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

To analyze objective and subjective progression of speech intelligibility in oral cancer patients undergoing high-frequency speech therapy during early rehabilitation. Oral cancer patients in the Department of Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany, participated in the study from March 2016 to November 2017. Speech intelligibility was analyzed preoperatively (t1), post radiation (t2), and post speech therapy (t3). Objective measures were the Munich Intelligibility Profile (Online) and the Frenchay Dysarthria Assessment-2 (FDA-2). Subjective measures were the Speech Handicap Index (SHI), the speech subscale of the EORTC QLQ-C30&HN35, and the WHO-5 Index II. For nine patients with complete data, progression analyses showed a non-existent-to-low intelligibility impairment at t1 (means/SDs: e.g. FDA-2: 8.96/0.11, SHI: 17.5/15.15), increasing towards t2 (means/SDs/p-values for difference from t1: e.g. FDA-2: 7.40/0.80/0.000, SHI: 21.7/14.24/0.213), and then decreasing towards t3, without ever reaching the initial level (means/SDs/p-values for difference from t1: e.g. FDA-2: 8.22/0.60/0.005, SHI: 23.5/15.85/0.481). The objective changes in intelligibility were significant; the subjective changes were not. Overall, the ability to speak intelligibly after oral cancer treatment follows a typical pattern. Therefore, high-frequency speech therapy in the early rehabilitation phase might be recommendable. It might help patients to adapt to their situation after surgery, and facilitates compensating for possible functional deficits.

Development of the German Speech Intelligibility Index for the treatment of oral cancer patients.

OBJECTIVES: This study aimed at 1) adapting the well-established Speech Handicap Index (SHI) to German, 2) testing the suitability of the instrument for assessing speech-related quality of life, 3) comparing it to the German Voice-Handicap-Index (VHI), in order to support treatment of oral cancer patients who experience posttreatment speech difficulties that affect their quality of life. MATERIAL AND METHODS: Participants completed a web-based survey that employed a 2 (experienced problem: speech/articulation-related vs. voice-related) x 2 (SHI vs. VHI) between-subject experimental design, enabling it to distinguish between the experiences of voice and intelligibility impairments, and to determine the discriminatory ability of the two instruments. RESULTS: The German SHI reliably assessed speech intelligibility and articulation-related Quality of life. While voice impairments were equally well assessed by both, VHI: M 2.48, SD 0.65; SHI: M 2.52, SD 0.63; only the latter appropriately registered intelligibility handicap in speech impairments (VHI: M 2.05, SD 0.70; SHI: 2.68, SD 0.73). The responsivity of the SHI in capturing the experienced handicap was significantly greater in the speech/articulation-impairment condition (p = .001). CONCLUSION: The German SHI is a reliable and responsive measure for speech intelligibility and articulation-related quality of life that should be chosen in preference to the VHI.

Well-being and quality of life among oral cancer patients - Psychological vulnerability and coping responses upon entering initial treatment.

BACKGROUND: Little is known about the psychological constitution and potential coping mechanisms of oral cancer patients when they enter initial treatment. This study aimed at 1) establishing a feasible study protocol and 2) implementing it to examine patients' coping and psychological responses during the initial treatment phase in the hospital. METHODS: In three consecutive feasibility phases a study procedure including measurement time points and instrumentation as well as a patient recruitment strategy was developed. To assess patients' responses, the following qualitative (interviews) and quantitative (questionnaires) measures were applied: WOC-CA, briefCOPE, HADS, EORTCQlQC30- H&N35 and SAM/POMS. RESULTS: Results revealed a highly burdened and distressed patient group that had not yet developed clear coping strategies. Further, one third of examined patients showed severe levels of anxiety and depression, indicating a high vulnerability to develop psychological disorders. CONCLUSION: At this early stage of oral cancer treatment, potential psychosocial interventions should prioritize addressing anxiety and depression to enable patients to develop functional coping strategies later on.