Voice problems among patients with head & neck cancer

Abstract

Head and Neck Cancer (HNC) in the world, and even more in developing countries (e.g., Bangladesh), where awareness and rehabilitative care were meager. Malignancies of the oral cavity, pharynx, and larynx (HNC) compromised several dimensions of communication and emotional well-being due to both aggressive tumor local invasion and potential treatment modality sequela (surgery, radiotherapy, and chemotherapy). The current study was conducted to assess the severity, quality, and effects of voice problems among HNC patient’s daily lives in Bangladesh. It was a cross-sectional design with purposive sampling for data collection from three major cancer hospitals. The Voice Handicap Index-10 (VHI-10) and GRBAS Scale were assessed in 185 subjects. As for voice problems classification were using the VHI-10, the study demonstrated that 28.6% patients presented as normal, whereas mild and moderate voice problems were demonstrated in 22.7% and 25.4% patients respectively, and severe voice disorder in 23.2% patients. Quality of voice was graded as per GRBAS scale and 28.1% had severe abnormality of voice quality, 20.5% had moderate abnormality, 26.5% had mild abnormality and 24.9% normal voice. They also found functional, physical, and emotional impairment, including difficulty being heard (27.6%), shortness of breath when speaking (23.2%), and anxiety around communication (25.9%). None of the subjects had undergone voice therapy or visited SLT, interestingly. This data indicated a high burden and impact of voice problem among HNC patients in Bangladesh but pointed to an unaddressed gap in rehabilitation services. SLTs were crucial in identifying, managing and supporting these individuals. These findings emphasized the need for timely voice rehabilitation, better accessed to voice rehabilitation through SLT and further education of both patients and healthcare professionals were regarding voice rehabilitation. Keywords: Head and Neck Cancer, Voice problems, Chemotherapy, Radiotherapy, Surgery, Voice Handicap Index-10 (VHI-10), GRBAS Scale