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Sökning: WFRF:(Tuomi Lisa 1985)

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1.
  • Abrahamsson, Malin, et al. (författare)
  • Effects of Voice Therapy: A Comparison Between Individual and Group Therapy
  • 2018
  • Ingår i: Journal of Voice. - : Elsevier BV. - 0892-1997. ; 32:4, s. 437-442
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. The primary aim of this clinical evaluation project is to study the effect of voice therapy given in the speech-language pathology clinic, as individual and group therapy, as well as finding out some of the reasons for not attending the recommended therapy. Method. All patients visiting the speech-language department during the study period were asked to participate in a clinical evaluation project. The project included filling out the questionnaire Swedish Voice Handicap Index (VHI-11) twice: at their first visit at the clinic, and approximately 1 year later. Depending on the degree of voice problems, the patients were offered either individual or group therapy. Result. The study included 187 patients at their first visit to the clinic and 109 patients at follow-up. All participants completed self-evaluation of voice function with the VHI-11 and separate questions regarding overall voice problems, hoarseness, and vocal fatigue. For the patients who responded to the follow-up survey, statistically significant improvements of self-perceived voice function were demonstrated in individual and group therapy. The improvement between the first visit and the follow-up was found to be of moderate to large effect size, with statistically significant improvements for both patients who attended individual therapy and those who attended group therapy. The most common reason for not attending the recommended voice therapy was lack of time. Conclusion. Individual and group therapy is effective, resulting in improved VHI-11 scores. The magnitude of improvement is similar when comparing individual and group therapy. Patients with higher scores of the VHI-11 were generally recommended individual voice therapy.
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2.
  • Aghajanzadeh, Susan, et al. (författare)
  • A 5-year prospective study of health-related quality of life in irradiated head and neck cancer patients: three trends of HRQL over time
  • 2023
  • Ingår i: European Archives of Oto-Rhino-Laryngology. - : Springer Science and Business Media LLC. - 0937-4477 .- 1434-4726. ; 280:5, s. 2617-22
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose Head and neck cancer (HNC) is one of the fastest increasing cancer-types, where both disease and oncologic treatment have severe impact on health-related quality of life (HRQL). This study aimed to report HRQL prospectively up to 5-years following radiotherapy-treatment in HNC and to, if possible, identify trends in HRQL over time. Methods This prospective study followed 211 patients receiving curatively intended radiotherapy pre-diagnosis, 3-, 6-, 12- and 60-months post-radiotherapy completion. HRQL was measured using EORTC QLQ-C30 and EORTC QLQ-HN35. Results A deterioration three months post-radiotherapy was reported in 14/15 domains of EORTC QLQ-C30. Eight out of 12 domains had recovered to baseline-values at 12 months post-radiotherapy and remained unchanged up to study endpoint. Corresponding figures for EORTC QLQ-HN35 were deteriorations in 15/16 domains at three months post-radiotherapy, with recovery of 5 domain at 12-months, whereas the other 11 domains remained significantly worse at 5-years post-RT compared to baseline. Conclusion Following the deterioration in HRQL seen immediately following radiotherapy, the continued course of HRQL can be divided into three trends: short-term deterioration, long-term deterioration and long-term improvements. The combination of disease- and diagnosis-specific questionnaires is crucial when assessing HRQL in the HNC population.
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3.
  • Aghajanzadeh, Susan, et al. (författare)
  • A prospective 5-year study of trismus prevalence and fluctuation in irradiated head and neck cancer patients
  • 2022
  • Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 142:7-8, s. 620-626
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Trismus is a complication post-radiotherapy for head and neck cancer (HNC), which causes pain, eating limitations and reduced quality-of-life. However, little is known about the condition long-term or how trismus fluctuates within an irradiated population. Aim/Objective To prospectively map trismus prevalence in irradiated HNC patients up to 5-years following treatment completion including describing intra-group fluctuation of maximum interincisal opening (MIO). Materials and Methods 211 patients receiving curatively intended radiotherapy for HNC were included in this prospective study. Patients were followed pre-radiotherapy (baseline), 3-, 6-, 12-, 24-, 36- and 60-months post-radiotherapy completion using MIO. Results Mean MIO at baseline, 12-months and 5-years following radiotherapy were 51.5 mm, 41.7 mm and 41.3 mm respectively. A total of 28% (n = 36) fulfilled the trismus criterion at 5-years post-radiotherapy. Eighty percent of patients (n = 24) with trismus at 5 years post-radiotherapy also suffered from trismus at 12 months post-radiotherapy, whilst 88-92% of all patients reported reduced MIO at any given timepoint compared to baseline. 15% of patients never exceeded an MIO of >35 mm at any time-point. Conclusion Trismus is a prevalent long-term complication of HNC and its treatment, which does not appear to heal spontaneously. The majority of fluctuations in MIO occur during the first 12 months post-radiotherapy completion.
