Background: Head and neck cancer (HNC) affects structures related to swallowing, speech, and voice, and negatively impacts health-related quality of life. While many studies have investigated swallowing outcomes, very little is known about pre-treatment voice and speech function in this group of patients. This shortcoming has two major implications. First, without pre-treatment measures, there is no way to isolate the effect of the tumor on voice and speech function at baseline, independent from treatment effects. This makes it difficult to compare the efficacy of different treatment modalities on functional voice and speech outcomes. Second, without baseline measures, it is not possible to measure changes in voice and speech over time. Additionally, multiple instruments currently are used for measuring voice and speech outcomes, making comparisons difficult when different symptoms are experienced. Consequently, our team has validated a patient-reported measure of “communicative participation”, or communication in everyday settings in HNC patients. This measure is valid for patients with tumors that affect both voice (e.g., laryngeal tumors) and speech (e.g., oral, oropharyngeal tumors) function, rendering comparisons valid within a large group of HNC patients.
Objective: To determine how communicative participation is affected in HNC patients at pre-treatment, and to determine how communicative participation predicts health-related quality of life at pre-treatment.
Methods: Currently, 105 patients diagnosed with HNC (oral, orophyaryngeal, hypopharyngeal, laryngeal) have been recruited. Tumor site, T stage, p16 status, and planned treatment approach (surgical, chemoradiation, radiation) variables are being extracted from the medical record. Patients provided additional demographic information and completed validated patient-reported measures. Communicative participation was measured using the 10-item short form of the Communicative Participation Item Bank (CPIB; Baylor et al., 2013). HNC-related quality of life was measured using the University of Washington Quality of Life scale (UW-QOL; Hassan & Weymuller, 1993; Rogers et al., 2002). Relationships will be determined among the measures using correlational analyses. Regression analyses will be completed using communicative participation as the predictor variable, and the UWQOL composite score as the predicted variable.
Results: At present, data have been analyzed in a preliminary subgroup of patients, including 48 males and 15 females (average age = 60.3 years). Tumor sites include 20% larynx/hypopharynx, 44% oral, 29% oropharynx, and 7% nasopharynx. The average CPIB-10 T-score for the subgroup at pre-treatment is 61.70 (min = 24.2; max = 71; SD = 12.50). This average score is one SD above (better communicative participation) long term HNC survivor scores obtained in a previous study. Additional recruitment and data analysis are ongoing.
Conclusions: Communicative participation scores in pre-treatment HNC patients range from 2.5 SDs below the mean (i.e., very poor communicative participation) to scores that are comparable to healthy speakers (2 SDs above the mean). The average score is 1 SD better than the mean score of communicative participation in long-term HNC survivors, suggesting that many long term HNC survivors may not return to baseline after treatment. Prospective follow-up in this group will be important for interpreting results, and for suggesting directions for counseling and rehabilitation.