Head and neck cancer treatment outcome priorities: A multi-perspective concept mapping study.

With the increasing focus on patient-centred care, this study sought to understand priorities considered by patients and healthcare providers from their experience with head and neck cancer treatment, and to compare how patients' priorities compare to healthcare providers' priorities. Group concept mapping was used to actively identify priorities from participants (patients and healthcare providers) in two phases. In phase one, participants brainstormed statements reflecting considerations related to their experience with head and neck cancer treatment. In phase two, statements were sorted based on their similarity in theme and rated in terms of their priority. Multidimensional scaling and cluster analysis were performed to produce multidimensional maps to visualize the findings. Two-hundred fifty statements were generated by participants in the brainstorming phase, finalized to 94 statements that were included in phase two. From the sorting activity, a two-dimensional map with stress value of 0.2213 was generated, and eight clusters were created to encompass all statements. Timely care, education, and person-centred care were the highest rated priorities for patients and healthcare providers. Overall, there was a strong correlation between patient and healthcare providers' ratings (r = 0.80). Our findings support the complexity of the treatment planning process in head and neck cancer, evident by the complex maps and highly interconnected statements related to the experience of treatment. Implications for improving the quality of care delivered and care experience of head and cancer are discussed.

Associations Between Voice and Gestural Characteristics of Transgender Women and Self-Rated Femininity, Satisfaction, and Quality of Life.

Purpose Client-based subjective ratings of treatment and outcomes are becoming increasingly important as speech-language pathologists embrace client-centered care practices. Of particular interest is the value in understanding how these ratings are related to aspects of gender-affirming voice and communication training programs for transgender and gender-diverse individuals. The purpose of this observational study was to explore relationships between acoustic and gestural communication variables and communicator-rated subjective measures of femininity, communication satisfaction, and quality of life (QoL) among transfeminine communicators. Method Twelve acoustic and gestural variables were measured from high-fidelity audio and motion capture recordings of transgender women (n = 20) retelling the story of a short cartoon. The participants also completed a set of subjective ratings using a series of Likert-type rating scales, a generic QoL questionnaire, and a population-specific voice-related QoL questionnaire. Correlational analyses were used to identify relationships between the communication measures and subjective ratings. Results A significant negative relationship was identified between the use of palm-up hand gestures and self-rated satisfaction with overall communication. The acoustic variable of average semitone range was positively correlated with overall QoL. No acoustic measures were significantly correlated with voice-related QoL, and unlike previous studies, speaking fundamental frequency was not associated with any of the subjective ratings. Conclusions The results from this study suggest that voice characteristics may have limited association with communicator-rated subjective measures of communication satisfaction or QoL for this population. Results also provide preliminary evidence for the importance of nonverbal communication targets in gender-affirming voice and communication training programs.

Mastication in maxillectomy patients: A comparison between reconstructed maxillae and implant supported obturators: A cross-sectional study.

OBJECTIVE: The aim of this study was to compare masticatory performance and patient reported eating ability of maxillectomy patients with implant-supported obturators and patients with surgically reconstructed maxillae. METHODS: This cross-sectional study was conducted at the University of Alberta, Edmonton, Canada and at Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. Eleven surgically reconstructed maxillectomy patients have been included at University of Alberta and nine implant-supported obturator patients at MUMC+. The mixing ability test (MAT) was used to measure masticatory performance. In addition, the oral health related quality of life (OHRQoL) was measured with shortened versions of the oral health impact profile (OHIP) questionnaire. Values of the implant-supported obturator group versus the surgical reconstruction group were compared with independent t-tests in case of normal distribution, otherwise the Mann-Whitney U test was applied. RESULTS: Patients with reconstructed maxillae and patients with implant-supported obturator prostheses had similar mean mixing ability indices (18.20 ± 2.38 resp. 18.66 ± 1.37; P = .614). The seven OHRQoL questions also showed no differences in masticatory ability between the two groups. CONCLUSION: With caution, the results of this study seem to confirm earlier results that implant-supported obturation is a good alternative to surgical reconstruction for all Class II maxillary defects. With both techniques, the masticatory performance is sufficiently restored, with careful planning being highly desirable.

Contributions of Voice and Nonverbal Communication to Perceived Masculinity-Femininity for Cisgender and Transgender Communicators.