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4.
  • Aghajanzadeh, Susan, et al. (författare)
  • Facial pain, health-related quality of life and trismus-related symptoms up to 5years post-radiotherapy for head and neck cancer
  • 2023
  • Ingår i: Supportive Care in Cancer. - 0941-4355 .- 1433-7339. ; 31:12
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Pain is a frequent symptom of head and neck cancer (HNC) but longitudinal studies investigating facial pain are scarce. We aimed to investigate prevalence of facial pain, its effect on health-related quality of life (HRQL) and trismus-related symptoms in a HNC cohort. Methods: Patients (n = 194) were prospectively followed post completion of radiotherapy (RT). Outcome measures included facial pain, HRQL, trismus-specific symptoms, and maximal interincisal opening (MIO). Results: Facial pain was reported by 50% at baseline. Corresponding figures for 3-, 12-, and 60months post-RT were 70%, 54% and 41%. Moderate to severe pain was reported in 29–44% of patients reporting pain during the study period. Patients reporting pain scored significantly worse on more HRQL variables and trismus symptoms, as well as had significantly smaller MIO at all follow-up time points. Conclusions: Facial pain was common in HNC patients pre- and post-RT and remained prevalent up to 5years after completion of RT. Reductions in MIO were associated with more facial pain. Pain was also associated with worse HRQL.
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5.
  • Aghajanzadeh, Susan, et al. (författare)
  • Postradiation trismus in head and neck cancer survivors: a qualitative study of effects on life, rehabilitation, used coping strategies and support from the healthcare system
  • 2024
  • Ingår i: EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY. - 0937-4477 .- 1434-4726.
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose This study aimed to explore the experiences of head and neck cancer (HNC) survivors with postradiation trismus, specifically how oncological treatment affected their lives, rehabilitation, use of coping strategies, and healthcare experiences. Methods: A qualitative descriptive approach was used and semi-structured interviews of 10 HNC survivors with postradiation trismus were conducted 6-30 months after completing oncological treatment. The interviews were transcribed verbatim and analyzed by qualitative content analysis.Results The analysis of interviews yielded four main categories: Bodily symptoms, Effects on life, Support from the healthcare system, and Strategies to handle life and symptoms. Participants reported ongoing problems with xerostomia, dysgeusia, eating, and limited physical fitness. Pain related to trismus was not a major issue in this cohort. Participants expressed limitations in their social lives due to their eating difficulties, yet a sense of thankfulness for life and overall satisfaction with the healthcare they received. Psychological and practical coping strategies developed by the participants were also revealed.Conclusion The results highlight areas of unmet need among HNC survivors that healthcare providers can target by establishing multi-professional teams dedicated to individualizing post-cancer rehabilitation care.
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6.
  • Aghajanzadeh, Susan, et al. (författare)
  • The effect of jaw exercises on anxiety and depression in patients with head and neck cancer receiving radiotherapy: Prospective 2-year follow-up study
  • 2020
  • Ingår i: Head and Neck-Journal for the Sciences and Specialties of the Head and Neck. - : Wiley. - 1043-3074. ; 42:2, s. 330-335
  • Tidskriftsartikel (refereegranskat)abstract
    • Background This nonrandomized matched study investigates jaw exercise effect on anxiety/depressive symptoms in head and neck cancer patients with trismus during 2 years postradiotherapy. Methods Fifty patients with trismus postradiotherapy were included in a 10-week jaw-training intervention. A matched control group was included (N = 50). Maximum interincisal opening (MIO) <= 35 mm was used as the trismus criterion. Patients were assessed using MIO and Hospital Anxiety Depression Scale preintervention, postintervention, and at 2-year follow-up. Results A significant difference was found in depressive symptoms between the intervention group and control group (4% vs 33%) at 2-year follow-up, with more control group patients reporting possible depression. In the intervention group, significantly fewer patients had possible/probable depressive symptoms at follow-up (4%) compared to preintervention (34%). No change was seen within the control group. Conclusion Structured jaw exercise in patients with postradiation trismus had positive effects on MIO and depressive symptoms but does not seem to have any significant effects on anxiety symptoms.
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7.
