Smoking, Race and Survival Time May Affect Speaking for Survivors of Oropharyngeal Cancer

Several factors contributed to voice and speech impairments in survivors of oropharyngeal cancer including simultaneous chemotherapy regimens, several modalities of chemotherapy induction, total radiotherapy dose, and continued smoking, according to data published in JAMA Otolaryngology-Head & Neck Surgery.

Findings from the study also demonstrated that Black and Hispanic survivors of oropharyngeal cancer were more likely to have moderate to severe speech and voice symptoms.

“We postulate that the racial/ethnic differences observed in our study may be owing to low income, lack of health insurance, lack of awareness, differences in the perception of symptoms, behavioral/lifestyle choices, cultural and social differences and possibly other environmental factors or other comorbidities,” the study authors wrote.

Patients with oropharyngeal cancer are often treated with surgery and/or radiotherapy that can affect their oral cavity, pharynx and larynx. As a result, this can affect a patient’s voice and speech production. “Voice and speech production are complex physiological functions that are critical for verbal communication and social interaction and an inherent part of a person’s individuality and psychological well-being,” the study authors noted in the introduction.

Researchers sought to discover clinical and demographic risk factors that affect voice and speech symptoms through patient-reported outcomes. To do so, researchers analyzed survey responses from 881 survivors of oropharyngeal cancer (median age, 56 years; 15.5% women; 92.4% White; 1.9% Black; 3.8% Hispanic), which were used to calculate scores on speech and voice functionality. Voice and speech scores rated zero to four were considered none to mild symptoms, and scores five through 10 were considered moderate to severe symptoms.

A total of 113 survivors (12.8%) reported moderate to severe symptoms and 288 survivors (32.7%) reported none to mild symptoms.

Risk factors associated with moderate to severe voice and speech symptoms included increasing survival time, increasing total radiation dosage, treatment with induction and concurrent chemotherapy, and late and baseline lower cranial neuropathy.

In addition, Black race and Hispanic ethnicity were associated with a higher risk of speech and voice symptoms. Five out of 16 survivors (31.2%) who self-identified as Black and nine out of 33 survivors (27.3%) who self-identified as Hispanic reported moderate to severe voice and speech symptoms.

Continued smoking at the time the survey was completed was also associated with a higher risk of voice and speech symptoms. The study authors link this connection to the fact that smoking may cause irritation and dry laryngeal mucosa (mucus lining of larynx), which can lead to vocal cord inflammation and irritability.

Those with an increased survival time also had an increased risk of voice and speech symptoms due to the survivor experiencing late toxic effects of cancer treatment as they get older.

Notably, intensity-modulated radiotherapy split-field regimen was linked with a lower likelihood of moderate to severe speech and voice symptoms.

“Given the ever-growing population of comparatively healthy patients with human papillomavirus-associated (oropharyngeal cancer) who are likely to survive decades after treatment, our therapeutic efforts to preserve function and (quality of life) are important but should not compromise oncological outcomes,” the study authors concluded. “In situations in which these goals are competing, they should be prioritized and consider individual patient preferences and priorities through a shared decision-making process with the patient and their families.”

Some limitations of the study include the fact that the study only had one question to assess the severity of speech and voice impairment without a clinician’s assessment of the severity, and that both voice and speech outcomes were combined as outcomes.

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