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Cheng JT, Ramos Emos M, Leite V, Capozzi L, Woodrow LE, Gutierrez C, Ngo-Huang A, Krause KJ, Parke SC, Langelier DM. Rehabilitation Interventions in Head and Neck Cancer: A Scoping Review. Am J Phys Med Rehabil 2024; 103:S62-S71. [PMID: 38364033 DOI: 10.1097/phm.0000000000002384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
OBJECTIVE The aim of the study is to identify and appraise current evidence for rehabilitation interventions in head and neck cancer. DESIGN A previously published scoping review spanning 1990 through April 2017 was updated through January 11, 2023 and narrowed to include only interventional studies (Arch Phys Med Rehabil. 2019;100(12):2381-2388). Included studies had a majority head and neck cancer population and rehabilitation-specific interventions. Pairs of authors extracted data and evaluated study quality using the PEDro tool. Results were organized by intervention type. RESULTS Of 1338 unique citations, 83 studies with 87 citations met inclusion criteria. The median study sample size was 49 (range = 9-399). The most common interventions focused on swallow (16 studies), jaw (11), or both (6), followed by whole-body exercise (14) and voice (10). Most interventions took place in the outpatient setting (77) and were restorative in intent (65 articles). The overall study quality was fair (median PEDro score 5, range 0-8); none were of excellent quality (PEDro >9). CONCLUSIONS Most head and neck cancer rehabilitation interventions have focused on restorative swallow and jaw exercises and whole-body exercise to address dysphagia, trismus, and deconditioning. More high-quality evidence for head and neck cancer rehabilitation interventions that address a wider range of impairments and activity and social participation limitations during various cancer care phases is urgently needed to reduce head and neck cancer-associated morbidity.
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Affiliation(s)
- Jessica T Cheng
- From the Department of Supportive Care Medicine, City of Hope Orange County Lennar Foundation Cancer Center, California (JTC); Department of Orthopedic Surgery and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, New York (ME); Rehabilitation Department, Instituto do Cancer, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (VL); Faculty of Kinesiology, University of Calgary, Calgary, Canada (LC); Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, Canada (LC); Department of Internal Medicine, Section of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Canada (LEW); Department of Physical Medicine and Rehabilitation, McGovern Medical School at UTHealth Houston, Houston, Texas (CG); Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas (AN-H); Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas (KJK); Department of Physical Medicine and Rehabilitation, Mayo Clinic Arizona, Phoenix, Arizona (SCP); and Department of Medicine, Division of Physical Medicine and Rehabilitation, University Health Network and University of Toronto, Toronto, Canada (DML)
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Yildiz MG, Sagiroglu S, Bilal N, Kara I, Orhan I, Doganer A. Assessment of Subjective and Objective Voice Analysis According to Types of Sulcus Vocalis. J Voice 2023; 37:729-736. [PMID: 34112548 DOI: 10.1016/j.jvoice.2021.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sulcus vocalis (SV) subtypes are difficult to diagnose. Non-invasive techniques are sometimes not feasible in the diagnosis. The study aims to demonstrate the effectiveness and applicability of objective and subjective voice analysis combined with videolaryngostroboscopic examination (VLS) in the diagnosis of SV types. MATERIAL AND METHODS This is a retrospective study that includes patients who presented to Phoniatric outpatient clinic with complaints related to voice and diagnosed with SV on VLS examination between 2017-2020. The SV type was determined based on VLS findings and the patients were categorized into respective groups. Between- and within-group assessment of objective and subjective voice analysis of SV types was conducted. RESULTS 47 patients were included in the study; Type I, Type II, Type III SV patients were 16, 17, and 14 in number, respectively. Fundamental frequency (F0) and Shimmer (%) values were significantly high in Type II and III SV cases, whereas the Maximum Phonation Time (MPT) was significantly low. GRBAS, Voice Handicap Index -10 (VHI-10), Reflux Symptom Index (RSI) scores were statistically significantly high in pathological SV and Voice Related Quality of Life (V-RQOL) scores were low. A moderate correlation between VHI-10 and V-RQOL and between RSI and V-RQOL was detected. CONCLUSIONS Objective and subjective voice analysis in Type II and III SV show a significant difference compared to Type I SV. The use of objective and subjective voice analysis combined with VLS examination can be helpful in the diagnosis of SV types.
