A prospective longitudinal study of voice characteristics and health-related quality of life outcomes following laryngeal cancer treatment with radiotherapy

Abstract

Background To investigate potential changes in perceptual, acoustic and patient-reported outcomes over 12 months for laryngeal cancer patients treated with radiotherapy. Material and methods A total of 40 patients with Tis-T3 laryngeal cancer treated with curative intent by radiotherapy were included in this prospective longitudinal descriptive study. Patients were followed pre-radiotherapy, one month, six months and 12 months post-radiotherapy, where voice recordings and patient-reported outcome instruments (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core30, Head and Neck35, Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer) were completed at each appointment. Perceptual analysis, using the Grade-Roughness-Breathiness-Asthenia-Strain scale and vocal fry parameters, and acoustic measures including harmonics-to-noise ratio (HNR), jitter, shimmer and mean spoken fundamental frequency (MSFF) were produced from voice recordings. Results All patients presented with dysphonic voices pre-radiotherapy, where 95% demonstrated some degree of vocal roughness. This variable improved significantly immediately post-radiotherapy, however, then deteriorated again between six and 12 months. Vocal fry also increased significantly at 12 months. Acoustic measures were abnormal pre-and post-treatment with no significant change noted except for MSFF, which lowered significantly by 12 months. Health-related quality of life (HRQL) deteriorated postradiotherapy but returned to pretreatment levels by 12 months. Conclusion By 12 months, most perceptual, acoustic, patient-reported voice and HRQL outcomes for laryngeal cancer patients treated by radiotherapy had showed no significant improvements compared to pretreatment function. Further studies are required to investigate potential benefits of voice rehabilitation following radiotherapy.

Dysphagia, Speech, Voice, and Trismus following Radiotherapy and/or Chemotherapy in Patients with Head and Neck Carcinoma: Review of the Literature

“…Most studies included patients with laryngeal tumors only; however 11 studies [ 22 , 27 , 29 , 30 , 33 – 37 , 44 ] also included nonlaryngeal tumors. Seventeen studies [ 21 , 23 , 25 , 26 , 28 , 30 – 32 , 34 – 36 , 38 – 43 ] included patients with low-grade tumors (i.e., T1 and T2) and 15 studies included patient with advanced tumors [ 22 , 24 , 27 , 29 – 37 , 40 , 42 , 44 ].…”

“…Nine studies [ 23 , 28 , 30 , 32 , 33 , 35 , 38 , 42 , 44 ] used acoustic analysis to evaluate voice quality, six studies [ 24 – 26 , 34 , 35 , 39 ] used the Voice Handicap Index, and three studies [ 21 , 38 , 43 ] used videolaryngostroboscopy. In several studies, either descriptions of how voice quality was evaluated were missing or nonvalidated tools were used (e.g., patients self-reporting or trial-specific questionnaires).…”

Quality of life and voice outcome of patients treated with transoral CO2 laser microsurgery for early glottic carcinoma (T1–T2): a 2-year follow-up study

“…Several studies have investigated QoL in patients with early glottic carcinoma after treatment with radiotherapy or TLM [9][10][11][12][13]. Most have reported good postoperative QoL scores that were either the same or better than preoperative scores.…”

Voice rehabilitation after laryngeal cancer: Associated effects on psychological well-being

“…Often presenting as a complex dysphonia, the voice post (C)RT has been characterised as harsh, rough, strained and breathy, with glottal fry and altered pitch which may remain with the patient long term [1–5]. Patients themselves report poor vocal quality, hoarseness, reduced volume and vocal fatigue following laryngeal cancer treatment [6–9].…”

“…Research specific to non-surgical treatment outcomes indicates that the majority of HRQL (function and symptom scales) deteriorate 1 month post radiotherapy then improve 6–12 months to reach baseline levels (pre-radiotherapy), although these remain below normative values [1, 10]. Most HRQL function and symptom outcomes present at 12 months continue to persist long term, up to 5 years post radiotherapy [11].…”