Voice quality, vocal performance and swallowing ability in early laryngeal cancer patients; a comparison before and after cancer treatment

Abstract

Advancement in early laryngeal cancer management led to excellent tumor control. Secondary outcomes such as voice quality and health-related quality of life are of growing importance. Purpose of this study was to investigate voice quality and patients based experiences on vocal functioning and swallowing ability before and after treatment. A prospective controlled study is conducted including twenty patients who were treated for small laryngeal carcinoma (≤T3). Patients were assessed before and ≥12 months after treatment. Fourteen patients were treated with CO2 laser surgery, six patients received radiotherapy. Vocal performance is made objective with audio recordings of a read aloud text and a sustained vowel /a/. Self-perception of voice and swallowing problems are surveyed. Acoustic analysis is performed using Praat software. Statistical analysis is performed using SPSS by means of the independent t-test, Welch’s t-test and Pearson’s correlation coefficient. Before treatment, a significantly larger impact on self-reported voice functioning is found in patients with T1 staged tumors compared to patients with T2 staged tumors (t(10) = 3.32, p = .008). After treatment patients with T1 staged tumors show an improvement in vocal functioning compared to patients with T2 staged tumors where deterioration is seen (VHI; t(7)= -3.60, p = .009). No significance is found for the acoustic analyses and for the questionnaires evaluating swallowing problems. Wide standard deviation values for the acoustic measurements and health-related quality of life values indicate the existence of deviant functioning. Strong correlations are found between the acoustic parameters, as well as strong correlations between the parameters of the validated health-related quality of life questionnaires. Weak and debatable correlations are found when evaluating the correlations between these two concepts. The evidence to date shows presence of voice and swallowing problems in the group of early laryngeal cancer patients. Findings of the evaluated studies, this study and future research can lead to recommendations that ensure optimal preservation of function and maximization of health-related quality of life.