  • Aghajanzadeh, Susan, et al. (författare)
  • Trismus, health-related quality of life, and trismus-related symptoms up to 5 years post-radiotherapy for head and neck cancer treated between 2007 and 2012
  • 2023
  • Ingår i: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 31:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Radiotherapy-induced trismus is present in up to 40% of patients treated radiotherapeutically for head and neck cancer (HNC) and impacts health-related quality of life (HRQL) negatively. This prospective study aimed to investigate the development of trismus and its influence on HRQL and trismus-related symptoms in HNC patients for up to 5 years post-radiotherapy completion as no such follow-up studies exist. Methods: Patients (n = 211) were followed prospectively from pre-radiotherapy to 12 and 60 months post-radiotherapy. At each follow-up, maximum interincisal opening (MIO) was measured, and patients filled in the European Organization for Treatment of Cancer Quality-of-Life Questionnaire Core-30 (EORTC QLQ-C30), Head and Neck-35 (EORTC QLQ-HN35), and Gothenburg Trismus Questionnaire (GTQ). Trismus was defined as an MIO ≤ 35 mm. Results: At 1 year post-radiotherapy, a total of 27% met the trismus criterion, and at 5 years post-radiotherapy, the corresponding figure was 28%. Patients in the trismus group scored significantly worse compared to the patients without trismus on 8/15 domains at 1 year post-radiotherapy on EORTC QLQ-C30, further worsening in 11/15 domains at 5 years post-radiotherapy. Similar results were found for EORTC QLQ-HN35. Patients with trismus reported more trismus-related symptoms according to the GTQ at both timepoints compared to those without trismus. Conclusion: This study highlights that HNC patients suffering from radiotherapy-induced trismus report poorer HRQL and more trismus-specific symptoms compared to patients without trismus. These differences persist and increase up to at least 5 years following treatment completion. Hence, our results highlight that radiotherapy-induced trismus affects long-term HRQL, jaw symptoms, and pain, further stressing the need for early and structured intervention.
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8.
  • Albinsson, Sofie, 1992, et al. (författare)
  • Patient-Reported Dysphagia in Adults with Eosinophilic Esophagitis: Translation and Validation of the Swedish Eosinophilic Esophagitis Activity Index
  • 2022
  • Ingår i: Dysphagia. - : Springer Science and Business Media LLC. - 0179-051X .- 1432-0460. ; 37, s. 286-296
  • Tidskriftsartikel (refereegranskat)abstract
    • The lack of a Swedish patient-reported outcome instrument for eosinophilic esophagitis (EoE) has limited the assessment of the disease. The aims of the study were to translate and validate the Eosinophilic Esophagitis Activity Index (EEsAI) to Swedish and to assess the symptom severity of patients with EoE compared to a nondysphagia control group. The EEsAI was translated and adapted to a Swedish cultural context (S-EEsAI) based on international guidelines. The S-EEsAI was validated using adult Swedish patients with EoE (n = 97) and an age- and sex-matched nondysphagia control group (n = 97). All participants completed the S-EEsAI, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Oesophageal Module 18 (EORTC QLQ-OES18), and supplementary questions regarding feasibility and demographics. Reliability and validity of the S-EEsAI were evaluated by Cronbach's alpha and Spearman correlation coefficients between the domains of the S-EEsAI and the EORTC QLQ-OES18. A test-retest analysis of 29 patients was evaluated through intraclass correlation coefficients. The S-EEsAI had sufficient reliability with Cronbach's alpha values of 0.83 and 0.85 for the "visual dysphagia question" and the "avoidance, modification and slow eating score" domains, respectively. The test-retest reliability was sufficient, with good to excellent intraclass correlation coefficients (0.60-0.89). The S-EEsAI domains showed moderate correlation to 6/10 EORTC QLQ-OES18 domains, indicating adequate validity. The patient S-EEsAI results differed significantly from those of the nondysphagia controls (p < 0.001). The S-EEsAI appears to be a valid and reliable instrument for monitoring adult patients with EoE in Sweden.
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9.
  • Albinsson, Sofie, 1992, et al. (författare)
  • Validation of the Swedish Watson Dysphagia Scale for adult patients with eosinophilic esophagitis
  • 2022
  • Ingår i: Diseases of the Esophagus. - : Oxford University Press (OUP). - 1120-8694 .- 1442-2050. ; 35:7
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The Swedish Watson Dysphagia Scale (S-WDS) has been used to assess dysphagia in patients with eosinophilic esophagitis (EoE) but has not been validated for this patient group. The aim of this study was to validate the S-WDS for adult patients with EoE. Methods: Ninety-seven Swedish adult patients with EoE and 97 controls without dysphagia filled out the S-WDS, the Swedish Eosinophilic Esophagitis Activity Index (S-EEsAI) and a set of supplementary questions. The reliability of the S-WDS was evaluated using Cronbach's alpha, Pearson correlation of items and total score, and test-retest analysis (n = 29). Validity was investigated using Spearman correlations of the S-WDS items, S-EEsAI domains and a self-assessment score, and by investigating floor and ceiling effects. Results: The Cronbach's alpha of the S-WDS was 0.77 and all items demonstrated moderate to strong correlation to the S-WDS score (r = 0.40-0.81) indicative of sufficient reliability of the instrument. In addition, the test-retest results reflected excellent reliability with an intraclass correlation coefficient of 0.85 for the S-WDS score. Adequate validity of the instrument was demonstrated, the S-WDS score correlated moderately with the self-assessment score and with 4/6 S-EEsAI domains, and strongly with the remaining two domains. Floor effects were more common for liquids and soft-textured foods and ceiling effects increased with increasing food consistency. The S-WDS scores of the patient group were significantly different from those of the nondysphagia control group (P < 0.001). Conclusion: The S-WDS instrument is an appropriate and valid instrument for assessment of dysphagia in patients with EoE.