Purpose The purpose of this study was twofold: (a) to identify a set of communication-based predictors (including both acoustic and gestural variables) of masculinity-femininity ratings and (b) to explore differences in ratings between audio and audiovisual presentation modes for transgender and cisgender communicators. Method The voices and gestures of a group of cisgender men and women (n = 10 of each) and transgender women (n = 20) communicators were recorded while they recounted the story of a cartoon using acoustic and motion capture recording systems. A total of 17 acoustic and gestural variables were measured from these recordings. A group of observers (n = 20) rated each communicator's masculinity-femininity based on 30- to 45-s samples of the cartoon description presented in three modes: audio, visual, and audio visual. Visual and audiovisual stimuli contained point light displays standardized for size. Ratings were made using a direct magnitude estimation scale without modulus. Communication-based predictors of masculinity-femininity ratings were identified using multiple regression, and analysis of variance was used to determine the effect of presentation mode on perceptual ratings. Results Fundamental frequency, average vowel formant, and sound pressure level were identified as significant predictors of masculinity-femininity ratings for these communicators. Communicators were rated significantly more feminine in the audio than the audiovisual mode and unreliably in the visual-only mode. Conclusions Both study purposes were met. Results support continued emphasis on fundamental frequency and vocal tract resonance in voice and communication modification training with transgender individuals and provide evidence for the potential benefit of modifying sound pressure level, especially when a masculine presentation is desired.

A pilot study of masticatory function after maxillectomy comparing rehabilitation with an obturator prosthesis and reconstruction with a digitally planned, prefabricated, free, vascularized fibula flap.

STATEMENT OF PROBLEM: Oral rehabilitation after maxillectomy can be performed by prosthetic obturation or with a free fibula flap. Successful prosthetic obturation of large maxillectomy defects can be difficult, and masticatory function is at risk in these patients. Surgical reconstruction might provide adequate masticatory function, but the literature is lacking evidence regarding this topic. PURPOSE: The purpose of this pilot clinical study was to assess masticatory functions and health-related quality of life (HR-QoL) outcomes in patients after maxillectomy reconstructed by using the Rohner or the Alberta Reconstructive Technique and to compare outcomes with patients rehabilitated with an obturator prosthesis. MATERIAL AND METHODS: Mixing ability, maximum occlusal force, maximum mouth opening, and HR-QoL were assessed. Differences between the 2 groups were analyzed by using the Kruskal-Wallis tests for continuous variables and chi-squared tests for categorical variables. RESULTS: The reconstructed patients (n=11) showed better mixing ability, occlusal force (nonoperated side), and overall mean HR-QoL. The nonreconstructed group (n=13) did not differ from the reconstructed groups in terms of maximum mouth opening, overall mean occlusal force, occlusal force on the operated side, and most HR-QoL questionnaire domains. CONCLUSIONS: Maxillary reconstruction might be beneficial for masticatory performance in patients undergoing maxillectomy. A larger study is justified to support the possible benefit of the reconstruction of maxillary defects regarding mixing ability, occlusal force (nonoperated side), and HR-QoL.

Acoustic Predictors of Gender Attribution, Masculinity-Femininity, and Vocal Naturalness Ratings Amongst Transgender and Cisgender Speakers.

PURPOSE: This study aimed to identify the most salient set of acoustic predictors of (1) gender attribution; (2) perceived masculinity-femininity; and (3) perceived vocal naturalness amongst a group of transgender and cisgender speakers to inform voice and communication feminization training programs. This study used a unique set of acoustic variables and included a third, androgynous, choice for gender attribution ratings. METHOD: Data were collected across two phases and involved two separate groups of participants: communicators and raters. In the first phase, audio recordings were captured of communicators (n = 40) during cartoon retell, sustained vowel, and carrier phrase tasks. Acoustic measures were obtained from these recordings. In the second phase, raters (n = 20) provided ratings of gender attribution, perceived masculinity-femininity, and vocal naturalness based on a sample of the cartoon description recording. RESULTS: Results of a multinomial logistic regression analysis identified mean fundamental frequency (fo) as the sole acoustic measure that changed the odds of being attributed as a woman or ambiguous in gender rather than as a man. Multiple linear regression analyses identified mean fo, average formant frequency of /i/, and mean sound pressure level as predictors of masculinity-femininity ratings and mean fo, average formant frequency, and rate of speech as predictors of vocal naturalness ratings. CONCLUSION: The results of this study support the continued targeting of fo and vocal tract resonance in voice and communication feminization/masculinization training programs and provide preliminary evidence for more emphasis being placed on vocal intensity and rate of speech. Modification of these voice parameters may help clients to achieve a natural-sounding voice that satisfactorily represents their affirmed gender.

