Puja Aggarwal , PhD, BDS, MPH 1 , Katherine A. Hutcheson , PhD 2 , 3 , Adam S. Garden , MD 3 , Frank E. Mott , MD 4 , Ryan P. Goepfert , MD 2 , Amber Duvall , MS 2 , Clifton D. Fuller , MD, PhD 3 , Stephen Y. Lai , MD, PhD 2 , 3 , G. Brandon Gunn , MD 3 , Erich M. Sturgis , MD, MPH 5 , Ehab Y. Hanna , MD 2 , Sanjay Shete , PhD , 1 , 6 , 7
6 May 2021
What factors are associated with moderate to severe voice and speech symptoms among long-term survivors of oropharyngeal cancer (OPC)?
In this retrospective cohort study with cross-sectional survivorship survey administration, of 881 survivors of OPC who were included in analysis, 113 (12.8%) reported moderate to severe voice and speech symptoms. Increasing survival time and total radiation dose, Black race, Hispanic ethnicity, current cigarette smoking at the time of the survey, multimodality treatment with induction and concurrent chemotherapy, and late and baseline lower cranial neuropathy were identified as risk factors for moderate to severe voice and speech symptoms, and an intensity-modulated split-field radiotherapy regimen was associated with better voice and speech symptoms.
Voice and speech production are critical physiological functions that affect quality of life and may deteriorate substantially after oropharyngeal cancer (OPC) treatment. There is limited knowledge about risk factors associated with voice and speech outcomes among survivors of OPC.
To identify the risk factors of voice and speech symptoms among long-term survivors of OPC.
This retrospective cohort study with cross-sectional survivorship survey administration includes cancer-free survivors of OPC who were treated curatively between January 2000 and December 2013 at MD Anderson Cancer Center (Houston, Texas) who participated in a survey from September 2015 to July 2016. Of 906 survivors of OPC with a median survival duration at time of survey of 6 years (range, 1-16 years), patient-rated voice and speech outcomes for 881 were available and analyzed. The data were analyzed from June 30, 2020, to February 28, 2021.
The primary outcome variable was patient-reported voice and speech scores that were measured using the MD Anderson Symptom Inventory–Head and Neck Cancer Module. Voice and speech scores of 0 to 4 were categorized as none to mild symptoms, and scores of 5 to 10 were categorized as moderate to severe symptoms. Risk factors for moderate to severe voice and speech symptoms were identified by multivariable logistic regression.
Among 881 survivors of OPC (median [range] age, 56 [32-84] years; 140 women [15.5%]; 837 White [92.4%], 17 Black [1.9%], and 35 Hispanic individuals [3.8%]), 113 (12.8%) reported moderate to severe voice and speech scores. Increasing survival time (odds ratio [OR], 1.17; 95% CI, 1.06-1.30) and increasing total radiation dose (OR, 1.16; 95% CI, 1.00-1.34), Black race (OR, 3.90; 95% CI, 1.02-14.89), Hispanic ethnicity (OR, 3.74; 95% CI, 1.50-9.35), current cigarette smoking at the time of survey (OR, 3.98; 95% CI, 1.56-10.18), treatment with induction and concurrent chemotherapy (OR, 1.94; 95% CI, 1.06-3.57), and late (OR, 7.11; 95% CI, 3.08-16.41) and baseline lower cranial neuropathy (OR, 8.70; 95% CI, 3.01-25.13) were risk factors associated with moderate to severe voice and speech symptoms. Intensity-modulated radiotherapy split-field regimen (OR, 0.31; 95% CI, 0.12-0.80; P = .01) was associated with lower likelihood of moderate to severe voice and speech symptoms.
This large OPC survivorship cohort study identified many treatment-related factors, including increasing total radiotherapy dose, multimodality induction and concurrent chemotherapy regimens, and continued smoking, as well as clinical and demographic factors, as risk factors that were associated with moderate to severe voice and speech symptoms. The key findings in this study were the protective associations of split-field radiation and that longer-term survivors, and those who continued to smoke, had worse voice and speech symptoms. These findings may inform research and effective targeted clinical voice and speech preservation interventions and smoking cessation interventions to maximize voice and speech function and address quality of life among patients with OPC.
This cross-sectional study examines risk factors of voice and speech symptoms among survivors of long-term oropharyngeal cancer.