Effects of high-frequency speech therapy on speech-related quality of life and objective speech intelligibility of oral cancer patients

Long-term health-related quality of life in oral cancer survivors following microvascular tongue reconstruction

BACKGROUND

Evaluation of long-term health-related quality of life (HRQOL) is essential for optimization of functional and psychological outcomes in head and neck cancer survivors. However, few studies have assessed long-term HRQOL in survivors following microvascular tongue reconstruction.

METHODS

A retrospective, cross-sectional study was performed, including all consecutive patients who underwent microvascular reconstruction following tongue cancer resection between 2010 and 2020. The primary outcome was HRQOL, assessed using the FACE-Q Head and Neck Cancer Module at least 3 years after surgery. Patients were grouped by the extent of the resection: partial or hemiglossectomy versus (sub)total glossectomy. Multivariable analyses were performed between clinical variables and HRQOL.

RESULTS

Overall, 77 of 108 invited patients with a microvascular tongue reconstruction could be included with a mean follow-up of 7.9 years (SD 2.6) after surgery. Partial or hemiglossectomy was performed in 66 patients (86 %) and (sub)total glossectomy in 11 patients (14 %). In the long-term, mostly functional domains (eating, oral competence, salivation, speech and swallowing) and psychological domains of eating distress and speaking distress were affected. In multivariable analyses, postoperative radiotherapy was associated with worse speech (p = 0.002) and swallowing function (p = 0.027). (Sub)total glossectomy was significantly associated with worse speech (p = 0.011). Older age at surgery was significantly associated with poorer oral competence (p = 0.004). Females had significantly lower scores for the domain of swallowing (p = 0.044).

CONCLUSION

Long-term survivors after tongue reconstruction mainly report functionally-related HRQOL deficits. These long-term results can serve to enhance symptom management and may aid in managing patient expectations regarding long-term HRQOL.

Efficacy of Oral Rehabilitation Techniques in Patients With Oral Cancer: A Systematic Review and Meta-Analysis

Oral cancer commonly affects various parts of the oral cavity, including the lips, tongue, gums, palate, and inner cheeks. Oral rehabilitation involves multiple approaches aimed at restoring and improving oral function, esthetics, and overall well-being. This study assessed the functional outcomes and quality of life in patients who underwent rehabilitation following an oral cancer diagnosis. A comprehensive literature search was performed across PubMed, Cochrane Library, Dimensions, ScienceDirect, CINAHL, and Google Scholar databases. The study included patients diagnosed with oral cancer who had undergone oral rehabilitation. Functional outcomes and quality of life were key selection criteria. The methodological quality of the included studies was assessed, and data were systematically extracted and analyzed. A significant relationship was observed between the type of maxillectomy and quality of life, with obturator retention and stability being critical factors. Radiotherapy was found to adversely impact oral function and implant survival rates, with a strong correlation between radiation treatment and reduced implant survival (p < 0.00001). Additionally, dentition and the timing of implant placement were associated with recurrence rates and adverse effects. The findings highlight the crucial role of oral rehabilitation in improving both functional outcomes and quality of life in oral cancer patients. This study underscores the importance of incorporating oral rehabilitation into oral cancer treatment to enhance patient recovery and overall health.

Agreement between patient-reported and clinician-rated speech and swallowing outcomes - Understanding the trend in post-operative oral cavity cancer patients

AIM

To find the agreement between clinician-rated and patient-reported speech and swallowing outcomes in post-operative oral cavity cancer patients.

METHODS

In this prospective observational study, a total of 53 post-operative oral cavity cancer patients were recruited. The Speech Handicap Index - Kannada (SHI-K) and the Dysphagia Handicap Index - Kannada (DHI-K) were used as the patient-reported outcome measures (PROMs), and the Mann Assessment of Swallowing Ability-Cancer (MASA-C) and Ali Yavar Jung National Institute of Speech & Hearing Disabilities (DIVYANGJAN) AYJNISHD(D)'s speech intelligibility rating scale were used as the clinician-rated scales to evaluate speech and swallowing status.

RESULTS

Intraclass correlation coefficient (ICC) was poor, with a value of 0.480 between clinician-rated speech AYJNISHD(D)'s scale and patient-reported SHI-K scale. ICC was poor, with a value of 0.471 between clinician-rated swallowing MASA-C and patient-reported swallowing DHI-K.

CONCLUSION

In our study, there was no agreement between patient-reported and clinician-rated speech and swallowing outcomes in post-operative oral cavity cancer patients. Incorporating PROMs into routine clinical practice is advisable, and clinicians need to balance PROMs with clinical and instrumental speech and swallowing assessments to ensure comprehensive care.

Perioperative Symptom Burden and Its Influencing Factors in Patients with Oral Cancer: A Longitudinal Study

Objective

The aim of this study was to identify the symptom burden of perioperative oral cancer patients, its trajectory, and the factors influencing it.

Methods

A longitudinal, repeated measures design with consecutively identified sampling was used to recruit oral cancer patients scheduled for surgical treatment. Data collected included sociodemographic and clinical information, nutritional risk by the Nutritional Risk Screening 2002, and symptom burden by M. D. Anderson Symptom Inventory-Head and Neck Module (MDASI-HN) at preoperation, 7 days postsurgery, and 1 month postsurgery.

Results

Perioperative patients with oral cancer had multiple symptoms. Pain, difficulty swallowing/chewing, and mouth/throat sores (61.9%–76.1%) were the most prevalent symptoms before surgery. The symptom burden was the highest at 7 days after surgery, with the most prevalent symptoms, including difficulty swallowing/chewing, difficulty with voice/speech, and problems with mucus (87.8%–95.4%). At 1 month postsurgery, the 3 main symptoms were numbness or tingling, difficulty swallowing/chewing, and difficulty with voice/speech (all 87.8%). Treatment stage, job, comorbidity, cancer stage, adjuvant therapy, and Nutritional Risk Screening 2002 score were correlated with symptom burdens.

Conclusions

Our study illustrates that perioperative oral cancer patients have multiple symptoms and high symptom burdens, especially at 7 days postsurgery, with prominent symptoms and symptom burdens varying with the treatment stage.

Development of a Subjective Symptom Rating Scale for Postoperative Oral Dysfunction in Patients with Oral Cancer: Reliability and Validity of the Postoperative Oral Dysfunction Scale-10

Currently, there is no scale to subjectively assess postoperative oral dysfunction in patients with oral cancer. The purpose of this study was to evaluate the reliability and validity of the Postoperative Oral Dysfunction Scale (POD-10) that we developed. Between September 2019 and August 2021, 62 eligible oral cancer patients (median age, 72 years; 42 men and 20 women) were enrolled in the study. The Cronbach’s alpha coefficient, which indicates the internal consistency of the scale, was 0.94, and the intraclass correlation coefficient, which indicates reproducibility, was 0.85 (95% confidential interval: 0.40–0.96, p < 0.05). Concurrent validity testing showed a statistically significant correlation between POD-10 and Eating Assessment Tool (EAT-10) (r = 0.89, p < 0.05). To test discriminant validity, statistically significant differences were found between early-stage cancer (stage I and II) and advanced-stage cancer (stage III and IV) (p < 0.05). Twenty-four points were calculated as the cutoff value for POD-10 using receiver operating characteristic analysis to calculate the cutoff value. The POD-10 was shown to be a clinically reliable and valid scale that can be used to subjectively assess postoperative oral dysfunction in patients with oral cancer and is expected to be used as a simple diagnostic tool.