Patients With Oropharyngeal Cancer Report Decreased Quality of Voice and Speech After Treatment
Patients with oropharyngeal cancer treated with combined chemotherapy and radiation therapy reported a decrease in their voice and speech quality for up to 1 year after the completion of treatment, according to research presented today at the 2014 Multidisciplinary Head and Neck Cancer Symposium. The study further showed that limiting the dose of radiation to the glottic larynx to less than 20 Gy resulted in a decrease in post-treatment voice and speech quality problems. In addition, patient-reported voice and speech quality indicated more adverse effects from treatment compared to independent physician assessment.
Study Methods
The research evaluated the voice and speech quality of 91 patients with stage III/IV oropharyngeal cancer at the University of Michigan. The patients were treated from 2003 to 2011 in two prospective studies of definitive concurrent chemotherapy and radiation therapy, using advanced intensity-modulated radiation therapy techniques intended to minimize the radiation dose to the pharyngeal constrictors, salivary glands, oral cavity, glottic larynx, supraglottic larynx, and esophagus.
Patients’ voice and speech problems were evaluated and reported independently by patients and their physicians. Patient-reported voice and speech quality was assessed using the communication domain of the University of Michigan’s Head and Neck Quality of Life (HNQOL-C) questionnaire and the single speech question on the University of Washington Quality of Life (UWQOL-S) questionnaire.
Patients completed questionnaires prior to treatment, and 1, 3, 6, 12, 18, and 24 months after chemotherapy and radiation therapy. Factors associated with worsening patient-reported voice and speech quality were assessed and were defined as a decrease in HNQOL-C or UWQOL-S scores from the patients’ baseline evaluations.
Discrepancy Between Patient- and Physician-Reported Changes
A maximum decrease in voice and speech quality was reported at 1 month post-treatment, with 68% of patients reporting worsening HNQOL-C scores and 41% reporting lower UWQOL-S scores. Improvements to the scores were seen thereafter, with patients on average reporting scores back to baseline by 12 months post-treatment when scored on the HNQOL-C and by 18 months post-treatment when scored on the UWQOL-S.
At 12 months after treatment, however, one-third of patients continued to report a decrease in voice and speech quality compared to baseline, with 33% showing lower HNQOL-C scores and 28% showing lower UWQOL-S scores.
In contrast, physician assessment was much less sensitive to voice and speech problems at post-treatment, with voice and speech quality reported (grade 1 toxicity) by physicians in only 5% of patients at 3 months and 0% at either 1 or 2 years.
Effect of Radiation Dose to Glottic Larynx
On further analysis, patient-perceived voice quality worsening was closely related to the radiation dose received by the glottic larynx, while patient-perceived speech difficulty was related to radiation dose received by both the glottic larynx and oral cavity.
Worse patient-reported HNQOL-C scores at 6 months post-treatment were correlated with mean radiation dose to the glottic larynx. Twenty-five percent of patients whose glottic larynx received < 20 Gy, 33% who received 20 to 30 Gy, 59% who received 30 to 40 Gy, 50% who received 40 to 50 Gy, and 64% who received > 50 Gy reported worse scores at 6 months compared to pretreatment.
The association of worse HNQOL-C scores with dose to the glottic larynx persisted at the 12-month post-treatment mark, as reported by 10% of patients whose glottic larynx received < 20 Gy, 32% receiving 20 to 30 Gy, 25% receiving 30 to 40 Gy, 30% receiving 40 to 50 Gy, and 63% receiving > 50 Gy, (χ2 for trend P = .02 at 6 months, P = .011 at 12 months).
“In contrast to chronic mouth dryness and swallowing difficulties, which have been recognized for years as potential complications in patients receiving radiation therapy for cancers of the head and neck, relatively little attention has been directed to treatment-related changes in voice and speech quality,” said lead author Jeffrey Vainshtein, MD, Chief Resident in the Department of Radiation Oncology at the University of Michigan.
“The wide discrepancy between patient- and physician-reporting of voice and speech changes in our study underscores the fact that physicians may tend to underestimate the detrimental effects of head and neck radiation on this aspect of our patients’ quality of life,” he continued. “Our findings suggest that minimizing the radiation dose to the voice box and oral cavity in situations where they are not at risk of involvement by cancer is likely to reduce voice and speech problems, and thus improve post-treatment quality of life. Additionally, our research serves as a reminder of the critical role that patient-reported outcomes must continue to play in guiding modifications to our current therapies in order to ultimately improve our patients’ quality of life.”
The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