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Affiliation(s)
- Muhammed Gazi Yildiz
- The department of ENT, Kahramanmaraş Sütcü Imam university faculty of medicine, TURKEY.
| | - Saime Sagiroglu
- The department of ENT, Kahramanmaraş Sütcü Imam university faculty of medicine, TURKEY
| | - Nagihan Bilal
- The department of ENT, Kahramanmaraş Sütcü Imam university faculty of medicine, TURKEY
| | - Irfan Kara
- The department of ENT, Kahramanmaraş Sütcü Imam university faculty of medicine, TURKEY
| | - Israfil Orhan
- The department of ENT, Kahramanmaraş Sütcü Imam university faculty of medicine, TURKEY
| | - Adem Doganer
- The department of biostatistics, Kahramanmaraş Sütcü Imam university faculty of medicine, TURKEY
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Nguyen DD, Madill C. Auditory-perceptual Parameters as Predictors of Voice Acoustic Measures. J Voice 2023:S0892-1997(23)00088-7. [PMID: 37003863 DOI: 10.1016/j.jvoice.2023.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Much research has examined the relationship between perceptual and acoustic measures. However, little is known about the prediction values of perceptual measures on an acoustic parameter. AIMS This study utilized simulated and disordered voice samples to investigate the prediction values of breathiness, roughness, and strain ratings on the selection of some time-based and spectral-based measures of voice quality. METHOD This study retrospectively analysed two sets of precollected data. The experimental data had been collected from nine trained speakers manipulating false vocal fold activity, true vocal fold mass, and larynx height. The voice-disordered data had been extracted from a clinical database for 68 patients with muscle tension voice disorders (MTVD). Both data sets had been perceptually rated for breathiness, roughness, and strain. Voice samples (prolonged vowel /ɑ/ and Rainbow Passage readings) had undergone acoustic analysis using Praat for harmonics-to-noise ratio (HNR) and the program "Analysis of Dysphonia in Speech and Voice" (ADSV) for cepstral peak prominence (CPP), Cepstral/Spectral Index of Dysphonia (CSID), and Low/High spectral ratio (L/H ratio). Perceptual parameters were regressed against these acoustic measures to test their prediction values. RESULTS Reliability data showed satisfactory intra- and inter-reliability of perceptual ratings for both data sets. Breathiness significantly predicted CPP (both vocal tasks) and CSID (Rainbow Passage) in experimental data and predicted all the acoustic measures in MTVD data. Roughness significantly predicted HNR, CPP, and CSID in experimental data, and CPP (Rainbow Passage) and CSID (both vocal tasks) in MTVD data. Strain (both vocal tasks) significantly predicted L/H ratio in both data sets. CONCLUSIONS Breathiness ratings predicted selection of HNR, CPP and CSID; roughness ratings predicted selection of CPP and CSID, and strain ratings predicted L/H ratio.
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Affiliation(s)
- Duy Duong Nguyen
- Voice Research Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catherine Madill
- Voice Research Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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Dubey P, Fernandes JB, Bhat M. Acoustic Analysis of Voice in Laryngopharyngeal Cancers Pre and Post Radiotherapy. Indian J Otolaryngol Head Neck Surg 2022; 74:1973-1978. [PMID: 36452640 PMCID: PMC9701928 DOI: 10.1007/s12070-020-01934-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/23/2020] [Indexed: 12/01/2022] Open
Abstract
Laryngopharyngeal cancers are one of the most commonly diagnosed head and neck malignancies frequently presenting primarily with change in voice. Radiotherapy being the main modality of treatment for early cancers continues to affect voice. Hence, acoustic analysis of the voice offers quantifiable values of several parameters delineating the obvious effect of the therapy. A total number of 60 patients, diagnosed with laryngopharyngeal cancers undergoing radiotherapy underwent acoustic voice assessment using Dr. speech software pre-treatment and at 1 and 3 months post radiotherapy. Data analysis was done using Mann-Whitney test and Wilcoxon signed rank test and a significant p value was obtained. The results of the study showed fundamental frequency (F0) and noise to harmonic ratio (NHR) to be the most affected in comparison to Jitter and Shimmer. The F0 and NHR values across baseline evaluation, first month and third month follow up showed a steady deterioration which was significant. The deterioration noted from the first to third month was not statistically significant. Across genders both F0 and NHR deterioration is more in males than in females. Radiotherapy causes definitive alterations in some acoustic measures of voice, which make the voice disharmonic and hoarse with contribution of harshness and breathiness. The effect is more pronounced on vocal parameters that are structure and projection based as evidenced by deterioration in values noted in F0 and NHR. Persistent deteriorated acoustic parameters for a longer duration of time are more likely which emphasizes the need for early voice rehabilitation.
