A prospective longitudinal study of voice characteristics and health-related quality of life outcomes following laryngeal cancer treatment with radiotherapy

Figures & data

Table 1. Clinical characteristics at pre-radiotherapy.

		Whole group n (%)	Subdivision
			T1 only n (%)	T2 only n (%)	Inter-group differences (p-value)
n		40	20	13
Age
Mean (SD)		62.8 (9.0)	62.9 (7.9)	60.3 (9.7)	0.61
Gender	Male	36 (90)	18 (90)	11 (85)
	Female	4 (10)	2 (10)	2 (15)	0.49
Localization	Glottic	29 (72)	19 (95)	7 (54)
	Supraglottic	9 (23)	1 (5)	4 (31)	0.053
	Subglottic	2 (5)	0	2 (15)
Tumor size	Tis	2 (5)
	T1	20 (50)	–	–	–
	T2	13 (33)
	T3	5 (12)
	T4	0
Nodal stage	N0	40 (100)	20 (100)	13 (100)	–
	N+	0	0	0
Radiotherapy	Conventional	29 (73)	19 (95)	4 (31)
	Hyperfractionated	11 (27)	1 (5)	9 (69)	<0.001
	Adjuvant lymph node	15 (38)	1 (5)	9 (69)	<0.001
Comorbidity (ACE-27)	None	17 (42.5)	7 (35)	5 (39)
	Mild	17 (42.5)	10 (50)	6 (46)	0.90
	Moderate	6 (15)	3 (15)	2 (15)
	Severe	0	0	0
Smoking habits	Smoking	21 (53)	11 (55)	7 (54)
	Quit smoking >12 m	15 (37)	8 (40)	5 (38)	0.95
	Non-smoker	4 (10)	1 (5)	1 (8)
Working status	Retired	19 (48)	10 (50)	6 (46)
	Working	21 (52)	10 (50)	7 (54)	0.52
Voice use in employment	Working using voice	8 (38)	4 (40)	3 (43)
	Working not using voice	13 (62)	6 (60)	4 (57)	0.56

ACE-27, Adult Comorbidity Evaluation-27, SD, standard deviation.

Table 2. Results of grade, roughness, asthenia, strain and vocal fry at pretreatment and follow-up (n = 39).

	Pre-RT n (%)	Post-RT n (%)	6 months post-RT n (%)	12 months post-RT n (%)	Difference between all visits (p-value)
Grade					0.74
normal	0	0	0	1 (2)
mild	12 (31)	12 (31)	15 (38.5)	14 (36)
moderate	20 (51)	22 (56)	15 (38.5)	21 (54)
severe	7 (18)	5 (13)	9 (23)	3 (8)
Roughness					0.015
normal	2 (5)	6 (15)	11 (28)	2 (5)
mild	19 (49)	22 (56)	15 (39)	16 (41)
moderate	15 (38)	10 (26)	11 (28)	20 (51)
severe	3 (8)	1 (3)	2 (5)	1 (3)
Breathiness		14 (36)			0.21
normal	15 (39)	11 (28)	13 (33)	22 (57)
mild	13 (33)	12 (31)	16 (41)	11 (28)
moderate	7 (18)	2 (5)	6 (16)	4 (10)
severe	4 (10)		4 (10)	2 (5)
Asthenia					0.67
normal	36 (92)	37 (95)	38 (97)	38 (97)
mild	3 (8)	2 (5)	1 (3)	1 (3)
Strain					0.54
normal	14 (36)	7 (18)	8 (20)	12 (31)
mild	15 (38)	18 (46)	19 (49)	16 (41)
moderate	9 (23)	13 (33)	9 (23)	8 (20)
severe	1 (3)	1 (3)	3 (8)	3 (8)
Vocal fry					0.049
normal	31 (79)	33 (84)	25 (64)	22 (57)
Mild	3 (8)	3 (8)	10 (26)	13 (33)
moderate	3 (8)	3 (8)	3 (8)	2 (5)
severe	2 (5)	0	1 (2)	2 (5)

RT, radiotherapy. p-Value calculated using Friedman’s test, detecting differences in scores across multiple time points.

