Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
BACKGROUND: Patients with oral cavity cancer (OCC) often experience oral pain and speech difficulties. It is unclear to what degree surgical resection affects self-reported speech function during the immediate post-operative period and longer term, compared to baseline. Using a validated questionnaire, the speech handicap index (SHI), we aimed to determine the impact of OCC on individuals’ self-perception of speech intelligibility and quality of life at the preoperative, immediate postoperative and longer-term postoperative stages compared to controls.
METHODS: A multi-institutional prospective cohort study was conducted with institutional board approval. Patients over 18 years with pathologically confirmed OCC were recruited to participate. For the control group, exclusion criteria included those with a speech pathology, under 18 years, or who refused consent. Participants completed the SHI and the study team collected demographics, disease presentation, staging, treatment, and oncologic follow up. Preoperative (PREOP) timepoints were from diagnosis to definitive treatment, immediate postoperative (IMP) from surgery to 35 days post-surgery, and postoperative (POSTOP) beyond 35 days post-surgery. Higher SHI scores (0-120) indicated poorer speech function. An additional self-report question on speech quality was separately analyzed. Statistical analysis was performed with Kruskal-Wallis tests, and statistical significance was defined as p-value below 0.05.
RESULTS: Fifty-two patients with OCC and 41 controls were consented to the study. There were 14 PREOP patients, 4 IMP patients, 34 POSTOP patients. Resections included 20 glossectomies, 4 wide local excision, 2 maxillectomies. 11 included mandibulectomies, and 19 included free flap reconstruction. Among OCC patients, 29 (56%) were male, with average ages of 67 years for PREOP (SD = 8.58), 54.5 years for IMP (SD = 4.12), and 64.6 years for POSTOP (SD = 11.0). Among controls, 13 (32%) were male, with an average age of 56 years (SD = 17.3). Total SHI scores were significantly higher in both IMP (median 64.5, IQR 40-83]) and POSTOP OCC (39.5 [34-58]) cohorts compared to controls (32 [30-36], p < 0.0001). The SHI score among the PREOP cohort was higher than controls (34 [32-40]), however this was not significant (p=0.12). Both IMP and POSTOP cohorts reported lower speech quality compared to controls (mean difference = -3.30, p = 0.0029; mean difference = -4.16, p = 0.0001). Speech impairment predictably worsened immediate postoperatively, then returned to near-baseline levels after 35 days (p>0.05). Recruitment for this study is ongoing.
CONCLUSION: Patients with OCC are often symptomatic in self-perceived speech function. Preliminary data indicates a non-significant negative trend in self-perception of speech intelligibility in patients with OCC compared to controls prior to surgery. In both short and longer-term postoperative treatment stages, speech impairment is worse compared with controls, however speech function approaches the preoperative baseline after 35 days. These findings will be helpful in preoperative patient counseling to help prepare patient expectations for postoperative speech function and recovery.