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Affiliation(s)
- Priya Dubey
- Department of ENT, Father Muller Medical College, Mangalore, India
- Bhopal, India
| | - Jacqueline B. Fernandes
- Department of Speech and Language Pathology, Father Muller Medical College, Mangalore, India
| | - Mahesh Bhat
- Department of ENT, Father Muller Medical College, Mangalore, India
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Sleight A, Gerber LH, Marshall TF, Livinski A, Alfano CM, Harrington S, Flores AM, Virani A, Hu X, Mitchell SA, Varedi M, Eden M, Hayek S, Reigle B, Kerkman A, Neves R, Jablonoski K, Hacker ED, Sun V, Newman R, McDonnell KK, L'Hotta A, Schoenhals A, Dpt NLS. Systematic Review of Functional Outcomes in Cancer Rehabilitation. Arch Phys Med Rehabil 2022; 103:1807-1826. [PMID: 35104445 PMCID: PMC9339032 DOI: 10.1016/j.apmr.2022.01.142] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains. DATA SOURCES PubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019. STUDY SELECTION Prospective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion. DATA EXTRACTION Extraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV). DATA SYNTHESIS Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome. CONCLUSIONS These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.
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Affiliation(s)
- Alix Sleight
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, United States; Center for Integrated Research in Cancer and Lifestyle (CIRCL), Cedars-Sinai Medical Center, Los Angeles, California, United States; Cedars Sinai Cancer, Los Angeles, California, United States; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States.
| | - Lynn H Gerber
- College of Health and Human Services, George Mason University, Fairfax County, Virginia, United States; Inova Health System, Inova Medicine Services, Falls Church, Virginia, United States
| | | | - Alicia Livinski
- National Institutes of Health Library, Office of Research Services, National Institutes of Health, Bethesda, Maryland, United States
| | - Catherine M Alfano
- Northwell Health Cancer Institute, New Hyde Park, New York, United States; Center for Personalized Health, Feinstein Institutes for Medical Research, Manhasset, New York, United States; Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, United States
| | - Shana Harrington
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
| | - Ann Marie Flores
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States; Robert H. Lurie Comprehensive Cancer Center, Cancer Survivorship Institute, Chicago, Illinois, United States
| | - Aneesha Virani
- Rehabilitation Department, Northside Hospital, Atlanta, Georgia, United States
| | - Xiaorong Hu
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Boston, Massachusetts, United States; Rehabilitation Medicine School, Nanjing Medical University, Nanjing, China
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States
| | - Mitra Varedi
- Epidemiology and Cancer Control Department, St Jude Children's Research Hospital, Memphis, Tennessee, United States
| | - Melissa Eden
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, Arizona, United States
| | - Samah Hayek
- Clalit Health Services, Clalit Research Institute, Ramat-Gan, Israel
| | - Beverly Reigle
- College of Nursing, University of Cincinnati, Cincinnati, Ohio, United States
| | - Anya Kerkman
- Lincoln Cancer Rehabilitation, Lincoln, Nebraska, United States; CHI Health St Elizabeth, Lincoln, Nebraska, United States
| | - Raquel Neves
- Czech Rehabilitation Hospital, Al Ain, United Arab Emirates
| | - Kathleen Jablonoski
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States; Department of Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Eileen Danaher Hacker
- Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, Indiana, United States
| | - Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, California, United States; Department of Surgery, City of Hope, Duarte, California, United States
| | - Robin Newman
- Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, Massachusetts, United States
| | - Karen Kane McDonnell
- College of Nursing, University of South Carolina, Columbia, South Carolina, United States
| | - Allison L'Hotta
- Department of Occupational Therapy, Washington University in St Louis, St Louis, Missouri, United States
| | - Alana Schoenhals
- Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, United States
