Pre- and posttreatment voice and speech outcomes in patients with advanced head and neck cancer treated with chemoradiotherapy: expert listeners' and patient's perception.
OBJECTIVE
Perceptual judgments and patients' perception of voice and speech after concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer.


METHODS
Prospective clinical trial.


METHODS
A standard Dutch text and a diadochokinetic task were recorded. Expert listeners rated voice and speech quality (based on Grade, Roughness, Breathiness, Asthenia, and Strain), articulation (overall, [p], [t], [k]), and comparative mean opinion scores of voice and speech at three assessment points calculated. A structured study-specific questionnaire evaluated patients' perception pretreatment (N=55), at 10-week (N=49) and 1-year posttreatment (N=37).


RESULTS
At 10 weeks, perceptual voice quality is significantly affected. The parameters overall voice quality (mean, -0.24; P=0.008), strain (mean, -0.12; P=0.012), nasality (mean, -0.08; P=0.009), roughness (mean, -0.22; P=0.001), and pitch (mean, -0.03; P=0.041) improved over time but not beyond baseline levels, except for asthenia at 1-year posttreatment (voice is less asthenic than at baseline; mean, +0.20; P=0.03). Perceptual analyses of articulation showed no significant differences. Patients judge their voice quality as good (score, 18/20) at all assessment points, but at 1-year posttreatment, most of them (70%) judge their "voice not as it used to be." In the 1-year versus 10-week posttreatment comparison, the larynx-hypopharynx tumor group was more strained, whereas nonlarynx tumor voices were judged less strained (mean, -0.33 and +0.07, respectively; P=0.031). Patients' perceived changes in voice and speech quality at 10-week post- versus pretreatment correlate weakly with expert judgments.


CONCLUSIONS
Overall, perceptual CCRT effects on voice and speech seem to peak at 10-week posttreatment but level off at 1-year posttreatment. However, at that assessment point, most patients still perceive their voice as different from baseline.
Department of Head and Neck Oncology & Surgery, The Netherlands Cancer Institute, Plesmanlaan, Amsterdam, The Netherlands.
Lisette
L
van der Molen
Maya A
MA
van Rossum
Irene
I
Jacobi
Rob J J H
RJ
van Son
Ludi E
LE
Smeele
Coen R N
CR
Rasch
Frans J M
FJ
Hilgers
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D059248:Chemoradiotherapy / Q000009:adverse effects*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D005081:Exercise Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000523:psychology / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D007262:Infusions, Intravenous; D007600:Judgment; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology* / Q000523:psychology; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D013061:Speech Acoustics; D013067:Speech Perception; D013068:Speech Production Measurement; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014832:Voice Disorders / Q000139:chemically induced / Q000209:etiology* / Q000523:psychology; D014833:Voice Quality / Q000187:drug effects* / Q000528:radiation effects*
D000970:Antineoplastic Agents; D002945:Cisplatin