Figure 1. Mean spoken fundamental frequency (MSFF) for A) males (n = 35) and B) females (n = 4) at pretreatment and follow-up. The line inside the box represents the median, the dot represents the mean value and the upper and lower border are the upper and lower quartiles. §MSFF (healthy reference values).

Table 3. Mean values (SD) (95% CI) for acoustic measures pretreatment and follow-up time points.

	Pre-RT	Post-RT	6 months post-RT	12 months post-RT	Difference between all visits (p-value)
HNR n = 39	15.3 (7.1) (13.0–17.6)	17.3 (5.6) (15.5–19.2)	16.0 (5.4) (14.2–17.7)	17.0 (6.6) (14.8–19.1)	0.47
Jitter n = 39	1.14 (1.28) (0.72–1.55)	1.07 (1.70) (0.52–1.62)	1.15 (1.48) (0.67–1.63)	1.71 (2.86) (0.78–2.63)	0.71
Shimmer n = 39	0.69 (0.47) (0.53–0.84)	0.57 (0.36) (0.45–0.69)	0.64 (0.46) (0.49–0.79)	0.53 (0.36) (0.41–0.65)	0.35
MSFF – female n = 4	158.9 (30.1) (111.0–206.8)	160.4 (29.7) (113.2–207.5)	139.4 (19.4) (108.4–170.3)	140.1 (21.0) (106.6–173.5)	0.025
MSFF – male n = 35	132.6 (31.5) (121.8–143.4)	124.3 (26.5) (115.2–133.4)	108.8 (20.5) (101.8–115.9)	108.7 (18.3) (102.4–115.0)	<0.001

CI, confidence intervals; HNR, harmonic to noise ratio; MSFF, mean spoken fundamental frequency; RT, radiotherapy; SD, standard deviation. Lower values for jitter and shimmer, in this case, indicate an improvement. HNR >7.4–13 dB indicates a normal voice [26].

Table 4. Longitudinal S-SECEL scores presented as mean (SD) (95% CI) values including p-values and effect sizes for changes at follow-up compared to pretreatment.

	Pre-RT	Post-RT	6 months post-RT	12 months post-RT	Overall difference between all visits (p-value)
Environment p^a/ES^b	13.2 (9.0) (10.3–16.1)	11.2 (8.8) (8.3–14.0) -/0.20	12.3 (8.8) (9.4–15.1) -/0.09	11.4 (7.3) (9.1–13.8) -/0.16	0.12
Attitudinal p^a/ES^b	6.7 (6.8) (4.5–8.9)	5.3 (6.0) (3.3–7.2) -/0.20	7.0 (8.9) (4.1–9.9) -/0.03	6.1 (7.1) (3.8–8.4) -/0.07	0.41
Total score p^a/ES^b	25.4 (16.9) (20.0–30.9)	21.2 (16.1) (16.0–26.4) 0.046/0.24	23.9 (18.5) (17.9–29.9) 0.34/0.08	22.1 (15.3) (17.1–27.1) 0.22/0.16	0.043

CI, confidence interval; ES, effect size; RT, radiotherapy; SD, standard deviation, S-SECEL, Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer questionnaire. Min-max subscales: 0–42 (environmental), 0–45 (attitudinal), 0–102 (total score). A higher value indicates greater perceived communicative dysfunction.

p-Value for overall difference was calculated using Friedman’s test, which detects differences in scores across multiple testing attempts.

a p-Value for post-hoc analyses using Wilcoxon Signed Rank test calculated for change compared to baseline, where Friedman’s test showed significance;

b Effect size of change calculated as mean change from baseline divided by the standard deviation of change. Criteria: trivial 0–<0.20; small 0.20–<0.50; moderate 0.50–<0.80; and large ≥ 0.80.

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