| | - Nicole L Stout Dpt
- West Virginia University Cancer Institute, West Virginia University School of Public Health, Morgantown, West Virginia, United States; Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States
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Ahmed EA, Atar S, Atar Y, Sari H, Anarat MEA, Saltürk Z, Karaketir SG, Uyar Y, Kuru Ö. Evaluation of the Swallowing and Voice Functions in Ankylosing Spondylitis Patients. Dysphagia 2021; 37:455-462. [PMID: 34259915 DOI: 10.1007/s00455-021-10340-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/08/2021] [Indexed: 11/26/2022]
Abstract
This study aimed to evaluate the swallowing and voice functions in patients with ankylosing spondylitis. Thirty patients with ankylosing spondylitis (Group 1) and 30 healthy individuals (Group 2) were included in the study. Following the laryngoscopic evaluation of the patients, the fiberoptic endoscopic evaluation of swallowing was performed, and then, the penetration-aspiration score was determined. The participants were asked to fill the eating assessment tool form. Voice recordings obtained to evaluate sound disorders were measured acoustically and analyzed using the PRAAT program. In terms of swallowing, the penetration-aspiration score obtained as a result of the flexible endoscopic swallowing assessment and eating assessment tool score was found to be higher in Group 1 than in Group 2, and a statistically significant difference was noted (p ≤ 0.001). When analyzing the maximum phonation time (p < 0.001) and fundamental frequency (p = 0.408) values in phonation evaluation, a statistically significant difference was found between the two groups. Group 1 showed a deterioration in terms of jitter (p = 0.040) and shimmer (p = 0.007) compared to Group 2, and a statistically significant difference was noted. There was no statistically significant difference in the harmonic/noise ratio (mean ± standard deviation) between the two groups (p = 0.051). Swallowing and voice functions significantly affect quality of life. Therefore, approaches aimed to improve the associated symptoms have become increasingly important. In patients with ankylosing spondylitis, swallowing quality and phonation ability may be negatively affected. These patients should be monitored for hidden or overt food aspiration.Trial Registry: https://clinicaltrials.gov/ct2/show/NCT04437394.
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Affiliation(s)
| | - Sevgi Atar
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Darulaceze Cad. No: 25 Okmeydani-Sisli, Istanbul, Turkey.
| | - Yavuz Atar
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Hüseyin Sari
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Melis Ece Arkan Anarat
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Ziya Saltürk
- Department of Otorhinolaryngology, Anadolu Medical Center, In Affiliation With Johns Hopkins Medicine, Istanbul, Turkey
| | | | - Yavuz Uyar
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Ömer Kuru
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Darulaceze Cad. No: 25 Okmeydani-Sisli, Istanbul, Turkey
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Janik S, Stanisz I, Grasl S, Denk-Linnert DM, Erovic BM, Schneider-Stickler B. Using the PRAAT software to describe dependence of speech intelligibility on tongue mobility in 6 patients after salvage glossectomy and reconstruction with a serratus anterior free flap. Clin Otolaryngol 2021; 46:1100-1105. [PMID: 33773035 DOI: 10.1111/coa.13773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/26/2021] [Accepted: 03/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Stefan Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University Vienna, Vienna, Austria
| | - Isabella Stanisz
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University Vienna, Vienna, Austria
| | - Stefan Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University Vienna, Vienna, Austria
| | - Doris-Maria Denk-Linnert
- Department of Otorhinolaryngology, Division of Phoniatrics and Speech Language Therapy, Medical University Vienna, Vienna, Austria
| | - Boban M Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, Vienna, Austria
| | - Berit Schneider-Stickler
- Department of Otorhinolaryngology, Division of Phoniatrics and Speech Language Therapy, Medical University Vienna, Vienna, Austria
