Researchers identified several risk factors for moderate to severe voice and speech symptoms in long-term survivors of oropharyngeal cancer (OPC), in a new study published in JAMA Otolaryngology.

In this cross-sectional, retrospective cohort study, survivors of OPC who underwent curative treatment at MD Anderson Cancer Center in Houston, Texas, completed a survey regarding voice and speech symptoms. The primary outcome of the study was patient-reported voice and speech scores using the MD Anderson Symptom Inventory-Head and Neck Cancer Module.

Of 881 survivors who participated in this study, moderate to severe voice and speech symptom scores were reported by 12.8% of the participants. Among participants, the median time from diagnosis to survey was 6.0 years (range, 1 to 16).

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In a multivariable analysis, several factors were linked to moderate to severe voice and speech symptoms. These included baseline lower cranial neuropathy (odds ratio [OR], 8.70), late lower cranial neuropathy (OR, 7.11), current cigarette smoking status (OR, 3.98), Black race (OR, 3.90), Hispanic ethnicity (OR, 3.74), treatment with induction and concurrent chemotherapy (OR, 1.94), increasing survival time (OR, 1.17), and higher total radiation dose (OR, 1.16).

A variable that was associated with a reduced likelihood of moderate to severe voice and speech symptoms was the use of an intensity-modulated radiotherapy (RT) split-field (SF) regimen (OR, 0.31).

The researchers determined many factors were associated with voice and speech impairment reported among survivors of OPC. “The key finding in this study was the protective association of SF radiation technique, which was a laryngeal dose-sparing RT planning technique that was popular at our institution during the study period,” the researchers explained in their report. Additionally, they noted, worse outcomes were seen in this study among longer-term survivors and those who were smokers at the time of study.


Aggarwal P, Hutcheson KA, Garden AS, et al. Association of risk factors with patient-reported voice and speech symptoms among long-term survivors of oropharyngeal cancer. JAMA Otolaryngol Head Neck Surg. Published online May 6, 2021. doi:10.1001/jamaoto.2021.0698