Risk Factors for Adverse Voice and Speech in Oropharyngeal Cancer Identified Through Patient-Reported Surveys

According to the dating of a retrospective cohort study published in JAMA Otolaryngology-Head and Neck Surgery.

The study looked at 881 OPC survivors of white, black, and Hispanic ethnicity, 12.8% of whom had previously reported moderate to severe voice and speech scores. Risk factors such as black race, Hispanic origin, current smoking at the time of investigation, and induction and concomitant chemotherapy have been identified.

“To our knowledge, this study is the first to identify demographic and treatment-related risk factors that are associated with moderate to severe voice and speech symptoms,” wrote researchers from the MD Anderson Cancer Center at the ‘University of Texas at Houston.

The research team distributed questionnaires to patients treated between January 2000 and December 2013; this study took place between September 2015 and July 2016. Survivors (n = 1,740) were contacted, resulting in a participation rate of 56%. Only those who had been disease free for more than a year, were over 18 and spoke English were allowed to participate in the study.

Investigators found a longer survival time (odds ratio [OR], 1.17; 95% CI, 1.06-1.30), increased 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 consumption (OR, 3.98; CI at 95%, 1.56-10.18), reception of induction chemotherapy and concomitant (OR, 1.94; 95% CI, 1.06-3.57) and late (OR, 7.11 ; 95% CI: 3.08-16.41) and lower cranial neuropathy (NCNP; OR: 8.70; 95% CI: 3.01 to 25.13) were all associated with moderate to severe effects on voice and speech.

The MD Anderson Symptom Inventory Head and Neck Cancer Module (MDASI-HN) survey was used and consisted of 28 items: 13 items common to all tumor types, 9 items specific to head and neck cancer, and 6 items related to daily life. The head and neck portion included questions regarding voice and speech difficulties, dry mouth, difficulty chewing and swallowing, and any mucus in the mouth, among others.

Those who identified as black and Hispanic reported moderate to severe speech symptoms at rates of 31.2% and 27.3%, respectively. Among patients treated with induction and concomitant chemotherapy, 20.6% reported effects considered to be moderate or severe.

By multivariate logistic regression analysis, increased survival time (OR, 1.17; 95% CI, 1.06-1.30), higher radiotherapy dose (OR, 1.16; 95% CI, 1.00-1.34), black race (OR, 3.90; 95% CI, 1.02-14.89), Hispanic origin (OR, 3.74; 95% CI, 1.50- 9.35), cigarette consumption (OR, 3.98; 95% CI, 1.56-10.18), combined therapy with induction and concomitant chemotherapy (OR, 1.94; 95% CI, 1, 06-3.57), late LCNP (OR, 7.11; 95% CI, 3.08-16.41) and baseline LCNP (OR, 8.70; 95% CI, 3.01 to 25,13) were risk factors for speech symptoms.

Notably, the intensity modulated split-field radiotherapy (IMRT-SF) treatment technique was found to reduce the likelihood of symptoms (OR, 0.31; 95% CI, 0.12 to 0.80). Investigators noted that increasing the radiation therapy dose, even by 1 Gy, can lead to a 17% increase in moderate to severe voice / speech effects.

Some limitations noted by investigators included that a single question from the MDASI-HN was used to determine the level of voice / speech difficulty. There was also no availability of patient voice and speech scores before treatment.

“Consistent with other studies, we found that OPC survivors who received more modern compliant RT regimens, such as IMRT-SF, were less likely than survivors who received RT regimens older 3-dimensional compliant report moderate to severe voice and speech scores, ”investigators said.

The researchers concluded that preserving the quality of life of long-term survivors by taking these factors into account will likely require shared decision-making regarding prioritization of treatment goals and lifestyle changes.


Aggarwal P, Hutcheson KA, Garden AS et al. Association of risk factors with vocal and patient-reported vocal symptoms in long-term oropharyngeal cancer survivors. JAMA Otolaryngol Head and Neck Surgery. May 6, 2021. doi: 10.1001 / jamaoto.2021.0698

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