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Johansson M, Finizia C, Persson J, Tuomi L. Cost-effectiveness analysis of voice rehabilitation for patients with laryngeal cancer: a randomized controlled study. Support Care Cancer 2020; 28:5203-5211. [PMID: 32078058 PMCID: PMC7547033 DOI: 10.1007/s00520-020-05362-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/13/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Voice problems are common following radiotherapy for laryngeal cancer. Few studies exist covering the effect of voice rehabilitation, and no previous studies exist regarding the cost of said rehabilitation. This randomized controlled study aimed to analyze the cost-effectiveness of voice rehabilitation after radiotherapy for patients with laryngeal cancer. MATERIAL AND METHODS A total of 66 patients with laryngeal cancer with follow-up data 12 months post-radiotherapy were included. Patients were randomized into receiving either voice rehabilitation (n = 32) or no voice rehabilitation (n = 34). The patient outcome was measured as quality-adjusted life years (QALYs). The index range between 0 and 1, where 0 equals death and 1 represents perfect health. The QALYs were assessed with the European Organization for Research and Treatment of Cancer questionnaire QLQ-C30 mapped to EuroQoL 5 Dimension values. The cost of rehabilitation and other healthcare visits was derived from hospital systems. The patients reported the total amount of sick leave days during the first 12 months following radiotherapy. The cost-effectiveness of the voice rehabilitation was compared with no rehabilitation intervention based on the incremental cost-effectiveness ratio. RESULTS The cost per gained QALY with voice rehabilitation compared to no rehabilitation from a societal perspective was - 27,594 € (SEK - 250,852) which indicates that the voice rehabilitation is a cost-saving alternative compared to no rehabilitation due to lower costs and a slightly better health outcome. From a healthcare perspective, the voice rehabilitation indicates a cost 60,800 € (SEK 552,725) per gained QALY. CONCLUSION From a societal perspective, i.e., including the costs of production loss, voice rehabilitation compared to no voice rehabilitation following radiotherapy for laryngeal cancer seems to be cost-saving. When analyzing only the healthcare costs in relation to health outcomes, voice rehabilitation indicates an incremental cost of 60,800 € per gained QALY, which is just above the threshold of the maximum willingness to pay level.
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Affiliation(s)
- Mia Johansson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the Gothenburg University, Gothenburg, Sweden
- Department of Oncology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Josefine Persson
- Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
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Porras Alonso E, Vilaseca González I, García Teno M, Barberá Durbán R, Viscasillas Pallàs G, Sancho Mestre M, Rebollo Otal J, Menoyo Bueno A, Díaz de Cerio Canduela P. Early glottic tumours with anterior commissure involvement. Literature review and consensus document. Head and Neck and Skull Base Commission, SEORL-CCC. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71 Suppl 1:1-20. [PMID: 32532450 DOI: 10.1016/j.otorri.2020.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 01/08/2023]
Abstract
The choice of the most appropriate treatment in early-stage glottic cancer with anterior commissure involvement remains controversial. Its therapeutic management is complex because it is a significant prognostic indicator of local control with 37% recurrence, due to the difficulty in establishing tumour extension with understaging of up to 40%, and due to the comparison of results in series on tumours that behave variably as they progress, such as T1a, T1b and T2a with commissure involvement. Furthermore, the complexity of the surgical approach using transoral CO2 laser microsurgery requires surgical skill, appropriate equipment and experience. Aspects to be reviewed in this document are: an updated anatomical definition of the anterior commissure, tumour progression based on histopathological studies, usefulness of videostroboscopy and NBI in diagnostic accuracy, validity of imaging tests, oncological results published in series reviews, systematic reviews and meta-analyses, tumour margin treatment and voice evaluation.Finally, by way of a summary, the document includes a series of recommendations for the treatment of these tumours.