Functional Outcomes and Quality of Life After Segmental Mandibulectomy and Reconstruction with a Reconstruction Plate or Bone Graft Compared to a Digitally Planned Fibula Free Flap.

PURPOSE: To compare oral function and health-related quality of life (HRQoL) in patients reconstructed with either a reconstruction plate or a free vascularized bone flap with or without 3D planning. MATERIALS AND METHODS: Patients from the Institute for Reconstructive Sciences in Medicine, University Medical Center Utrecht, and Radboud University Medical Center were included. This cross-sectional study assessed objective masticatory performance with the mixing ability test (mixing ability index [MAI]), maximum bite force, maximum mouth opening, and HRQoL. Differences between groups were analyzed using analysis of variance or Kruskal-Wallis test for continuous variables and chi-square test for categorical variables. RESULTS: Six patients with digitally planned resections and reconstructions were included. For comparison, five patients treated with freehand bone reconstruction and four patients treated with plate reconstruction were also included. Mixing ability was superior in 3D-planned reconstructions (MAI: 20.7 ± 6.7) compared to plate reconstructions (MAI: 30.0 ± 0.1, P = .017) and freehand reconstructions (MAI: 29.5 ± 1.1, P = .017). Maximum mouth opening, bite force, and HRQoL differences did not reach statistical significance. CONCLUSION: This study indicated a possible benefit to masticatory performance of adequate surgical planning for one-phase reconstruction using 3D technology. A larger prospective study is necessary to gain more evidence regarding this finding.

Top 10 research priorities in head and neck cancer: Results of an Alberta priority setting partnership of patients, caregivers, family members, and clinicians.

BACKGROUND: The epidemiology, etiology, and management of head and neck cancer are evolving. Understanding the perspectives and priorities of nonresearchers regarding treatment uncertainties is important to inform future research. METHODS: Using the James Lind Alliance approach, patients, caregivers, and clinicians responded to a survey regarding their unanswered questions about treating and managing head and neck cancer. Distinct uncertainties were extracted from responses and sorted into themes. Uncertainties already answered in the literature were removed. Those remaining were ranked by patients and clinicians to develop a short list of priorities, which were discussed at a workshop and reduced to the top 10. RESULTS: One hundred sixty-one respondents posed 818 uncertainties, culminating in 77 for interim ranking and 27 for discussion at a workshop. Participants reached consensus on the top 10, which included questions on prevention, screening, treatment, and quality of life. CONCLUSION: Nonresearchers can effectively collaborate to establish priorities for future research in head and neck cancer.

Pretreatment Acoustic Predictors of Gender, Femininity, and Naturalness Ratings in Individuals With Male-to-Female Gender Identity.

PURPOSE: The purpose of this study was to describe the pretreatment acoustic characteristics of individuals with male-to-female gender identity (IMtFGI) and investigate the ability of the acoustic measures to predict ratings of gender, femininity, and vocal naturalness. METHOD: This retrospective descriptive study included 2 groups of participants. Speakers were IMtFGI who had not previously received communication feminization treatment (N = 25). Listeners were members of the lay community (N = 30). Acoustic data were retrospectively obtained from pretreatment recordings, and pretreatment recordings also served as stimuli for 3 perceptual rating tasks (completed by listeners). RESULTS: Acoustic data generally were within normal limits for male speakers. All but 2 speakers were perceived to be male, limiting information about the relationship between acoustic measures and gender perception. Fundamental frequency (reading) significantly predicted femininity ratings (p = .000). A total of 3 stepwise regression models indicated that minimum frequency (range task), second vowel formant (sustained vowel), and shimmer percentage (sustained vowel) together significantly predicted naturalness ratings (p = .005, p = .003, and p = .002, respectively). CONCLUSIONS: Study aims were achieved with the exception of acoustic predictors of gender perception, which could be described for only 2 speakers. Future research should investigate measures of prosody, voice quality, and other aspects of communication as predictors of gender, femininity, and naturalness.

Functional outcomes related to the prevention of radiation-induced xerostomia: oral pilocarpine versus submandibular salivary gland transfer.

