Speech- and voice function and quality of life in laryngeal cancer patients with regard to treatment

Abstract

The overall aim of the study was to identify differences between laryngeal cancer patients treated with total laryngectomy with treacheoesophageal speech and patients treated with radiotherapy with laryngeal speech. We also wanted to find suitable instruments for identification and rehabilitation of communication and quality of life problems. Further we wanted to describe differences between T3 and T4 laryngeal cancer patients treated with laryngectomy and patients treated with radiotherapy in a Swedish joint programme. Laryngeal cancer patients were assessed according to perceptual analysis of voice- and speech characteristics and quality of life (n=28), acoustic analysis (n=24), a communication experience questionnaire (n=93) and survival and locoregional control (n=160).In the auditory-perceptual voice- and speech ratings the irradiated laryngeal speakers showed significantly (p<0.001) better results compared to the tracheoesophageal speakers, and inexperienced listeners rated the tracheoesophageal speakers significantly higher than the experienced listeners. However, the tracheoesophageal patients´ perceptual voice- and speech self-evaluation was significantly better when compared to the auditory perceptual evaluation.When patients treated with radiotherapy were compared to patients with laryngectomy regarding quality of life (QOL), global QOL was similar, and only small, nonsignificant differences were found (except for hoarseness). The results confirm that QOL is of a multifactorial subjective nature and that voice- and speech function is not the only dimension affecting QOL after treatment for laryngeal cancer.The successful alaryngeal tracheoesophageal speakers typically felt a strong sense of accomplishment, were rarely ashamed of their new voices, and appeared to be satisfied with the voices they managed to achieve, which might in part be due to modern techniques of speech rehabilitation (tracheoesophageal prosthesis) following laryngectomy.Both tracheoesophageal and irradiated patients could be distinguished regarding acoustic and temporal measures when compared to normal controls. For clinical purposes perceptual measures are superior to acoustic analysis in laryngeal cancer patients, but acoustic and temporal measures can be used in order to support and complement perceptual voice- and speech evaluation after treatment for laryngeal cancer.The study results showed voice- and speech related problems after treatment for laryngeal cancer not only for the laryngectomised patients who had lost the ability of vocal communication, but also for the patients treated with radiotherapy. This indicates the need of voice- and speech rehabilitation in both patient groups.In the psychometric evaluation of a communication experiences questionnaire; Swedish version-Self Evaluation of Communication Experiences after Laryngeal Cancer (S-SECEL), the results were satisfactory for the Environment and Attitude subscales, while the General subscale construct was not optimal (Cronbach´s alpha >0.90, and 0.60), respectively.In a multicenter study, T4 patients treated with laryngectomy with or without radiotherapy had significantly better 5-year survival and locoregional control compared to T4 patients treated with radical radiotherapy. However, a non randomised study must be interpreted with caution, and in future treatment discussions the results must be related to the expanding treatment options for laryngeal cancer.Conclusion: Tracheoesophageal communication in laryngectomised patients might facilitate the psychosocial rehabilitation. QOL is affected by other factors than voice- and speech function in patients with laryngeal cancer, and voice- and speech rehabilitation is indicated in patients treated with radiotherapy as well as in laryngectomised patients. The S-SECEL can be used as an instrument for assessment of rehabilitation needs and outcome of psychosocial care in patients with laryngeal cancer.