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Early Glottic Tumours With Anterior Commissure Involvement. Literature Review and Consensus Document. Head and Neck and Skull Base Commission, SEORL-CCC. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Karlsen T, Sandvik L, Heimdal JH, Aarstad HJ. Acoustic Voice Analysis and Maximum Phonation Time in Relation to Voice Handicap Index Score and Larynx Disease. J Voice 2018; 34:161.e27-161.e35. [PMID: 30093166 DOI: 10.1016/j.jvoice.2018.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Patients with voice-related disorders are ideally treated by a multidisciplinary team. Acoustic voice analysis and patient-reported outcome measures are recommended parts of the clinical assessment. The present paper aims at further documenting the importance of acoustic voice analyses, maximum phonation time (MPT) and Voice Handicap Index (VHI) into clinical investigations. STUDY DESIGN The participants (N = 80 larynx cancer, N = 32 recurrent palsy, N = 23 dysfunctional, N = 75 degenerative/inflammation (N = 19 various excluded)) were included consecutively at the outpatient laryngology clinic at Haukeland University Hospital. In addition, a control group of 98 healthy subjects were included. METHOD Voice samples, MPT, and the VHI scores in addition to standard clinical information were obtained. Acoustic analyses were performed from these samples determining level of jitter, shimmer and Noise-to-Harmonic ratio (NHR) as well as analyzing frequency of a prolonged vowel. RESULTS Jitter, shimmer, and NHR scores correlated strongly (r ≈ 0.8; P < 0.001) to each other. By Analysis of Variance analyses, we have determined significant dependence on diagnostic group analyzing all the obtained acoustic scores (all P < 0.001). All patient groups but the dysfunctional group scored to some extent worse than the control group (mostly at P < 0.001). In addition, jitter scores from dysfunction group were lower than recurrent palsy group (P < 0.05) and shimmer scores were lower among dysfunctional than the cancer group (P < 0.05). Regarding NHR the cancer patients scored higher than the degenerative/inflammatory group (P < 0.05). The cancer group scored with longer MPT than the degenerative/inflammatory (P < 0.001) and recurrent palsy groups (P < 0.05). CONCLUSION Among larynx disease patients acoustic and MPT analyses segregated with all determined analyses between patients and control conditions except the dysfunctional group, but also to some extent between various patient groups. VHI scores correlated to jitter, shimmer and NHR scores among cancer and degenerative/inflammatory disease patients. Acoustic analyses potentially add information useful to laryngological patient studies.
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Affiliation(s)
- Tom Karlsen
- Department of Otorhinolaryngology-Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway; Department of Speech and Language, Statped Vest, Bergen, Norway.
| | - Lorentz Sandvik
- Department of Otorhinolaryngology-Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - John-Helge Heimdal
- Department of Otorhinolaryngology-Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Hans Jørgen Aarstad
- Department of Otorhinolaryngology-Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Zhang MJ, Mu JW, Chen XR, Zhang X, Feng C. Effect of voice rehabilitation training on the patients with laryngeal cancer after radiotherapy. Medicine (Baltimore) 2018; 97:e11268. [PMID: 29953001 PMCID: PMC6039695 DOI: 10.1097/md.0000000000011268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This retrospective study examined the effect of voice rehabilitation training (VRT) for patients with laryngeal cancer (LC) after radiotherapy.Eighty-three eligible patients with LC were included. Forty-three patients were assigned to a treatment group, and underwent VRT, while the other 40 subjects were assigned to a control group, and were at waiting list. Primary outcome was measured by the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale. Secondary outcome was measured by Patient Perception Measures. All outcomes were measured before and 3 months after VRT intervention.Patients in the treatment group did not show better outcomes, measured by GRBAS scale (Grade, P = .78; Roughness, P = .61; Breathiness, P = .83; Ashenia, P = .89; and Strain, P = .41), and Patient Perception Measures (Vocal quality, P = .17; Acceptability, P = .35; Hoarseness, P = .23; Vocal fatigue, P = .39; and Ashamed, P = .51), compared with patients in the control group.The results of this study did not exert better outcomes in patients received VRT than those at waiting list.
