Pre- and Posttreatment Voice and Speech Outcomes in Patients With Advanced Head and Neck Cancer Treated With Chemoradiotherapy: Expert Listeners' and Patient's Perception

Objectives. Perceptual judgments and patients' perception of voice and speech after concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer. Study Design. Prospective clinical trial. Methods. A standard Dutch text and a diadochokinetic task were recorded. Expert listeners rated voice and speech quality (based on Grade, Roughness, Breathiness, Asthenia, and Strain), articulation (overall, [p], [t], [k]), and comparative mean opinion scores of voice and speech at three assessment points calculated. A structured study-specific questionnaire evaluated patients' perception pretreatment (N = 55), at 10-week (N = 49) and 1-year posttreatment (N = 37). Results. At 10 weeks, perceptual voice quality is significantly affected. The parameters overall voice quality (mean, -0.24; P = 0.008), strain (mean, -0.12; P = 0.012), nasality (mean, -0.08; P = 0.009), roughness (mean, -0.22; P = 0.001), and pitch (mean, -0.03; P = 0.041) improved over time but not beyond baseline levels, except for asthenia at 1-year posttreatment (voice is less asthenic than at baseline; mean, +0.20; P = 0.03). Perceptual analyses of articulation showed no significant differences. Patients judge their voice quality as good (score, 18/20) at all assessment points, but at 1-year posttreatment, most of them (70%) judge their "voice not as it used to be.'' In the 1-year versus 10-week posttreatment comparison, the larynx-hypopharynx tumor group was more strained, whereas nonlarynx tumor voices were judged less strained (mean, -0.33 and +0.07, respectively; P = 0.031). Patients' perceived changes in voice and speech quality at 10-week post-versus pretreatment correlate weakly with expert judgments. Conclusion. Overall, perceptual CCRT effects on voice and speech seem to peak at 10-week posttreatment but level off at 1-year posttreatment. However, at that assessment point, most patients still perceive their voice as different from baseline.