BACKGROUND: Xerostomia has a devastating impact on oral function and quality of life in patients who receive radiation treatment for head and neck cancer. The purpose of this study was to examine functional outcomes related to 2 saliva-sparing treatments: (1) oral pilocarpine during radiotherapy; or (2) the submandibular salivary gland transfer (SGT) before radiotherapy. METHODS: Sixty-nine patients were recruited (SGT = 36; pilocarpine = 33). Speech intelligibility, swallowing outcomes, and quality of life were assessed at 4 points in time (pretreatment, and 1 month, 6 months, and 12 months after the pretreatment assessment). RESULTS: There were no differences between groups in speech outcomes; however, significant between-group differences existed in swallowing and quality of life outcomes. In all cases, patients who received the SGT procedure had better swallowing outcomes and quality of life scores than the patients who received oral pilocarpine. CONCLUSION: The SGT should be the treatment of choice between the 2 treatments offered to prevent xerostomia in the present study.

Listening levels of teenage iPod users: does measurement approach matter?

The main objective of this study was to determine the influence of background noise levels and measurement approach on user-selected listening levels (USLLs) chosen by teenaged MP3 player users. It was hypothesized that the presence of background noise would (i) increase the USLL across all measurement approaches, (ii) result in no significant USLL differences between survey reports, objective lab measures or calibrated self-report field measures, and (iii) cause no interaction effect between level of background noise and measurement approach. There were two independent variables in this study: the level of background noise and measurement approach. The first independent variable, level of background noise, had two levels: quiet and transportation noise. The second independent variable, measurement approach, had three levels: survey, objective in-ear lab measurement and calibrated self-report field measurement. The dependent variable was ear canal A-weighted sound pressure level (dBA SPL). A 2 × 3 repeated-measures ANOVA was used to determine the significance of the main and interaction effects. USLLs increased in the presence of background noise, regardless of the measurement approach used. However, the listening levels estimated by the participants using the survey and self-report field measure were significantly lower than those recorded using in-ear laboratory measurements by 9.6 and 3.3 dBA respectively. In-ear laboratory measures yielded the highest listening levels. Higher listening levels were observed in the presence of background noise for all measurement approaches. It appears that subjects' survey responses underestimate true listening levels in comparison to self-report calibrated field measures, and that both underestimate listening levels measured in the laboratory setting. More research in this area is warranted to determine whether measurement techniques can be refined and adjusted to accurately reflect real-world listening preferences.

Current practices for evaluation of resonance disorders in North America.

Improving treatment outcomes for people with resonance problems (due to velopharyngeal disorders) is a priority for many speech-language pathologists (SLPs), but there exists a limited understanding of the practices SLPs are using to assess and monitor therapeutic effects in this population. The current study was designed to answer the following questions: (1) What are current clinical practices versus best practices for assessing resonance disorders, tracking therapeutic effects, and determining discharge criteria? (2) What assessment practices would SLPs prefer to use with clients who have resonance disorders? (3) What are barriers to SLPs' use of best practices? and (4) What effects do SLP demographics have on clinical practices? Thirty-eight SLPs, specializing in the treatment of resonance disorders, participated in the study. Responses were compared with best practice recommendations derived from the literature. Most clinicians were using low-tech assessment tools, often because they lacked access to high-tech tools. Demographics and training did not affect clinical assessment practices. There is a need to increase the availability of high-tech assessment tools to SLPs practicing in the area of resonance disorders, as consistent use of sophisticated assessment devices would exemplify contemporary thinking about the transfer of knowledge to practice in this area.

Comparison of speech and aesthetic outcomes in patients with maxillary reconstruction versus maxillary obturators after maxillectomy.

BACKGROUND: Two options exist for restoring structure and function after maxillectomy. Prosthodontic rehabilitation requires that an obturator be constructed to address the oronasal communication that exists after resection of the maxilla. Surgical reconstruction of the defect is another option, often accomplished with the use of bone-containing flaps. OBJECTIVE: To determine whether prosthetic rehabilitation or surgical reconstruction of the maxilla provides better speech and facial aesthetic outcomes after maxillectomy. DESIGN, PARTICIPANTS, AND MEASURES: Fifty-nine patients in three groups were included: 23 patients with maxillary obturators, 16 patients with maxillary reconstruction, and 20 patients without any maxillary defects but who were diagnosed with nasopharyngeal cancer and who served as a control group. Using digitized photographs, facial attractiveness was rated on a 10-point scale by eight judges who were blinded to treatment group. Speech outcomes included nasalance, velopharyngeal orifice opening, and speech intelligibility. RESULTS AND CONCLUSIONS: There were no significant between-group differences found for facial attractiveness ratings. However, patients in either group who had involvement of the orbital rim or the orbital rim and zygoma were rated as significantly less attractive than those without such involvement. With respect to speech outcomes, the control group (ie, nasopharynx) had smaller velopharyngeal orifice areas than the obturator group; however, this was not clinically significant as scores in both groups were within normal limits. In conclusion, this study found no differences between surgical reconstruction or prosthodontic intervention of maxillary defects when facial attractiveness was assessed by naive raters and speech outcomes were assessed using objective measurements.