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10.
  • Alexandersson, Cecilia, et al. (författare)
  • Measurement of Nasal Nitric Oxide in Chronic Rhinosinusitis and Its Relationship to Patient-Reported Outcome: A Longitudinal Pilot Study
  • 2021
  • Ingår i: Ear, Nose and Throat Journal. - : SAGE Publications. - 0145-5613 .- 1942-7522. ; 100:7, s. 522-529
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To assess whether nasal nitric oxide (nNO) levels differ between healthy and sick sinuses in chronic rhinosinusitis (CRS). A secondary aim was to assess whether nNO levels change after treatment of CRS and whether there is an association with radiological findings or symptoms. Method: Three groups of 12 participants each were examined: patients with CRS without polyposis (CRS group), patients with symptoms of CRS but radiologically normal sinuses (symptoms-only), and healthy controls. Measurements of nNO were carried out using aspiration method and humming maneuver. All participants completed the Sino-Nasal Outcome Test (SNOT-22). A second nNO measurement was done after treatment in the CRS group (n = 9) and the healthy control group (n = 12). Results: Nasal NO did not differ between any of the groups with any of the measurement techniques. There was a trend toward lower nNO values in the CRS group compared with the symptoms-only group and healthy controls, but it did not reach statistical significance. The SNOT-22 demonstrated inferior values for the CRS and symptoms-only groups compared with the healthy controls. At follow-up, no statistically significant change was found for the nNO measurements in either group. Conclusion: Irrespective of occluded or open ostiomeatal complexes, no statistically significant differences in nNO were found in CRS compared with healthy controls using aspiration and humming methods. Treatment of CRS improved sinus patency without accompanying a significant change in nNO. This study can therefore not conclude that nNO can be used as a diagnostic tool for CRS without polyposis. © The Author(s) 2019.
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11.
  • Bengtsson, L., et al. (författare)
  • Effects of oral screen exercise on orofacial and pharyngeal activity: An exploratory study using videofluoroscopy and surface electromyography in healthy adults
  • 2022
  • Ingår i: Clinical and Experimental Dental Research. - : Wiley. - 2057-4347. ; 8:2, s. 519-528
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The oral screen is a device commonly used for treatment of orofacial disorders. The objective of this exploratory study was to examine the effect of oral screen exercise on the muscle activity in the lips, submental complex, masseter muscle, and kinematic activity of the tongue base, soft palate, pharynx, and larynx in healthy adults. This was compared with the kinematic activity during a dry swallow. It was hypothesized that not only the lip musculature but also other structures in the oral and pharyngeal cavities are activated while using an oral screen device. Method: Ten healthy subjects used an oral screen during examination with videofluoroscopy and surface electromyography (EMG). Three different instructions for oral screen application and a dry swallow were examined. Results: The lip muscles showed the highest activity during oral screen exercise. The other muscle groups were activated to a lesser degree. The pattern of activation differed between individuals. Compared with a dry swallow, the range of motion of the tongue base, posterior pharyngeal wall, and the larynx was significantly smaller during oral screen activation. No major differences were found between three different instructions. Conclusion: This study indicates that the lips and submental complex and, to a lesser degree, oral, pharyngeal, and laryngeal structures are activated with the oral screen, but the pattern of activation varied between individuals. In comparison to the activity during a dry swallow, range of motion during oral screen exercise is small.
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12.
  • Dotevall, Hans, 1958, et al. (författare)
  • Long-term effects on swallowing and laryngeal function after treatment for severe COVID-19 disease in intensive care
  • 2024
  • Ingår i: EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY. - 0937-4477 .- 1434-4726.
