Evaluation of speech in people with head and neck cancer: a Pilot Study

Background : A paucity of information exists on the effects of cancer on speech, with what little literature exists focussing on the effects of treatment. Baseline assessment of speech in head and neck cancer patients before treatment is important to distinguish accurately the effects of treatment from the effects of the cancer itself. Aims : This prospective study had four major foci: (1) to determine if speech intelligibility and motor speech functions of patients with head and neck cancer before treatment differed from the normal population; (2) to determine if impairments in speech intelligibility and motor speech functions were specific to the original site of cancer; (3) to determine which motor speech functions were most related to overall speech intelligibility; and (4) to determine whether there was a relationship between self-report of speech intelligibility, motor speech functions and the clinical assessment thereof. This study aimed incidentally to determine whether the Frenchay Dysarthria Assessment is a practicable, valid and reliable tool for assessing speech functions in the head and neck cancer population. Methods & Procedures : Twenty participants, between 47 and 76 years of age and all newly diagnosed with a cancer of the head and neck, participated in the pilot study. In examining speech, participants completed a self-report questionnaire pertaining to speech intelligibility and motor speech functions and were then assessed clinically using subscales of the Frenchay Dysarthria Assessment before the start of cancer treatment. The motor speech functions examined included: respiratory ability and functions of the lip, soft palate, larynx and tongue. Outcomes & Results : Results indicated that participants with head and neck cancer had a greater reduction in both speech intelligibility and in almost all aspects of speech when compared with the normal population. Results further demonstrated that the site of the cancer dictated the type of impairment experienced with respect to speech function. Not all motor speech characteristics correlated with overall speech intelligibility and, lastly, self-report and clinical assessment were significantly correlated with respect to motor speech characteristics, but they differed slightly in the assessment of speech intelligibility. Conclusions : This pilot study has highlighted the critical importance of collecting baseline measures and reporting functional results according to the cancer site in future research. It has also shown the usefulness of the Frenchay Dysarthria Assessment as a practicable, valid and reliable protocol of motor speech assessment for the head and neck cancer population.