Survey of current functional outcomes assessment practices in patients with head and neck cancer: initial project of the head and neck research network.

BACKGROUND: Functional outcomes assessment has become increasingly important in informing treatment decisions in the area of head and neck cancer. However, consistency of assessment methods across studies has been lacking. For the literature to inform clinical decision making, consensus regarding outcomes measurements is necessary. OBJECTIVE: The Head and Neck Research Network (HNRN) was founded in January 2008 to become a conduit for high-quality research in the area of functional outcomes in patients with head and neck defects. The present study surveyed experts in functional outcomes assessment to determine what are considered the most important tools for assessing speech and swallowing and what background patient characteristics are important to capture. DESIGN, PARTICIPANTS, AND MEASURES: Respondents to the online survey included 54 participants with a background in speech-language pathology, with the majority of respondents from the United States, Canada, and the United Kingdom. RESULTS AND CONCLUSIONS: The results from the survey indicated that clinicians consider both subjective and objective measures as important to use when assessing function. More advanced technical tools were often rated as less important; however, it also was noted that clinicians were most often not able to access these tools or were unfamiliar with them.

A longitudinal study of functional outcomes after surgical resection and microvascular reconstruction for oral cancer: tongue mobility and swallowing function.

PURPOSE: Controversy exists regarding physiologic outcomes related to the tongue after radial forearm free flap (RFFF) reconstruction of hemiglossectomy defects. The purpose of this study is to report swallowing and tongue mobility outcomes for patients with RFFF reconstruction of the anterior two thirds of the tongue. MATERIALS AND METHODS: Swallowing and tongue mobility were assessed at 4 different time points over the course of 1 year of treatment for 15 patients who underwent RFFF reconstruction of the anterior two thirds of the tongue. Preoperative swallowing function in the treatment group was compared with a patient group that had no involvement of the tongue. A comparison group of 14 patients with nasopharyngeal cancer was used to compare preintervention function in patients with and without lesions of the tongue. RESULTS: No differences existed between the experimental and comparison groups before intervention. Two significant differences were found for swallowing ability and tongue mobility in the experimental group. Some of the measures at 1 month postoperatively were significantly different from some of the preoperative measures for liquid swallows and posterior-tongue mobility. All measures returned to baseline by the study's end. CONCLUSION: Although some minor deficits exist in swallowing and tongue mobility after RFFF reconstruction, it appears that these problems are no longer evident 12 months postoperatively.

Oral sensation and function: a comparison of patients with innervated radial forearm free flap reconstruction to healthy matched controls.

BACKGROUND: Limited evidence exists for the use of innervated radial forearm free flap (RFFF) reconstruction of hemiglossectomy defects. This study reports on sensation, mastication, and speech outcomes for patients with innervated RFFF reconstruction of the anterior two-thirds of the tongue. METHODS: Sensation, mastication, and speech intelligibility were assessed in 8 patients and age- and sex-matched controls. RESULTS: Sensation of intact tongue tissue after reconstruction of the hemitongue did not differ from controls. Although some sensory ability was restored to patients' reconstructed tongue, differences existed between the patient group and controls. However, whole mouth sensations resulted in similar sensory ability as controls. Whereas patients demonstrated adequate masticatory and speech ability, differences existed between patients and controls. CONCLUSION: Although some sensory ability is preserved in patients who have had tongue reconstruction with an innervated RFFF, functional outcomes such as masticatory ability and speech intelligibility may be affected in some patients.

Double free-flap reconstruction: indications, challenges, and prospective functional outcomes.

