Speech and voice outcomes in oropharyngeal cancer and evaluation of the University of Washington Quality of Life speech domain.
BACKGROUND
Radical treatment of oropharyngeal cancer can have significant impact on speech & voice outcomes.


OBJECTIVE
(i) To assess the extent of speech & voice handicap in disease-free survivors of oropharyngeal squamous cell cancer. (ii) To assess the validity of the speech domain of UWQOL as a screening tool. (iii) To identify clinical characteristics associated with worse speech/voice outcome.


METHODS
Cross-sectional survey.


METHODS
University Hospital Aintree, a university teaching hospital and tertiary referral centre.


METHODS
All who were treated for oropharyngeal cancer between 1 January 1999 and 31 May 2005, were alive, disease free and willing to participate.


METHODS
Three patient-based questionnaires: University of Washington Quality of Life (UWQOL), voice handicap index (VHI) and voice related quality of life (VRQOL). Three expert-based assessments: GRBAS rating, speech intelligibility and dysarthria rating.


RESULTS
Sixty-six per cent of patients participated. Median VHI score (29) & VRQOL score (15) imply mild to moderate voice impairment. 20% of patients had severe handicap (VHI score >60). Forty-eight per cent had normal voice ratings. Speech was normal in 26%, mildly impaired in 62% and significantly impaired in 12% patients (UWQOL). Correlation between UW-QOL speech domain with speech intelligibility rating was 0.52 (P < 0.001). There were clear demarcations between UW-QOL scores of 30, 70 and 100 on the voice questionnaires. Adverse speech and voice function were associated with tumour stage, radiotherapy (RT) & free-flap surgery.


CONCLUSIONS
Voice & speech impairment is prevalent in >70% of oropharyngeal cancer patients. There is moderate correlation between UWQOL speech domain and speech intelligibility assessment & voice tools making it a quick and easy screening instrument. The main clinical correlates associated with adverse patient and observer rated speech and voice outcomes were tumour stage, RT and free-flap reconstruction.
Thomas
L
L
Alderhey Hospital, Liverpool, UK.
Jones
T M
TM
Tandon
S
S
Carding
P
P
Lowe
D
D
Rogers
S
S
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D018572:Disease-Free Survival; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy / Q000601:surgery; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D013064:Speech Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D013065:Speech Intelligibility; D013070:Speech Therapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014832:Voice Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D014833:Voice Quality; D014861:Washington