song","sequence":"first","affiliation":[{"name":"Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine B.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Statistics, Rice University, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariana","family":"Sahli","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaowen","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carly","family":"Barbon","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy C.","family":"Moreno","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolaas C.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Neurology, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"McMillan","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Jack","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J.","family":"Frank","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston"},{"name":"Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifton David","family":"Fuller","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston"},{"name":"Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen Y.","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston"},{"name":"Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Hutcheson","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston"},{"name":"Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"23","key":"ooi260015r1","doi-asserted-by":"publisher","first-page":"5793","DOI":"10.1002\/cncr.27631","article-title":"Late dysphagia after radiotherapy-based treatment of head and neck cancer.","volume":"118","author":"Hutcheson","year":"2012","journal-title":"Cancer"},{"issue":"11","key":"ooi260015r2","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1001\/jamaoto.2018.1791","article-title":"Symptom burden associated with late lower cranial neuropathy in long-term oropharyngeal cancer survivors.","volume":"144","author":"Aggarwal","year":"2018","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"8","key":"ooi260015r3","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.1002\/hed.24789","article-title":"Delayed lower cranial neuropathy after oropharyngeal intensity-modulated radiotherapy: a cohort analysis and literature review.","volume":"39","author":"Hutcheson","year":"2017","journal-title":"Head Neck"},{"issue":"32","key":"ooi260015r4","doi-asserted-by":"publisher","first-page":"4294","DOI":"10.1200\/JCO.2011.36.4596","article-title":"Human papillomavirus and rising oropharyngeal cancer incidence in the United States.","volume":"29","author":"Chaturvedi","year":"2011","journal-title":"J Clin Oncol"},{"issue":"1","key":"ooi260015r5","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1056\/NEJMoa0912217","article-title":"Human papillomavirus and survival of patients with oropharyngeal cancer.","volume":"363","author":"Ang","year":"2010","journal-title":"N Engl J Med"},{"issue":"2","key":"ooi260015r6","doi-asserted-by":"publisher","DOI":"10.1046\/j.1533-2500.2001.01023-30.x","article-title":"Assessing symptom distress in cancer patients.","volume":"1","author":"Cleeland","year":"2001","journal-title":"Pain Pract"},{"issue":"7","key":"ooi260015r7","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1002\/ca.21011","article-title":"Human tongue neuroanatomy: nerve supply and motor endplates.","volume":"23","author":"Mu","year":"2010","journal-title":"Clin Anat"},{"issue":"5","key":"ooi260015r8","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1001\/jamaoto.2020.5269","article-title":"Risk and clinical risk factors associated with late lower cranial neuropathy in long-term oropharyngeal squamous cell carcinoma survivors.","volume":"147","author":"Aggarwal","year":"2021","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"6","key":"ooi260015r9","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1016\/j.jpainsymman.2015.12.320","article-title":"Psychometric validation of the M. 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K. High dose steroid therapy (prednisone or methylprednisolone) for the improvement of symptoms of late radiation-associated lower cranial neuropathy in oropharyngeal cancer survivors. 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