OBJECTIVE: To investigate the increasing use of double free flaps in the reconstruction of large head and neck defects. DESIGN: A 5-year retrospective medical record review in a large tertiary care head and neck oncology program. Prospectively collected functional data were also analyzed. SETTING: Academic research. PATIENTS: A consecutive series of 35 patients (24 men and 11 women; mean age, 57.7 years). MAIN OUTCOME MEASURES: The use of double free flaps in the reconstruction of large head and neck defects and prospective functional outcomes. RESULTS: The most common indication for surgery (n = 25 [71.4%]) was squamous cell carcinoma. The most common double free-flap combination (n = 22 [62.9%]) included an osteocutaneous fibular free flap with a fasciocutaneous radial forearm free flap. Objective evaluation by naive listeners demonstrated a mean single-word intelligibility score of 66.2% and a mean sentence intelligibility score of 84.8% in this group of patients. Modified barium swallow study results revealed no evidence of laryngeal penetration for swallowing liquid consistencies in 21 patients (60.0%), pudding consistencies in 30 patients (85.7%), and cookie consistencies in 32 patients (91.4%). CONCLUSIONS: With proper patient selection and planning and the use of 2 surgical teams, the length of surgery and complication rates are not significantly increased in double free-flap reconstruction. Furthermore, by using 2 free flaps, the best osseous and soft-tissue elements may be independently selected, yielding appropriate tissue characteristics for ideal defect reconstruction.

Speech outcomes after soft palate reconstruction with the soft palate insufficiency repair procedure.

BACKGROUND: Measurement of functional outcomes related to different methods of soft palate reconstruction is necessary to determine efficacy of surgical intervention after resection for oropharyngeal cancer. METHODS: Speech data were collected across 4 evaluation times for 4 groups of patients (2 groups consisted of patients with

A review of functional outcomes related to prosthetic treatment after maxillary and mandibular reconstruction in patients with head and neck cancer.

PURPOSE: This review examined literature that reported functional outcomes across 3 categories of prosthetic treatment after microvascular reconstruction of the maxilla and mandible: (1) conventional dental/tissue-supported prosthesis, (2) implant-retained prosthesis, and (3) no prosthesis. MATERIALS AND METHODS: Library databases were searched for articles related to reconstruction of the maxilla and mandible, and references of selected articles were hand searched. Relevant literature was identified and reviewed with criteria specified a priori. RESULTS: Forty-nine articles met the inclusion criteria. Twelve articles reported on function after maxillary reconstruction, with the majority of articles reporting on outcomes for 1 to 6 subjects. Thirty-nine articles reported on function after mandibular reconstruction. Speech outcomes were satisfactory across all groups. Swallowing reports indicated that many patients who received either type of prosthetic rehabilitation resumed a normal diet, whereas those without prosthetic rehabilitation were often restricted to liquid diets or feeding tubes. Patients without prosthetic rehabilitation reportedly had poor masticatory ability, whereas conventional prosthetic treatment allowed some recovery of mastication and implant-retained prosthetic treatment resulted in the most favorable masticatory outcomes. Quality-of-life outcomes were similar across all patients. CONCLUSIONS: Several limitations of the current literature prevented definitive conclusions from being reached within this review, especially regarding maxillary reconstruction. However, recognition of these limitations can direct functional assessment for the future.

Methods of functional outcomes assessment following treatment of oral and oropharyngeal cancer: review of the literature.

OBJECTIVE: The purpose of this article is to review and document the differing methods of functional outcome measurements following treatment for oral and oropharyngeal carcinoma. STUDY DESIGN: Literature review. METHODS: Articles were identified using the MEDLINE database search engine. The "Methods" sections of relevant articles were then reviewed, and functional outcomes assessment methods were tabulated. RESULTS: We identified 60 articles published in the last 7 years (2000-2007) that reported on functional outcomes following treatment for oral or oropharyngeal cancer. Twenty-three studies used quality of life questionnaires and 12 used clinical observations to describe function. Swallowing was assessed objectively in 29 studies, with videofluoroscopic swallowing studies as the primary method of assessment. Speech was assessed in only 10 articles, with perceptual analysis used as the primary assessment modality. CONCLUSIONS: Preserving good speech and swallowing function following treatment for oral and oropharyngeal cancer remains an extremely important aspect of cancer care. Nevertheless, there is a clear lack of uniform methods for assessing functional outcomes. We propose that functional outcome studies should include both objective and subjective assessments of swallowing and speech to gain sufficient information on posttreatment function.