Laryngeal cancer management: Voice, communication and quality of life outcomes following non-surgical treatment

Abstract

Organ-preservation treatments, such as radiotherapy + chemotherapy ([C]RT), are used to manage laryngeal cancer with the dual aim of achieving cancer cure, whilst enabling preservation of the larynx for improved functional outcomes post treatment. Research, however, has shown that organ-preservation is not synonymous with function-preservation. It is now recognised that vocal impairments often remain after organ-preservation treatment and that a return to normal voice function does not occur for all patients. Consequently, further research is needed to investigate the varying sequelae of laryngeal cancer management, specifically the impact on function and quality of life (QOL) over time, and the efficacy of rehabilitation. Positive benefits following rehabilitation have been reported within the greater head and neck cancer (HNC) population, however, research specifically exploring laryngeal cancer management, impact on voice function, communication, QOL and patient well-being is comparatively sparse. Hence, the aims of the current thesis are to (1) investigate voice function, communication and QOL for patients treated with (C)RT, and (2) examine the impact of voice rehabilitation on function, patient perceptions and psychological well-being. The first three studies of this thesis (Chapters 2-4) address the first aim, while studies 4 and 5 (Chapters 5-6) address the second. Data used in the current thesis were derived from (a) a large, randomised controlled trial (RCT), (b) a normative cohort, (c) a community listener group, and (d) speech-language pathology (SLP) clinicians. The first study (Chapter 2) investigates the potential impact of laryngeal biopsy on voice outcomes in a pilot group of 15 patients, and a matched control cohort (n=15). Voice outcomes were collected via voice recordings for both groups with the patient group undergoing recordings pre and post biopsy. No significant difference was observed pre-post biopsy, however examination of individual data suggested that multiple punch biopsies may negatively impact functional outcomes. Although the biopsy is a necessary component of cancer diagnosis, this pilot study concluded that type of biopsy may influence functional outcomes and that this is in an area requiring further research. Chapter 3 presents a longitudinal study investigating voice characteristics, communication and QOL outcomes for a cohort of patients (n=40) who received radiotherapy for laryngeal cancer. Voice function, patient reported communication and QOL outcomes were recorded pre treatment, then again at 1, 6 and 12 months post treatment. Results indicated that patients with laryngeal cancer demonstrated impaired and/or reduced perceptual, acoustic, patient reported communication and QOL outcomes pre radiotherapy, which persisted up to 12 months post. Results also documented patterns of change during the 12 month follow-up period. The implications for the nature and timing of voice rehabilitation are discussed.