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Affiliation(s)
- Mei-Jia Zhang
- Department of Otolaryngology, First Affiliated Hospital of Jiamusi University, Jiamusi Department of Ultrasound, Second Affiliated Hospital of Mudanjiang Medical University Department of Ultrasound, Hongqi Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
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13
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Law T, Lee KYS, Wong RWM, Leung Y, Ku PKM, Wong EWY, Li HN, Ng LKY, van Hasselt CA, Tong MCF. Effects of electrical stimulation on vocal functions in patients with nasopharyngeal carcinoma. Laryngoscope 2016; 127:1119-1124. [PMID: 27859286 DOI: 10.1002/lary.26243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to evaluate the effects of neuromuscular electrical stimulation (NMES) on vocal functions in patients with nasopharyngeal carcinoma following radiation therapy. STUDY DESIGN Prospective, randomized controlled trial. METHODS One hundred forty newly treated NPC patients were recruited and randomized into NMES or traditional swallowing exercise (TE) group. Participants received intensive NMES or traditional swallowing therapy and were followed up until 12 months postrandomization. Fifty-seven participants completed the treatment and all of the follow-up assessments. The Voice Handicap Index-30 (VHI-30) was used to measure the vocal functions of the participants. RESULTS The NMES group showed no significant changes to their vocal functions, whereas the TE group showed a short-term deterioration of voice functions at the 6-month follow-up. VHI-30 scores returned to the baseline level for both groups at the 12-month follow-up. CONCLUSIONS NMES is shown to provide a short-term benefit on vocal functions for NPC patients following radiation therapy. LEVEL OF EVIDENCE 1b Laryngoscope, 127:1119-1124, 2017.
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Affiliation(s)
- Thomas Law
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Kathy Y-S Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Rita W M Wong
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Yeptain Leung
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter K M Ku
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Eddy W Y Wong
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hok-Nam Li
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Louisa K Y Ng
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - C Andrew van Hasselt
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Michael C F Tong
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, China
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Voice Range Profile and Health-related Quality of Life Measurements Following Voice Rehabilitation After Radiotherapy; a Randomized Controlled Study. J Voice 2016; 31:115.e9-115.e16. [PMID: 27091469 DOI: 10.1016/j.jvoice.2016.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/18/2016] [Accepted: 03/22/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE The aim of the present study was to investigate the effects of voice rehabilitation in patients treated with radiotherapy for laryngeal cancer. METHOD A total of 42 patients with laryngeal cancer who are treated with radiotherapy with curative intent participated in a randomized controlled study. The collected data were voice range profiles (VPRs) and patient-reported outcome (PRO) instruments for measurement of self-perceived communication function (Swedish Self-Evaluation for Communication Experiences after Laryngeal cancer (S-SECEL)) and health related quality of life (HRQL) (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30/Head and Neck module). Data were collected 1 month (pre voice rehabilitation), 6 months, and 12 months postradiotherapy. Of the patients, 19 received voice rehabilitation, whereas 23 constituted a control group. RESULTS There were several statistically significant improvements in the study group concerning the HRQL and self-perceived communication function. The largest improvements occurred between occasions 1 (prevoice rehabilitation) and 2 (6-month postradiotherapy) and then remained constant. VRP area demonstrated a statistically significant difference when comparing changes over time, where the study group improved more than the control group. CONCLUSION HRQL and self-perceived communication function showed improvement in the study group and trends of impairment in the control group. This result might suggest that it would be beneficial for the patients as well as in a health economic perspecitve, to receive voice rehabilitatiom to make a faster improvement of the HRQL and self-perceived communication function.
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Optimal ileocolic flap length for a reconstructed voice tube after laryngopharyngectomy. The Journal of Laryngology & Otology 2015; 130:190-3. [PMID: 26456108 DOI: 10.1017/s0022215115002625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Voice restoration after laryngopharyngectomy can be achieved with an autologous ileocolic flap. We have observed that the length of the flap influences vocal outcome. This investigation aimed to evaluate the association between ileocolic flap length and vocal quality after laryngopharyngectomy. METHODS The charts of patients who underwent voice rehabilitation with an ileocolic flap after laryngopharyngectomy between 1 January 2011 and 30 December 2012 were abstracted. The length of ileum segment in the ileocolic flap was stratified, and voice outcome was evaluated three months post-operatively, while adjusting for confounding variables. RESULTS There was a significant association between flap length and loudness, maximum phonation time and sound pressure level (p < 0.05). All three parameters were best in the 10 cm length group. CONCLUSION Voice rehabilitation after laryngopharyngectomy is possible with an ileocolic flap. The optimal ileocolic flap contains a 10 cm ileum segment. Complications are frequent but amenable to revision surgery.
