Health-related quality of life and voice following radiotherapy for laryngeal cancer – a comparison between glottic and supraglottic tumours

Figures & data

Table I. Patient characteristics subdivided for glottic and supraglottic tumours.

n	Glottic 54	Supraglottic 13	p-value
Mean age (SD)	64.4 (10.9) n (%)	65.6 (13.9) n (%)	0.515
Tumour size
Tis	2 (4)	0	< 0.001
T1	38 (70)	3 (23)
T2	13 (24)	4 (31)
T3	1 (2)	5 (38)
T4	0	1 (8)
Comorbidity (ACE-27)
None	24 (44.5)	4 (31)	0.491
Mild	19 (35)	6 (46)
Moderate	11 (20.5)	3 (23)
Severe	0	0
Smoking habits
Smoking	21 (39)	4 (31)	0.334
Quit smoking > 12 months ago	27 (50)	8 (61)
Non-smoker	6 (11)	1 (8)
Respiratory disease
COPD	4 (7.5)	2 (15)	0.660
Other respiratory disease	4 (7.5)	1 (8)
None	46 (85)	10 (77)
Feeding tube needed during and/or post RT
Yes	7 (13)	8 (62)	0.001
No	47 (87)	5 (38)

ACE-27, Adult Comorbidity Evaluation; COPD, chronic obstructive pulmonary disease; RT, radiotherapy.

Table II. Voice analysis and S-SECEL results pre- and post-radiotherapy for the patients with glottic and supraglottic tumours. The results are presented as mean (SD) p-values for comparisons with healthy controls.

	Glottic n = 54				Supraglottic n = 13				p-value ∆ between groups pre-RT	p-value ∆ between groups post-RT	Healthy controls n = 23
	Pre-RT	Post-RT	∆ within group pre-post RT	p-value within group	Pre-RT	Post-RT	∆ within group pre-post RT	p-value within group
Temporal
MPT (s)	11.1 (6.8) p = 0.001	12.0 (8.7) p = 0.005	1.0 (7.8)	0.668	16.1 (8.5) p = 0.771	16.8 (9.0) p = 0.913	0.6 (8.8)	0.966	0.058	0.111	16.9 (5.5)
Acoustic
Jitter	1.08 (1.04) p = 0.020	1.07 (1.53) p = 0.067	= 0.02 (1.83)	0.446	0.58 (0.25) p = 0.526	0.74 (0.36) p = 0.071	0.15 (0.31)	0.175	0.189	0.662	0.67 (0.78)
Shimmer	0.64 (0.40) p < 0.001	0.53 (0.33) p = 0.001	= 0.10 (0.48)	0.278	0.49 (0.26) p = 0.057	0.49 (0.25) p = 0.012	0.03 (0.26)	0.683	0.303	0.993	0.32 (0.18)
HNR	15.6 (6.4) p = 0.004	17.3 (5.4) p = 0.060	1.7 (7.6)	0.110	17.3 (4.2) p = 0.115	18.0 (4.4) p = 0.308	0.6 (3.9)	0.790	0.528	0.726	20.2 (5.0)
F0 mean	134.2 (26.2) p = 0.011	123.6 (27.2) p = 0.552	10.7 (26.0)	0.011	128.1 (25.0) p = 0.327	121.2 (23.6) p = 0.744	5.8 (32.7)	0.520	0.415	0.875	118.0 (19.3)
S-SECEL											n = 20
General	5.3 (2.8) p = 0.018	4.8 (2.6) p = 0.069	= 0.4 (2.2)	0.117	6.2 (1.9) p = 0.001	5.0 (2.1) p = 0.084	= 1.2 (3.3)	0.231	0.197	0.757	3.5 (2.2)
Environmental	14.3 (8.6) p < 0.001	13.8 (8.3) p < 0.001	= 0.4 (7.4)	0.510	15.4 (9.9) p < 0.001	12.0 (8.1) p = 0.003	= 3.4 (11.9)	0.216	0.729	0.567	3.5 (4.2)
Attitudinal	6.2 (5.9) p < 0.001	6.5 (5.9) p < 0.001	0.3 (5.7)	0.940	8.0 (6.5) p < 0.001	8.1 (7.8) p = 0.010	0.1 (10.0)	0.826	0.340	0.751	1.2 (1.9)
Total	25.8 (15.4) p < 0.001	25.1 (15.0) p < 0.001	= 0.5 (13.3)	0.566	29.5 (15.7) p < 0.001	25.1 (15.9) p = 0.003	= 4.5 (23.0)	0.380	0.439	0.981	7.4 (5.6)

F0, fundamental frequency; HNR, harmonics-to-noise ratio; MPT, maximum phonation time; RT, radiotherapy; SD, standard deviation; S-SECEL, Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer questionnaire. Maximum scores for the S-SECEL subscales: General: 15. Environmental: 42. Attitudinal: 45. Total: 102. A higher value indicates greater perceived communicative dysfunction.