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose This study aimed to assess swallowing and laryngeal function at long-term follow-up in patients treated for severe COVID-19 in the ICU.Methods Thirty-six patients with severe COVID-19 were prospectively examined with fiberendoscopic evaluation of swallowing (FEES) about 6 and 12 months after ICU discharge. Comparison with initial FEES examinations during the time in hospital was performed in 17 patients. Analysis of swallowing function and laryngeal features was performed from video recordings. Twenty-five participants responded to Eating Assessment Tool, Voice Handicap Index, and the Hospital Anxiety and Depression Scale at follow-up.Results Penetration to the laryngeal vestibule (PAS >= 3) was seen in 22% and silent aspiration (PAS = 8) in 11% of patients on at least one swallow at follow-up. Fourteen percent had obvious residue in the vallecula and/or pyriform sinuses after swallowing thick liquid or biscuits. Self-reported eating and swallowing difficulties were found in 40% of patients. Abnormal findings in the larynx were present in 53% at follow-up. Thirty-three percent had reduced or impaired vocal fold movement, of whom 22% had bilateral impaired abduction of the vocal folds. Possible anxiety and depression were found in 36% and 24% of responders, respectively.Conclusion Although a majority of patients appear to regain normal swallowing function by 1 year after treatment for severe COVID-19, our results indicate that dysphagia, abnormal laryngeal function, and anxiety/depression may remain in a substantial proportion of patients. This suggests that swallowing and laryngeal function, and emotional symptoms, should be followed up systematically over time in this patient group.
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13.
  • Dotevall, Hans, 1958, et al. (författare)
  • Treatment with head-lift exercise in head and neck cancer patients with dysphagia: results from a randomized, controlled trial with flexible endoscopic evaluation of swallowing (FEES)
  • 2023
  • Ingår i: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 31:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: This randomized study aimed to evaluate the effects of the Shaker head-lift exercise (HLE) to improve dysphagia following oncologic treatment for head and neck cancer (HNC). Methods: Patients with dysphagia following oncologic treatment for HNC were randomly assigned to intervention (n = 23) or control (standard dysphagia management, n = 24) groups. Swallowing was evaluated at baseline and at 8-week follow-up using flexible endoscopic evaluation of swallowing (FEES) and self-perceived swallowing with the Eating Assessment Tool (EAT-10). Analysis was performed regarding secretion, initiation of swallow, residue after swallowing, and penetration/aspiration. Results: Few statistically significant differences were found in the FEES analysis. Some improvement of self-perceived swallowing function was found in both groups. Adherence to training was high. Conclusions: This randomized study regarding the effect of the HLE demonstrated that swallowing outcome measures used in assessment of FEES did not improve in patients treated with radiotherapy for patients with dysphagia following HNC.
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14.
  • Ellie, Saghafi, et al. (författare)
  • The prevalence and symptoms of temporomandibular disorders in head and neck cancer patients
  • 2022
  • Ingår i: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 80:4, s. 252-257
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives This retrospective patient survey aimed to assess the prevalence of temporomandibular disorders (TMD) before and after curative oncological treatment and to identify possible risk factors. Materials and Methods Patients with squamous cell carcinoma in the tonsil or base of the tongue were included (n = 217). Medical records were collected to assess TMD prevalence before oncological treatment and at 6- and 12-month follow-up. Fisher's test and Pitman's test were used. Results Significantly reduced mouth opening was observed after oncological treatment at 6- and 12-month follow-up (p < .001). Symptoms from the temporomandibular joint and jaw muscles plus pain upon palpation (p = .0083, p < .001, respectively) and self-reported pain upon chewing (<0.001) and opening the mouth (<0.001) increased 12 months following radiotherapy. Pain and degree of mouth opening prior to treatment, self-reported depression, overall health status, brachytherapy and jaw exercise during radiotherapy were factors affecting the increase of TMD symptoms. Conclusion All TMD symptoms escalated significantly one year after radiotherapy except self-reported sounds from the temporomandibular joint. Reduction in the degree of mouth opening and pain in the jaw muscles and the temporomandibular joint when opening the mouth and upon chewing were commonly reported symptoms following radiotherapy. Several potential risk factors were identified.
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15.
  • Engberg, Alva Vilpi, et al. (författare)
  • Prevalence of Dysphagia and Risk of Malnutrition in Elderly Living in Nursing Homes
  • 2024
  • Ingår i: DYSPHAGIA. - 0179-051X .- 1432-0460.
  • Tidskriftsartikel (refereegranskat)abstract
    • Swallowing difficulties commonly co-occur with malnutrition in the elderly. However, there is no consensus on which assessment tools to use, and thus reported prevalence varies. The aim of this study was to survey the prevalence of dysphagia and risk of malnutrition in elderly people in nursing homes, evaluate the possible associations between swallowing function and malnutrition and survey whether there were associations between self-perceived function and the results of a screening of dysphagia. A total of 35 residents (aged 67-100 years old) without serious cognitive impairment in the general wards of two nursing homes in Gothenburg were investigated. Swallowing ability was assessed with the Gugging Swallowing Screen (GUSS) test, self-rated swallowing ability with the 4QT and the Swedish Eating Assessment Tool-10 (S-EAT-10) and risk of malnutrition with the Minimal Eating Observation and Nutrition Form-Version 2 (MEONF-II). Eleven participants (31.4%) exhibited dysphagia according to the GUSS and 10 participants (29.4%) showed moderate or high risk of malnutrition. In total 16 (46%) participants reported abnormal swallowing on 4QT and 14 (40%) participants reported abnormal swallowing on S-EAT-10. However, less than half of these had dysphagia according to the GUSS. No association was found between swallowing ability measured by the GUSS and risk of malnutrition, although a tendency towards a weak association was noted, or self-rated swallowing ability measured by the 4QT and S-EAT-10. The study found that approximately one-third of the tested participants presented with signs of dysphagia as measured with the screening instrument GUSS, even though only a few were known to have any difficulties prior to testing. This highlights that dysphagia is probably more prevalent than patients themselves and caregivers are aware of, thus, screening is of importance, to enable safer nutritional intake.
