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Voice and Speech Significantly Affected Following Treatment in Patients with Oropharyngeal Cancer

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According to a new study presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium, oropharyngeal cancer patients treated with chemotherapy and radiation therapy concurrently, reported a significant drawbacks in their voice and speech quality (VSQ) for up to one year following the completion of treatment.

The study further demonstrated that restricting the dose of radiation to the glottic larynx (GL) to less than 20 Gy led to a decrease in post-treatment VSQ problems, and that patient-reported VSQ showed more adverse effects from treatment as opposed to independent physician evaluation.

The research examined the VSQ of 91 patients with stage III/IV oropharyngeal cancer (OPC) at the University of Michigan. The patients were treated from 2003-2011 on two prospective studies of definitive simultaneous chemotherapy and radiation therapy (CRT), employingvadvanced intensity modulated radiation therapy (IMRT) methods in an effort to curtail the radiation dose to the pharyngeal constrictors, salivary glands, oral cavity (OC, the inside region of the mouth), GL, supraglottic larynx and esophagus.

Patients' voice and speech issues were assessed and reported separately by patients and their physicians. Patient-reported VSQ was evaluated using the communication domain of the University of Michigan's Head and Neck Quality of Life (HNQOL-C) questionnaire and the single speech question on the University of Washington Quality of Life (UWQOL-S) questionnaire.

Patients finished questionnaires before the commencement of treatment, and one, three, six, 12, 18 and 24 months following CRT. Components connected to worsening patient-reported VSQ were evaluated and were described as a decrease in HNQOL-C or UWQOL-S scores from the patients' baseline assessments.

A maximum decrease in VSQ was reported at one month post-treatment, with 68 percent of patients reporting worsening HNQOL-C scores and 41 percent reporting lower UWQOL-S scores. Improvements to the scores were documented thereafter, with patients on average reporting scores back to baseline by 12 months post-treatment when scored on the HNQOL-C and by 18 months post-treatment when scored on the UWQOL-S. At 12 months following treatment, however, one-third of patients continued to report a decrease in VSQ as opposed to baseline, with 33 percent exhibiting lower HNQOL-C scores and 28 percent expressing lower UWQOL-S scores.voice speech

In contrast, physician evaluation was much less sensitive to voice and speech complications at post-treatment, with VSQ reported (grade one toxicity) by physicians in only 5 percent of patients at three months and 0 percent at either one or two years.

Upon further analysis, voice quality decline (as reported by patients) was closely associated with the radiation dose received by the GL (the voice box), while patient-perceived speech difficulty was linked to radiation dose received by both the GL and OC.

Worse patient-reported HNQOL-C scores at six months post-treatment were allied with average radiation dose to the GL, with 25 percent of those whose GL received less than 20 Gy; 33 percent who received >20-30 Gy; 59 percent who received >30-40 Gy; 50 percent who received >40-50 Gy; and 64 percent who received >50 Gy reporting worse scores at six months compared to pre-treatment. The connection of worse HNQOL-C scores with dose to the GL endured at the 12-month post-treatment mark, as reported by 10 percent of patients whose GL received less than 20 Gy; 32 percent receiving >20-30 Gy; 25 percent receiving >30-40 Gy; 30 percent receiving >40-50 Gy; and 63 percent receiving >50 Gy, (?2 for trend p=0.02 at six months, p=0.011 at 12 months).

"In contrast to chronic mouth dryness and swallowing difficulties, which have been recognized for years as potential complications in patients receiving radiation therapy for cancers of the head and neck, relatively little attention has been directed to treatment-related changes in voice and speech quality," said lead author of the study and chief resident in the Department of Radiation Oncology at the University of Michigan, Jeffrey Vainshtein, M.D.

"The wide discrepancy between patient- and physician-reporting of voice and speech changes in our study underscores the fact that physicians may tend to underestimate the detrimental effects of head and neck radiation on this aspect of our patients' quality of life. Our findings suggest that minimizing the radiation dose to the voice box and oral cavity in situations where they are not at risk of involvement by cancer is likely to reduce voice and speech problems, and thus improve post-treatment quality of life. Additionally, our research serves as a reminder of the critical role that patient-reported outcomes must continue to play in guiding modifications to our current therapies in order to ultimately improve our patients' quality of life."

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