Radiation-Associated Speech (RASP) in Head and Neck Cancer Survivors

Introduction: Treatment for head and neck cancer (HNC) can lead to profound alterations in communication. The purpose of this investigation was to examine the prevalence of speech impairment in HNC survivors who have undergone radiotherapy (XRT).

Methods: A convenience sample of English-speaking adult patients with an intact larynx and disease-free at least 1 year from HNC treatment were recruited to complete the computerized Speech Intelligibility Test. Subjects were recorded while reading a random list of 50 words and 11 sentences. Two blinded judges (one speech-language pathologist, one naïve listener) transcribed the recordings. Scores for word and sentence intelligibility were calculated (total intelligible words/total words presented). A combined average of word and sentence scores (CS) of 90% was used as the cutoff for intelligibility. Charts were reviewed for demographics and Voice Handicap Index-10 (VHI-10) scores. Group comparisons were made using t-tests.

Results: Thirty patients were enrolled. Mean±SD age was 68.9±7.1 years and 83.3% (25/30) were male. Primary tumor subsites were 56.7% (17/30) oropharynx, 13.3% (4/30) oral cavity, 10.0% (3/30) larynx, 10.0% (3/30) nasopharynx, and 10.0% (3/30) other. Mean time since XRT was 7.8±8.8 years. Average intelligibility for words was 90.0±8.9% (range 63.0-99.5%), sentences was 90.5±9.8% (range 60.5-99.0%), and combined was 90.2±8.4% (range 67.5-98.6%). 30% (10/30) had a CS < 90%. Individuals with a CS < 90% had a mean VHI-10 of 18.3±9.8 compared to 8.3±8.3 for those with CS ≥ 90% (P < .05).

Conclusions: One-third of HNC survivors exhibit significant speech deficits (CS < 90%) after radiotherapy. We introduce the term radiation-associated speech (RASP) to differentiate XRT-associated speech impairment from articulation deficits and dysarthria caused by other disorders. Individuals with RASP appear more likely to have a poorer self-perception of voice on VHI-10.