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Karlsson T, Johansson M, Andréll P, Finizia C. Effects of voice rehabilitation on health-related quality of life, communication and voice in laryngeal cancer patients treated with radiotherapy: a randomised controlled trial. Acta Oncol 2015; 54:1017-24. [PMID: 25615892 DOI: 10.3109/0284186x.2014.995773] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aims to assess the effect of voice rehabilitation on health-related quality of life (HRQL) and communication experience for laryngeal cancer patients treated with radiotherapy. METHOD This prospective randomised controlled trial included 74 patients with Tis-T4 laryngeal cancer treated curatively by radiotherapy, of which 37 constituted the intervention group receiving voice rehabilitation and 37 patients as a control group. Patients were followed at one and six months post-radiotherapy, with voice rehabilitation conducted between these time-points. Endpoints included patient reported outcomes, including HRQL as measured by European Organisation for Research and Treatment of Cancer (EORTC) Core30 (C30) and Head & Neck35 (H&N35) as well as communication function as measured by Swedish Self-Evaluation of Communication Experiences after Laryngeal cancer (S-SECEL). RESULTS The intervention group reported statistically significant improvements in communication experience as measured by S-SECEL environmental, attitudinal and total score domains compared to the control group. Similar improvements were seen in EORTC H&N35 Speech domain and the EORTC C30 domain Global quality of life. Moderate correlations were noted (r = 0.51-0.59) between three of four S-SECEL domains and the EORTC domains Speech and Global quality of life. CONCLUSION Laryngeal cancer patients treated with radiotherapy who receive voice rehabilitation appear to experience beneficial effects on communication function and selected HRQL domains. Voice rehabilitation following radiotherapy is recommended but further research investigating potential target groups and long-term effects is required.
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Affiliation(s)
- Therese Karlsson
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mia Johansson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Paulin Andréll
- Department of Molecular and Clinical Medicine/Multidisciplinary Pain Centre, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Tuomi L, Andréll P, Finizia C. Effects of Voice Rehabilitation After Radiation Therapy for Laryngeal Cancer: A Randomized Controlled Study. Int J Radiat Oncol Biol Phys 2014; 89:964-972. [DOI: 10.1016/j.ijrobp.2014.04.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 04/14/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
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Wilkie MD, Lightbody KA, Lythgoe D, Tandon S, Lancaster J, Jones TM. Transoral laser microsurgery for early and moderately advanced laryngeal cancers: outcomes from a single centralised United Kingdom centre. Eur Arch Otorhinolaryngol 2014; 272:695-704. [PMID: 24682610 DOI: 10.1007/s00405-014-3011-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
Transoral laser microsurgery (TLM) represents an important treatment for selected laryngeal cancers. Utilisation of TLM, however, is highly variable between United Kingdom (UK) centres, and published data relating to its use in the UK is scarce. We report outcomes from our tertiary referral centre, and highlight lessons learned. Patients undergoing primary TLM for laryngeal cancer with curative intent (2007-2011) were studied retrospectively. Survival analyses were evaluated using the Kaplan-Meier method and log-rank statistics used to examine the influence of several variables. Overall, 170 cases were included-153 glottic and 17 supraglottic. Median follow-up was 39 months (range 14-79 months). Respective 3-year local control (LC), overall survival (OS), disease-specific survival (DSS), and disease-free survival were 92, 92, 98, and 86 % for glottic carcinomas. Three-year LC and OS were both 88 % for supraglottic carcinomas. For glottic cases, a significant impact of pT stage on DSS was observed, and of age on OS. Median hospital stay was one and 19 days for glottic and supraglottic cases respectively, with respective 3-year laryngeal preservation rates of 97 and 94 %, and tracheostomy rates of 0 and 29 %. One patient in the glottic group and four in the supraglottic group failed to regain swallowing function post-operatively, remaining either PEG dependent or undergoing functional total laryngectomy. Our series confirms the oncological and functional efficacy of TLM, offering a unique large-scale UK perspective. Our experience indicates, however, that treatment of larger supraglottic tumours should be considered carefully, as functional outcomes may be compromised.
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Affiliation(s)
- Mark D Wilkie
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK,
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