Voice and Swallowing Training After Laryngeal Cancer Surgery

Key Takeaways

• Among patients undergoing laryngeal cancer surgery at a Chinese cancer hospital, multimodal rehabilitation centered on voice and swallowing training was associated with significantly lower voice handicap than routine care at 6, 12, and 24 months.
• Dysphagia was less frequent with rehabilitation at 12 and 24 months.
• EQ-5D index and satisfaction scores were significantly higher with rehabilitation.

Investigators conducted a retrospective cohort comparison of voice and swallowing training after laryngeal cancer surgery at Shanxi Province Cancer Hospital in China. The cohort comprised 120 patients who underwent partial or total laryngectomy for laryngeal squamous cell carcinoma between June 2019 and June 2023. Sixty received a rehabilitation program and 60 received routine care. Group assignment was not randomized; groups were matched 1:1 by propensity score on age, sex, TNM stage, and surgical method.

The rehabilitation program combined graded voice and swallowing training with nutritional, pain, and psychological support, beginning 24 to 48 hours after nasogastric tube removal. Routine care also included pain management, nutritional support, and general vocal hygiene advice. Assessments at 6, 12, and 24 postoperative months used the Voice Handicap Index (VHI), the Standardized Swallowing Assessment (SSA), the Eating Assessment Tool-10 (EAT-10), and the EQ-5D-3L. Complications were recorded within the first postoperative month.

At 12 months, mean VHI scores were 35.25 ± 5.12 with rehabilitation versus 44.70 ± 6.84 with routine care (P<0.001). Lower scores indicate less reported voice handicap. At 24 months, VHI scores were 32.10 ± 4.85 versus 41.27 ± 6.15 (P<0.001). Dysphagia occurred in 10% of the rehabilitation group versus 30% of the routine-care group at 12 months (risk ratio, 0.33; 95% CI, 0.14–0.78), and in 6.7% versus 25.0% at 24 months. The EQ-5D index was significantly higher with rehabilitation at 12 months (0.82 ± 0.09 vs 0.68 ± 0.11) and at 24 months (0.84 ± 0.07 vs 0.70 ± 0.09; both P<0.001). Satisfaction scores were significantly higher at all assessments.

Total complications occurred in 7 of 60 rehabilitation patients (11.67%). The routine-care rate appears as 26.67% in the abstract and text, but as 22 of 60 (36.67%) in the complications table, whose individual counts sum to 22. No individual complication type differed significantly between groups.

In 24-month multivariable models, rehabilitation was associated with lower VHI scores (β = −9.215), lower SSA scores (β = −3.268), a higher EQ-5D index (β = 0.138), lower odds of dysphagia (odds ratio [OR], 0.176; 95% CI, 0.07–0.44), and lower odds of complications (OR, 0.218; 95% CI, 0.09–0.53). These adjusted findings are associations, not independently demonstrated treatment effects.

Patients with severe postoperative complications that precluded rehabilitation were excluded, which may favor the rehabilitation group in the complication comparison. The intervention bundled voice and swallowing training with nutritional, pain, and psychological support, so any association cannot be attributed to the training components alone. The cohort also mixed partial and total laryngectomy, which the authors note limits comparability of absolute scores. Internal inconsistencies in the reported VHI, SSA, and complication data further limit confidence in specific estimates.

The authors interpreted combined postoperative voice and swallowing rehabilitation as effective for promoting functional recovery and quality of life and for reducing complications after laryngeal cancer surgery.

Clinician Questions

Which variables were included in the adjusted analysis of voice and swallowing rehabilitation after laryngeal cancer surgery?

For multimodal rehabilitation after laryngeal cancer surgery, the 24-month multivariable models adjusted for age, sex, TNM stage, surgical method (total vs partial laryngectomy), and postoperative radiotherapy. The methods describe linear models for VHI, SSA, and EQ-5D but not the models used for dysphagia and complications. Coefficients for stage IV disease and total laryngectomy point toward better voice and swallowing scores, although the authors describe both as risk factors for poorer recovery, so covariate estimates warrant caution.

Were Swallowing Function Scale scores reported for patients receiving voice and swallowing training after laryngeal cancer surgery?

Swallowing function was measured with the SSA, which ranges from 18 to 46, with higher scores indicating worse function. Dysphagia risk was screened with the EAT-10, on which a score of 20 or more indicates risk. Several reported SSA means at 12 and 24 months fall below the scale minimum, so dysphagia incidence is the more interpretable swallowing outcome.