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Original Investigation
From the American Head and Neck Society
December 2016

Variables Associated With Communicative Participation After Head and Neck Cancer

Author Affiliations
  • 1Department of Speech and Hearing Sciences, University of Washington, Seattle
  • 2Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle
  • 3Department of Rehabilitation Medicine, University of Washington, Seattle
JAMA Otolaryngol Head Neck Surg. 2016;142(12):1145-1151. doi:10.1001/jamaoto.2016.1198
Key Points

Question  Which variables are significantly associated with communicative participation outcomes in adults with head and neck cancer?

Findings  In this study of 197 survey respondents, 4 significant variables emerged—self-rated speech severity, cognitive function, laryngectomy status, and time since diagnosis—making up 46% of the variance in the model.

Meaning  Better communicative participation was associated primarily with less severe speech and cognitive problems and, to a lesser extent, with not having undergone a total laryngectomy surgical procedure and longer time since diagnosis.


Importance  For patients with head and neck cancer (HNC), communication difficulties often create substantial barriers in daily life, affecting a person’s ability to return to work, establish or maintain relationships, or participate in everyday activities.

Objective  To examine variables significantly associated with communication in everyday activities, or communicative participation, in adult survivors of HNC.

Design, Setting, and Participants  In a cross-sectional study, from November 1, 2008, through March 18, 2011, participants completed questionnaires about specific experiences and symptoms associated with their health and communication. Seventeen variables were considered in association with communicative participation. Data were collected from adult survivors of HNC residing in a community. Participants completed questionnaires, in English, either online or using paper forms according to their preference. Participants were recruited through support groups, professional email lists, and professional contacts.

Main Outcomes and Measures  Communicative participation and predictor variables were measured using a variety of validated patient-report scales and demographic information. Multiple linear regression analysis was conducted with variables entered using a backward stepwise regression procedure. Variables with significant regression coefficients were retained in the model and reported as change in R2.

Results  One hundred ninety-seven adults (121 males and 76 females; mean age, 61.5 years) participated, all at least 6 months posttreatment of HNC with no additional medical conditions affecting speech. The final model contained 4 significant variables (R2 = 0.462): self-rated speech severity, cognitive function, laryngectomy status, and time since diagnosis. Better communicative participation was associated with less severe speech and cognitive problems; together, these 2 variables explained 42% of the variance in the model (self-rated speech severity, R2 = 0.227, and cognitive function, R2 = 0.193 [0.227 + 0.193 = 0.420 = 42%]). To a lesser extent, better communicative participation also was associated with not having undergone a total laryngectomy surgical procedure (R2 = 0.035) and longer time since diagnosis (R2 = 0.007); full model: R2 = 0.462, P < .001; regression coefficients [SE]: self-rated speech severity 0.551 [0.065], P < .001, R2 = 0.227; cognitive function 0.063 [0.011], P < .001, R2 = 0.193; laryngectomy status 0.285 [0.117], P = .02; and time since diagnosis 0.015 [0.006], P = .02.

Conclusions and Relevance  These results suggest that communicative participation in adults with HNC is associated with self-rated speech severity, cognitive function, whether or not a person has undergone total laryngectomy, and time since diagnosis. Clinicians can use these results to inform their practice in pretreatment counseling, patient education, and rehabilitation for survivors of HNC.