Predictors of speech and swallowing function following primary surgery for oral and oropharyngeal cancer.
OBJECTIVE
To examine the association between the speech and swallowing aspect of health-related quality of life (HRQOL) and selected clinical parameters, and particularly to determine those that are predictive of good outcomes at 1 year after surgery.


METHODS
Prospective questionnaire and clinical study.


METHODS
Regional Maxillofacial Unit.


METHODS
A total of 278 consecutive patients undergoing primary surgery for squamous cell carcinoma between 1995 and 1999. HRQOL was assessed using the University of Washington Quality of Life questionnaire (UW-QOL) pre-surgery, and post-surgery at 6 months, 1 year and later (median 39 months).


METHODS
Presentation of results was mainly descriptive, involving percentages and mean scores. Association of clinico-demographic factors with tumour site, and with UW-QOL swallowing and speech after 12 months, was tested with Fisher's exact or chi-squared tests as appropriate and modelled using logistic regression methods.


RESULTS
Univariate relationships were seen between speech and swallowing scores and with tumour size, T staging, radiotherapy, type of surgery (primary closure or free tissue transfer), tumour site, extent of resection of posterior tongue and soft palate, and UW-QOL taste and saliva scores. Multiple logistic regression showed that no radiotherapy (P<0.001) and primary surgical closure/laser surgery (P=0.003) were the main predictors of good swallowing, and primary surgical closure/laser surgery was the main predictor of good speech (P<0.001) at 1 year.


CONCLUSIONS
A number of clinical parameters can influence the speech and swallowing aspect of quality of life in these patients and when feasible, primary closure results in a better outcome than free flap reconstruction.
Zuydam
A C
AC
Speech and Language Therapy Department, University Hospital Aintree, Aintree Hospitals NHS Trust, Liverpool, UK. annette.zuydam@aht.nwest.nhs.uk
Lowe
D
D
Brown
J S
JS
Vaughan
E D
ED
Rogers
S N
SN
D000368:Aged; D003679:Deglutition / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009062:Mouth Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery*; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D012463:Saliva / Q000378:metabolism; D013060:Speech / Q000502:physiology*; D011795:Surveys and Questionnaires; D013649:Taste / Q000502:physiology; D016896:Treatment Outcome