Table III. EORTC QLQ-C30 and H&N35 pre- and post-radiotherapy for the patients with glottic and supraglottic tumours. The results are presented as mean 95% CI.

	Glottic n = 54				Supraglottic n = 13				p-value ∆ between groups pre-RT	p-value ∆ between groups post-RT	p-value difference between ∆
	Pre-RT	Post-RT	∆ within group	p-value ∆ within group	Pre-RT	Post-RT	∆ within group	p-value ∆ within group
EORTC QLQ C-30
Function scales
Physical	89.9 86.0; 93.8	82.5 77.8; 87.3	= 7.4 = 11.7; = 3.1	< 0.001	75.9 63.6; 88.2	71.8 64.2; 79.4	= 4.1 = 14.2; 6.0	0.421	0.009	0.017	0.920
Role	83.0 77.7; 88.4	75.8 69.6; 82.0	= 6.9 = 13.5; = 0.3	0.084	79.5 61.5; 97.5	69.2 55.7; 82.8	= 10.3 = 23.0; 2.4	0.072*	0.867	0.374	0.152
Social	87.0 82.4; 91.7	77.4 71.0; 83.7	= 9.4 = 15.6; = 3.2	0.001	83.3 71.7; 95.0	62.5 48.9; 76.1	= 23.6 = 41.4; 5.9	0.016*	0.450	0.029	0.097
Emotional	76.1 70.5; 81.6	79.6 74.5; 84.6	3.8 = 1.2; 8.8	0.069	76.9 65.1; 88.8	76.4 62.0; 90.8	= 1.4 = 5.8; 3.0	0.813	0.815	0.745	0.346
Cognitive	86.4 81.8; 91.0	82.4 77.1; 87.7	= 4.4 = 10.2; 1.4	0.248	67.9 54.6; 81.2	62.5 44.4; 80.6	= 5.6 = 21.4; 10.3	0.555	0.004	0.017	0.942
Global QOL	71.0 66.6; 75.4	66.4 61.8; 70.9	= 4.4 = 9.7; 0.9	0.167	68.6 52.8; 84.4	63.5 52.5; 74.4	= 5.1 = 20.3; 10.1	0.357	0.860	0.863	0.609
Symptom scales
Nausea/vomiting	2.8 0.7; 4.9	8.5 4.5; 12.5	5.7 1.7; 9.5	0.004	5.1 = 3.5; 13.7	32.1 18.8; 45.4	26.9 10.0; 43.6	0.006*	0.880	< 0.0001	< 0.001
Single item
Appetite loss	8.0 3.1; 13.0	18.2 9.9; 26.6	10.1 1.5; 18.6	0.01*	15.4 = 2.3; 33.1	41.0 16.1; 65.9	25.6 = 3.0; 54.3	0.141*	0.304	0.041	0.142
EORTC QLQ H&N-35
Speech	36.0 30.1; 41.9	32.5 26.4; 38.6	= 3.4 = 10.8; 4.1	0.193	39.3 28.1; 50.5	45.3 31.2; 59.4	6.0 = 8.2; 20.1	0.391	0.576	0.070	0.121
Swallowing	8.1 2.7; 13.5	12.3 6.8; 17.8	4.1 = 2.4; 10.7	0.110	21.8 1.2; 42.4	37.2 21.3; 53.1	15.4 = 12.9; 43.7	0.457	0.137	< 0.001	0.319
Social eating	8.2 2.9; 13.4	10.4 5.0; 15.8	2.0 = 4.3; 8.4	0.493	28.8 10.3; 47.4	32.7 12.5; 52.9	3.9 = 24.5; 32.2	0.734	0.002	0.031	0.890

*Clinically relevant change. CI, confidence interval; EORTC QLQ-C30, the European Organisation for Research and Treatment Quality of Life Questionnaire Core-30; EORTC QLQ-H&N35, the Head and Neck Cancer module; RT, radiotherapy. Higher scores on the function scales indicate a better function. A higher score on the symptom scale, single item, as well as the H&N35 indicates worse symptoms.