Speech-language pathology care and short- and long-term outcomes of oropharyngeal cancer treatment in the elderly.

OBJECTIVE: To examine associations between speech-language pathology (SLP) care and pretreatment variables, short-term and long-term swallowing and airway impairment, and survival in elderly patients treated for oropharyngeal squamous cell cancer (SCCA). STUDY DESIGN: Retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data. METHODS: We evaluated longitudinal data from 666 patients diagnosed with oropharyngeal SCCA from 2004 to 2007 using cross-tabulations, multivariate logistic regression, and survival analysis. RESULTS: SLP care was documented in 25% of patients. High-volume hospital care (odds ratio (OR) = 3.2 [1.0-10.0]) and dysphagia during treatment (OR = 13.0 [3.6-47.1]) were the only significant predictors of SLP care during the initial treatment period. SLP care was significantly more likely during the first year (OR = 5.3 [3.1-9.1]) and second year (OR = 4.5 [2.4-8.2]) following initial treatment. Subsequent dysphagia (OR = 32.5 [16.9-62.4]), stricture (OR = 2.2 [1.2-4.0]), gastrostomy (OR = 1.7 [1.1-2.7]), and tracheostomy tube use (OR = 2.4 [1.2-4.8]) were significantly associated with long-term SLP care. After controlling for patient, tumor, and treatment-related variables, SLP care was associated with significant relative attenuation of the OR for dysphagia (93%), stricture (35%), weight loss (8%), and airway obstruction (34%). Survival analysis, controlling for all other variables, demonstrated improved survival for patients under SLP care (hazard ratio = 0.73 [0.57-0.95]). CONCLUSION: SLP care is underutilized in elderly oropharyngeal SCCA patients and largely utilized after the onset of impaired airway and swallowing function, but is associated with improved outcomes. These data suggest a need for treatment guidelines that incorporate the routine use of SLP care in this population during the initial treatment period and beyond. LEVEL OF EVIDENCE: 2c. Laryngoscope, 128:1403-1411, 2018.

Evaluation of Dyspnea Outcomes After Endoscopic Airway Surgery for Laryngotracheal Stenosis.

Importance: Endoscopic airway surgery is a frequently used procedure in the management of laryngotracheal stenosis (LTS); however, no established outcome measures are available to assess treatment response. Objective: To assess acoustics and aerodynamic measures and voice- and dyspnea-related quality of life (QOL) in adult patients with LTS who undergo endoscopic airway surgery. Design, Setting, and Participants: This case series compared preoperative measures and postoperative outcomes among adult patients who underwent endoscopic airway surgery for LTS from September 1, 2013, to September 30, 2015, at the tertiary care Johns Hopkins Voice Center. Patients were excluded if they did not undergo balloon dilation or if they had multilevel or glottic stenosis. The Phonatory Aerodynamic System was used to quantify laryngotracheal aerodynamic changes after surgery. Final follow-up was completed 2 to 6 weeks after surgery. Main Outcomes and Measures: The voice-related QOL instrument (V-RQOL), Dyspnea Index, and Clinical Chronic Obstructive Pulmonary Disease Questionnaire were completed before and after endoscopic surgery. Consensus auditory perceptual evaluation of voice, acoustic measurements, and aerodynamic outcomes were also assessed. Results: Fourteen patients (1 man and 13 women; mean [SD] age, 45.4 [4.3] years) were enrolled. The mean postoperative V-RQOL scores (n = 14) increased from 74.3 to 85.5 (mean of difference, 11.3; 95% CI, 2.2 to 20.3). The mean postoperative Dyspnea Index (n = 14) decreased from 26.9 to 6.6 (mean of difference, -20.3; 95% CI, -27.9 to -12.7); the mean postoperative Clinical Chronic Obstructive Pulmonary Disease Questionnaire scores (n = 9) decreased from 3.2 to 1.0 (mean of difference, -2.2; 95% CI, -3.4 to -0.9). Postoperative mean vital capacity (n = 14) increased from 2.5 to 3.1 L (mean of difference, 0.6 L; 95% CI, 0.3-1.0 L), whereas mean laryngeal resistance (n = 14) decreased from 73.9 to 46.4 cm H2O/L/s (mean of difference, -27.5 cm H2O/L/s; 95% CI, -44.8 to -10.3 cm H2O/L/s) postoperatively. Conclusions and Relevance: Patients demonstrate statistically and clinically significant improvement in dyspnea-related QOL, whereas a few patients showed a clinically significant improvement in V-RQOL. Dyspnea-related QOL outcomes should be added to airway surgeons' regular assessment of patients with LTS to measure treatment response and inform the decision to perform a second operation, whereas V-RQOL outcomes need additional prospective study with a larger sample size. The Phonatory Aerodynamic System is not an optimal method to quantify changes in laryngotracheal aerodynamics after intervention in LTS.

Speech-language pathology care and short- and long-term outcomes of laryngeal cancer treatment in the elderly.

OBJECTIVES/HYPOTHESIS: To examine associations between speech-language pathology (SLP) care and pretreatment variables, swallowing and airway impairment, and survival in elderly patients treated for laryngeal cancer. STUDY DESIGN: Retrospective analysis of surveillance, epidemiology, and end results (SEER)-Medicare data. METHODS: We evaluated longitudinal data from 2,370 patients diagnosed with laryngeal cancer from 2004 to 2007 using cross-tabulations, multivariate logistic regression, and survival analysis. RESULTS: Initial treatment with total laryngectomy (odds ratio [OR] = 3.3 [1.6-6.8]), and dysphagia during treatment (OR = 4.0 [2.2-7.2]) were the only significant predictors of SLP care during the initial treatment period. Speech-language pathology care was more likely during the first year (OR = 4.1 [2.7-6.0]) and second year (OR = 1.6 [1.1-2.3]) following initial treatment; however, only 23.7% of patients ever received SLP care. Pretreatment tracheostomy tube placement (OR = 2.8 [1.1-7.0]), initial treatment with total laryngectomy (OR = 3.4 [2.0-5.6]), dysphagia (OR = 7.6 [5.5-10.4]), stricture (OR = 1.9 [1.1-3.1]), interval tracheostomy tube placement (OR = 3.5 [2.4-5.2]), and salvage surgery (OR = 3.1 [1.6-5.8]) were significantly associated with long-term SLP care. After controlling for relevant variables, SLP care was associated with significant relative attenuation of the OR for dysphagia (50%), stricture (26%), weight loss (20%), and pneumonia (21%). Hazards ratio for death, if under SLP care, was 0.83 (0.70-0.99). CONCLUSION: SLP care is underutilized in elderly laryngeal cancer patients and is largely reserved for select patients in anticipation of total laryngectomy or after the onset of impaired airway and swallowing function, but is associated with improved outcomes. These data suggest a need for treatment guidelines that incorporate the routine use of SLP care during the initial treatment period and beyond. LEVEL OF EVIDENCE: 2c.