Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
BACKGROUND: Individuals who are diagnosed and treated for oral cavity cancer (OCC) can have significant speech impairment. The Speech Handicap Index (SHI) is a self-reported survey that assesses the perception of speech quality originally validated in a cohort of oral or pharyngeal cancer. While many studies have looked at the psychosocial impact of both diseases together, the degree of impairment is unclear among an OCC-only cohort, and how demographic and treatment factors may contribute to a difference in speech handicap. Our primary aim of this study was to measure the SHI score and contributing factors in patients diagnosed with and treated for OCC, compared to controls.
METHODS: With institutional review board approval, we conducted a multi-institutional prospective cohort study from June to October 2024. Participants over 18 years diagnosed and treated for OCC were included using convenience sampling. Demographics and SHI results were collected during standard follow-up visits. Additional data included tumor presentation, treatment course, pathology, and oncologic follow-up. Controls were individuals over 18 without speech pathology who consented. Statistical analysis was performed using the Kruskal-Wallis test, with significance defined as p-value below 0.05. Higher SHI scores correlated with worse speech function.
RESULTS: A total of 58 patients diagnosed with OCC and 58 controls were consented onto the study. Thirty-three (56.9%) OCC patients were male, and the average age was 54 years (STD: 17.4) while 22 (37.9%) controls were male with an average of 65 years (STD: 10.4). 34% of patients underwent glossectomy as part of their cancer resection. Preliminary results show that patients diagnosed with OCC reported significantly higher SHI score compared to healthy controls (48 (range 28-114) versus 36 (range 29-81), p= <.01), particularly with regards to difficulty and effort with speech, social avoidance and isolation, emotional impact, and economic impact. SHI score did not vary with whether or not a glossectomy or free flap was included, but higher dysfunction among OCC was correlated with higher T stage (p = <.018). When comparing speech and psychosocial subscales, although both significant, the difference among OCC individuals was more pronounced in the latter (20.5 [IQR 17-31] versus 15 [IQR 14-19], p<0.01). Additionally, running out of air during speech, speech modification to adapt to speech challenges, and emotional reactions related to speech were items within the SHI that were significantly associated with older age (p <.05). Recruitment and statistical analysis are ongoing.
CONCLUSION: OCC significantly affects individuals’ perception of their own speech. In some instances, age may affect how individuals experience physical speech difficulties, their response to social interaction, and their use of speech modification strategies. These findings suggest that individuals diagnosed with OCC, particularity older individuals or those with a higher stage of cancer, may be more negatively impacted psychosocially and require more involved, multidisciplinary clinical follow-up and support. Our results can help to inform patients diagnosed with OCC, set expectations regarding speech function after surgery, and provide baseline data for understanding how to tailor free flap reconstruction to best preserve speech function.