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16.
  • Eriksson, Hedvig, et al. (författare)
  • Voice Outcomes Following Head-Lift Exercises in Head and Neck Cancer: A Randomized Controlled Study.
  • 2023
  • Ingår i: Journal of voice : official journal of the Voice Foundation. - : Elsevier BV. - 1873-4588. ; 37:2, s. 226-233
  • Tidskriftsartikel (refereegranskat)abstract
    • This prospective randomized study aimed to investigate whether patients with dysphagia after treatment for head and neck cancer improve their vocal function from doing head lift exercises (Shaker's exercise).Patients were randomized into an intervention group (n=24) or a control group (n=26). Patients in the intervention group performed the head lift exercise three times a day for 8 weeks. At baseline and at follow-up after 8 weeks, participants' voices were evaluated perceptually with the Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) scale. Vocal fry (VF) was also perceptually evaluated and patients filled in the Voice Handicap Index (VHI).Patients in the intervention group were perceptually evaluated as having less roughness and vocal fry in their voices at follow-up compared to the control group. There were no statistically significant changes between baseline and follow-up neither in the intervention nor the control group regarding GRBAS, VF, or VHI. Neither were there any statistically significant differences within the groups when results on the perceptual evaluations at baseline and follow-up were compared.The voices of the participants in the intervention group were slightly better than the voices of the participants in the control group with less roughness and VF at follow-up. However, no improvement in the VHI or the remaining GRBAS variables was found. Therefore, this study can only give cautious support to the head lift exercise as a method for improving the voice of patients with dysphagia after treatment for head and neck cancer.
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17.
  • Girod-Roux, Marion, et al. (författare)
  • A translation and validation of the French version of the Gothenburg Trismus Questionnaire 2 (F-GTQ-2)
  • 2024
  • Ingår i: JOURNAL OF ORAL REHABILITATION. - 0305-182X .- 1365-2842.
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Limitation of mouth opening, widely known as trismus, is a major symptom altering quality of life in individuals presenting from temporomandibular joint disorder or head and neck cancer. A French-language instrument addressing jaw opening limitation following treatment for head and neck cancer (HNC) or temporomandibular joint disorder (TMD) is lacking. Objective: The aim of this study was to translate and validate the Gothenburg Trismus Questionnaire-2 (GTQ-2) into French. Methods: A French translation of the GTQ-2 was performed according to established international guidelines, leading to the French-GTQ-2 (F-GTQ-2). The validation study included 154 participants with trismus (minimum interincisal opening of <= 35 mm) following treatment for TMD or HNC and 149 age-matched participants without trismus. All participants completed the F-GTQ-2 and participants with trismus completed additional health-related quality of life questionnaires to allow for analysis of convergent validity. Results: The F-GTQ-2 demonstrated retained psychometric properties with Cronbach's alpha values above 0.70 for the domains, jaw-related problems, eating limitations, facial pain and somewhat lower for muscular tension (0.60). Mainly moderate correlations were found when comparing the F-GTQ-2 to other instruments, which was in line with the pre-specified hypotheses, indicating satisfactory convergent validity. Discriminant validity was found with statistically significant differences in all domains of the F-GTQ-2 between trismus and non-trismus participants. Conclusion: The F-GTQ-2 can be considered a reliable and valid instrument to assess jaw-related difficulties in individuals with trismus due to HNC or TMD.
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18.
  • Hedström, Anna, 1983, et al. (författare)
  • Identifying organs at risk for radiation-induced late dysphagia in head and neck cancer patients.
