title: Variables Associated With Communicative Participation After Head and Neck Cancer.
abstract: For patients with head and neck cancer (HNC), communication difficulties often create substantial barriers in daily life, affecting a person's ability to return to work, establish or maintain relationships, or participate in everyday activities.
  
  
  
  To examine variables significantly associated with communication in everyday activities, or communicative participation, in adult survivors of HNC.
  
  
  
  In a cross-sectional study, from November 1, 2008, through March 18, 2011, participants completed questionnaires about specific experiences and symptoms associated with their health and communication. Seventeen variables were considered in association with communicative participation. Data were collected from adult survivors of HNC residing in a community. Participants completed questionnaires, in English, either online or using paper forms according to their preference. Participants were recruited through support groups, professional email lists, and professional contacts.
  
  
  
  Communicative participation and predictor variables were measured using a variety of validated patient-report scales and demographic information. Multiple linear regression analysis was conducted with variables entered using a backward stepwise regression procedure. Variables with significant regression coefficients were retained in the model and reported as change in R2.
  
  
  
  One hundred ninety-seven adults (121 males and 76 females; mean age, 61.5 years) participated, all at least 6 months posttreatment of HNC with no additional medical conditions affecting speech. The final model contained 4 significant variables (R2 = 0.462): self-rated speech severity, cognitive function, laryngectomy status, and time since diagnosis. Better communicative participation was associated with less severe speech and cognitive problems; together, these 2 variables explained 42% of the variance in the model (self-rated speech severity, R2 = 0.227, and cognitive function, R2 = 0.193 [0.227 + 0.193 = 0.420 = 42%]). To a lesser extent, better communicative participation also was associated with not having undergone a total laryngectomy surgical procedure (R2 = 0.035) and longer time since diagnosis (R2 = 0.007); full model: R2 = 0.462, P < .001; regression coefficients [SE]: self-rated speech severity 0.551 [0.065], P < .001, R2 = 0.227; cognitive function 0.063 [0.011], P < .001, R2 = 0.193; laryngectomy status 0.285 [0.117], P = .02; and time since diagnosis 0.015 [0.006], P = .02.
  
  
  
  These results suggest that communicative participation in adults with HNC is associated with self-rated speech severity, cognitive function, whether or not a person has undergone total laryngectomy, and time since diagnosis. Clinicians can use these results to inform their practice in pretreatment counseling, patient education, and rehabilitation for survivors of HNC.
authors.affiliation: Department of Speech and Hearing Sciences, University of Washington, Seattle.
authors.forename: Susan
authors.initials: S
authors.lastname: Bolt
authors.affiliation: Department of Speech and Hearing Sciences, University of Washington, Seattle2Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle.
authors.forename: Tanya
authors.initials: T
authors.lastname: Eadie
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Yorkston
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Baylor
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Amtmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D007825:Laryngectomy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013064:Speech Disorders / Q000209:etiology; D011795:Surveys and Questionnaires; D017741:Survivors; D013997:Time Factors; D014705:Verbal Behavior; D055815:Young Adult