Predictors of speech and swallowing function following primary surgery for oral and oropharyngeal cancer

A. Zuydam, D. Lowe, J.S. Brown, E. Vaughan, Simon Rogers

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Objectives:  To examine the association between the speech and swallowing aspect of health-related quality of life (HRQOL) and selected clinical parameters, and particularly to determine those that are predictive of good outcomes at 1 year after surgery. Design:  Prospective questionnaire and clinical study. Setting:  Regional Maxillofacial Unit. Participants:  A total of 278 consecutive patients undergoing primary surgery for squamous cell carcinoma between 1995 and 1999. HRQOL was assessed using the University of Washington Quality of Life questionnaire (UW-QOL) pre-surgery, and post-surgery at 6 months, 1 year and later (median 39 months). Main outcome measures:  Presentation of results was mainly descriptive, involving percentages and mean scores. Association of clinico-demographic factors with tumour site, and with UW-QOL swallowing and speech after 12 months, was tested with Fisher's exact or chi-squared tests as appropriate and modelled using logistic regression methods. Results:  Univariate relationships were seen between speech and swallowing scores and with tumour size, T staging, radiotherapy, type of surgery (primary closure or free tissue transfer), tumour site, extent of resection of posterior tongue and soft palate, and UW-QOL taste and saliva scores. Multiple logistic regression showed that no radiotherapy (P < 0.001) and primary surgical closure/laser surgery (P = 0.003) were the main predictors of good swallowing, and primary surgical closure/laser surgery was the main predictor of good speech (P < 0.001) at 1 year. Conclusions:  A number of clinical parameters can influence the speech and swallowing aspect of quality of life in these patients and when feasible, primary closure results in a better outcome than free flap reconstruction.
Original languageEnglish
Pages (from-to)428-437
JournalClinical Otolaryngology & Allied Sciences
Volume30
Issue number5
DOIs
Publication statusPublished - 2005

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Oropharyngeal Neoplasms
Mouth Neoplasms
Deglutition
Quality of Life
Laser Therapy
Radiotherapy
Logistic Models
Soft Palate
Neoplasms
Free Tissue Flaps
Saliva
Tongue
Squamous Cell Carcinoma
Demography
Outcome Assessment (Health Care)
Prospective Studies
Surveys and Questionnaires

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Zuydam, A. ; Lowe, D. ; Brown, J.S. ; Vaughan, E. ; Rogers, Simon. / Predictors of speech and swallowing function following primary surgery for oral and oropharyngeal cancer. In: Clinical Otolaryngology & Allied Sciences. 2005 ; Vol. 30, No. 5. pp. 428-437.
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Predictors of speech and swallowing function following primary surgery for oral and oropharyngeal cancer. / Zuydam, A.; Lowe, D.; Brown, J.S.; Vaughan, E.; Rogers, Simon.

In: Clinical Otolaryngology & Allied Sciences, Vol. 30, No. 5, 2005, p. 428-437.

Research output: Contribution to journalArticle

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AB - Objectives:  To examine the association between the speech and swallowing aspect of health-related quality of life (HRQOL) and selected clinical parameters, and particularly to determine those that are predictive of good outcomes at 1 year after surgery. Design:  Prospective questionnaire and clinical study. Setting:  Regional Maxillofacial Unit. Participants:  A total of 278 consecutive patients undergoing primary surgery for squamous cell carcinoma between 1995 and 1999. HRQOL was assessed using the University of Washington Quality of Life questionnaire (UW-QOL) pre-surgery, and post-surgery at 6 months, 1 year and later (median 39 months). Main outcome measures:  Presentation of results was mainly descriptive, involving percentages and mean scores. Association of clinico-demographic factors with tumour site, and with UW-QOL swallowing and speech after 12 months, was tested with Fisher's exact or chi-squared tests as appropriate and modelled using logistic regression methods. Results:  Univariate relationships were seen between speech and swallowing scores and with tumour size, T staging, radiotherapy, type of surgery (primary closure or free tissue transfer), tumour site, extent of resection of posterior tongue and soft palate, and UW-QOL taste and saliva scores. Multiple logistic regression showed that no radiotherapy (P < 0.001) and primary surgical closure/laser surgery (P = 0.003) were the main predictors of good swallowing, and primary surgical closure/laser surgery was the main predictor of good speech (P < 0.001) at 1 year. Conclusions:  A number of clinical parameters can influence the speech and swallowing aspect of quality of life in these patients and when feasible, primary closure results in a better outcome than free flap reconstruction.

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