title: Assessment of voice, speech, and related quality of life in advanced head and neck cancer patients 10-years+ after chemoradiotherapy.
abstract: OBJECTIVE
  Assessment of long-term objective and subjective voice, speech, articulation, and quality of life in patients with head and neck cancer (HNC) treated with concurrent chemoradiotherapy (CRT) for advanced, stage IV disease.
  
  
  METHODS
  Twenty-two disease-free survivors, treated with cisplatin-based CRT for inoperable HNC (1999-2004), were evaluated at 10-years post-treatment. A standard Dutch text was recorded. Perceptual analysis of voice, speech, and articulation was conducted by two expert listeners (SLPs). Also an experimental expert system based on automatic speech recognition was used. Patients' perception of voice and speech and related quality of life was assessed with the Voice Handicap Index (VHI) and Speech Handicap Index (SHI) questionnaires.
  
  
  RESULTS
  At a median follow-up of 11-years, perceptual evaluation showed abnormal scores in up to 64% of cases, depending on the outcome parameter analyzed. Automatic assessment of voice and speech parameters correlated moderate to strong with perceptual outcome scores. Patient-reported problems with voice (VHI>15) and speech (SHI>6) in daily life were present in 68% and 77% of patients, respectively. Patients treated with IMRT showed significantly less impairment compared to those treated with conventional radiotherapy.
  
  
  CONCLUSIONS
  More than 10-years after organ-preservation treatment, voice and speech problems are common in this patient cohort, as assessed with perceptual evaluation, automatic speech recognition, and with validated structured questionnaires. There were fewer complaints in patients treated with IMRT than with conventional radiotherapy.
authors.affiliation: The Netherlands Cancer Institute, Department of Head and Neck Oncology and Surgery, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: S A C
authors.initials: SA
authors.lastname: Kraaijenga
authors.affiliation: The Netherlands Cancer Institute, Department of Head and Neck Oncology and Surgery, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: I M
authors.initials: IM
authors.lastname: Oskam
authors.affiliation: The Netherlands Cancer Institute, Department of Head and Neck Oncology and Surgery, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; Institute of Phonetic Sciences, University of Amsterdam, Spuistraat 210, 1012 VT Amsterdam, The Netherlands.
authors.forename: R J J H
authors.initials: RJ
authors.lastname: van Son
authors.affiliation: The Netherlands Cancer Institute, Department of Radiation Oncology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: O
authors.initials: O
authors.lastname: Hamming-Vrieze
authors.affiliation: The Netherlands Cancer Institute, Department of Head and Neck Oncology and Surgery, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; Institute of Phonetic Sciences, University of Amsterdam, Spuistraat 210, 1012 VT Amsterdam, The Netherlands. Electronic address: f.hilgers@nki.nl.
authors.forename: F J M
authors.initials: FJ
authors.lastname: Hilgers
authors.affiliation: The Netherlands Cancer Institute, Department of Head and Neck Oncology and Surgery, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; Institute of Phonetic Sciences, University of Amsterdam, Spuistraat 210, 1012 VT Amsterdam, The Netherlands; Academic Medical Center, Department of Oral and Maxillofacial Surgery, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
authors.forename: M W M
authors.initials: MW
authors.lastname: van den Brekel
authors.affiliation: The Netherlands Cancer Institute, Department of Head and Neck Oncology and Surgery, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: van der Molen
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D059248:Chemoradiotherapy / Q000009:adverse effects*; D002945:Cisplatin / Q000009:adverse effects; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D013064:Speech Disorders / Q000209:etiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014833:Voice Quality / Q000187:drug effects / Q000528:radiation effects
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Automatic speech recognition; Chemoradiotherapy; GRBAS; Head and neck cancer; IMRT; Intelligibility; Long-term effects; Perceptual evaluation; Speech; Voice quality