  • 2019
  • Ingår i: Clinical and translational radiation oncology. - : Elsevier BV. - 2405-6308. ; 19, s. 87-95
  • Tidskriftsartikel (refereegranskat)abstract
    • Dysphagia is a common, severe and dose-limiting toxicity after oncological treatment of head and neck cancer (HNC). This study aims to investigate relationships between radiation doses to structures involved in normal swallowing and patient-reported as well as clinically measured swallowing function in HNC patients after curative (chemo-) radiation therapy (RT) with focus on late effects.Patients (n=90) with HNC curatively treated with RT±chemotherapy in 2007-2015 were assessed for dysphagia post-treatment by telephone interview and videofluoroscopy (VFS). A study-specific symptom score was used to determine patient-reported dysphagia. The Penetration-Aspiration Scale (PAS) was applied to determine swallowing function by VFS (PAS≥4/≥6=moderate/severe dysphagia). Thirteen anatomical structures involved in normal swallowing were individually delineated on the patients' original planning CT scans and associated dose-volume histograms (DVHs) retrieved. Relationships between structure doses and late toxicity were investigated through univariable and multivariable logistic regression analysis (UVA/MVA) accounting for effects by relevant clinical factors.Median assessment time was 7months post-RT (range: 5-34months). Mean dose to the contralateral parotid gland and supraglottic larynx as well as maximum dose to the contralateral anterior digastric muscle predicted patient-reported dysphagia (AUC=0.64-0.67). Mean dose to the pharyngeal constrictor muscle, the larynx, the supraglottic larynx and the epiglottis, as well as maximum dose to the contralateral submandibular gland predicted moderate and severe dysphagia by VFS (AUC=0.71-0.80).The patients in this cohort were consecutively identified pre-treatment, and were structurally approached and assessed for dysphagia after treatment at a specific time point. In addition to established dysphagia organs-at-risk (OARs), our data suggest that epiglottic and submandibular gland doses are important for swallowing function post-RT. Keeping DVH thresholds below V60=60% and V60=17%, respectively, may increase chances to reduce occurrence of severe late dysphagia. The results need to be externally validated in future studies.
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19.
  • Hedström, Johanna, et al. (författare)
  • Correlations Between Patient-Reported Dysphagia Screening and Penetration-Aspiration Scores in Head and Neck Cancer Patients Post-oncological Treatment.
  • 2018
  • Ingår i: Dysphagia. - : Springer Science and Business Media LLC. - 1432-0460 .- 0179-051X. ; 33:2, s. 206-215
  • Tidskriftsartikel (refereegranskat)abstract
    • Dysphagia is a common and severe toxicity after oncological treatment of head and neck cancer (HNC). The study aim was to investigate relationships between patient-reported dysphagia and clinically measured swallowing function in HNC after modern curative radiotherapy with or without chemotherapy to identify possible alarm symptoms for clinically manifest dysphagia. Patients with tumors of the tonsil, base of tongue, hypopharynx, and larynx treated in 2007-2015 were assessed for dysphagia post-treatment by telephone interview and videofluoroscopy (VFS). A study-specific categorized symptom score was used to determine patient-reported dysphagia (DESdC=presence of Drinking, Eating, Swallowing difficulties, and Coughing when eating/drinking (any combination); scores between 0 and 4 with 0=no symptom); the penetration-aspiration scale (PAS) to determine swallowing function by VFS. Swallowing difficulties were defined as DESdC≥1 and PAS≥2. Relationships between clinically relevant cut-offs for DESdC and PAS were determined by Pearson's correlation coefficient (Pr). Swallowing difficulties according to DESdC were reported by 89% of the patients and according to PAS by 60% at a median of 7months post-treatment. Averaged correlations between DESdC score 1/2/3/4 and PAS were 0.16/0.10/0.27/0.18. Almost one in two patients with DESdC score ≥3 had severe swallowing difficulties according to PAS. Correlations between individual DESdC:s were highest for swallowing and eating (Pr=0.53) and lowest for swallowing and coughing (Pr=0.11). Our data suggest that if a patient reports having swallowing difficulties, it is likely that he or she also has eating difficulties but not necessarily coughing problems when eating/drinking. However, if all these three symptoms are reported, it is likely that the patient will present with moderate or severe impaired swallowing function according to PAS and thus should be referred for further evaluation and treatment.
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20.
  • Hedström, Johanna, et al. (författare)
  • Quality of care in dysphagia patients: adaptation and validation of the Swedish SWAL-CARE questionnaire
  • 2020
  • Ingår i: Health and Quality of Life Outcomes. - : Springer Science and Business Media LLC. - 1477-7525. ; 18:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background The aim of this study was to adapt the instrument and evaluate the psychometric properties of the Swedish version of the Swallowing Quality of Care questionnaire (S-SWAL-CARE) in patients with oropharyngeal dysphagia. Methods Translation and adaptation of the original SWAL-CARE into Swedish was performed according to established international guidelines. Field testing was performed using 100 patients with oropharyngeal dysphagia due to multiple reasons such as head and neck cancer and neurologic/neuromuscular disease, who had undergone swallowing evaluation within 6 months prior to the study. The patients answered the S-SWAL-CARE, the Quality from the Patient's Perspective (QPP) and the Swallowing Quality of Life (SWAL-QOL). Test-retest was performed in 20% of the participants. The reliability and validity of the S-SWAL-CARE were assessed by Pearson correlation coefficient and Cronbach's alpha as well as convergent and discriminative validity, respectively. Results The field testing of the S-SWAL-CARE resulted in sufficient reliability, with Cronbach's alpha values exceeding 0.90 for all domains. All items correlated strongly to their own domain, with weaker correlations to the other domains, indicating proper scale structure. Results also indicate sufficient convergent and discriminant validity when tested for association to the QPP domains and the SWAL-QOL Total score. The test-retest reliability of the S-SWAL-CARE demonstrated sufficient intraclass correlation coefficient (ICC) for the General advice domain (0.73) and Clinical advice domain (0.82). The ICC for the Patient satisfaction domain was lower (0.44). Conclusion The S-SWAL-CARE can be considered a reliable and valid tool to assess the dysphagia-related quality of care in a mixed Swedish dysphagia patient population.
