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Speech and voice outcomes in oropharyngeal cancer and evaluation of the University of Washington Quality of Life speech domain
Author(s) -
Thomas L.,
Jones T.M.,
Tandon S.,
Carding P.,
Lowe D.,
Rogers S.
Publication year - 2009
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/j.1749-4486.2008.01830.x
Subject(s) - medicine , quality of life (healthcare) , audiology , referral , intelligibility (philosophy) , dysarthria , family medicine , philosophy , nursing , epistemology
Background: Radical treatment of oropharyngeal cancer can have significant impact on speech & voice outcomes. Aims: (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. Design: Cross‐sectional survey. Setting: University Hospital Aintree, a university teaching hospital and tertiary referral centre. Patients: All who were treated for oropharyngeal cancer between 1 January 1999 and 31 May 2005, were alive, disease free and willing to participate. Interventions: 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.