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21.
  • Hedström, Johanna, et al. (författare)
  • Within-Bolus Variability of the Penetration-Aspiration Scale Across Two Subsequent Swallows in Patients with Head and Neck Cancer
  • 2017
  • Ingår i: Dysphagia. - : Springer Science and Business Media LLC. - 0179-051X .- 1432-0460. ; 32:5, s. 683-690
  • Tidskriftsartikel (refereegranskat)abstract
    • To compare two consecutive swallowing attempts to study if there is a difference in Rosenbek's penetration-aspiration scale (PAS) scores between the first and second swallowing attempt of the same bolus type in videofluoroscopic examination of swallowing (VFS). Additional aims include reflecting on which bolus sizes and consistencies are the most relevant to include in further studies for head and neck cancer (HNC) patients. The VFS for 38 patients curatively treated for HNC was studied. All included patients showed swallowing difficulties (PAS >= 2). The examination protocol included two swallows each of six different boluses: 3, 5, 10, 20 ml thin, 5 ml mildly thick, and 3 ml of extremely thick liquid. All boluses were compared between the first and second swallowing attempt with regard to PAS scores. No statistically significant differences in PAS were found between the first and second swallow for any of the boluses in this study on group level. For 20 ml thin and 3 ml extremely thick liquid, there were low Intra-Class Correlations, indicating a low within-bolus agreement. The greatest within-bolus differences were found for 20 ml thin, 5 ml mildly thick and 3 ml extremely thick liquid, which demonstrated high intra-individual coefficient of variation (0.458-0.759). The data of this study show a high within-bolus variability of the PAS score between two subsequent swallows for all different consistencies. In order to assess swallowing safety, the highest PAS score for each bolus type is suggested for use in studies of HNC patients.
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22.
  • Håkansson, Axel, et al. (författare)
  • Transmyringeal ventilation tube treatment in children: Hearing outcome after 10 years.
  • 2015
  • Ingår i: International journal of pediatric otorhinolaryngology. - : Elsevier BV. - 1872-8464 .- 0165-5876. ; 79:2, s. 186-90
  • Tidskriftsartikel (refereegranskat)abstract
    • This ten-year cohort study intended to determine any hearing impairment and eardrum sequelae comparing children treated with ventilation tubes (VT) with an age- and gender-matched control group.
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23.
  • Johansson, Mia, 1977, et al. (författare)
  • Cost-effectiveness analysis of voice rehabilitation for patients with laryngeal cancer: a randomized controlled study
  • 2020
  • Ingår i: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 28, s. 5203-5211
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction Voice problems are common following radiotherapy for laryngeal cancer. Few studies exist covering the effect of voice rehabilitation, and no previous studies exist regarding the cost of said rehabilitation. This randomized controlled study aimed to analyze the cost-effectiveness of voice rehabilitation after radiotherapy for patients with laryngeal cancer. Material and methods A total of 66 patients with laryngeal cancer with follow-up data 12 months post-radiotherapy were included. Patients were randomized into receiving either voice rehabilitation (n = 32) or no voice rehabilitation (n = 34). The patient outcome was measured as quality-adjusted life years (QALYs). The index range between 0 and 1, where 0 equals death and 1 represents perfect health. The QALYs were assessed with the European Organization for Research and Treatment of Cancer questionnaire QLQ-C30 mapped to EuroQoL 5 Dimension values. The cost of rehabilitation and other healthcare visits was derived from hospital systems. The patients reported the total amount of sick leave days during the first 12 months following radiotherapy. The cost-effectiveness of the voice rehabilitation was compared with no rehabilitation intervention based on the incremental cost-effectiveness ratio. Results The cost per gained QALY with voice rehabilitation compared to no rehabilitation from a societal perspective was - 27,594 euro (SEK - 250,852) which indicates that the voice rehabilitation is a cost-saving alternative compared to no rehabilitation due to lower costs and a slightly better health outcome. From a healthcare perspective, the voice rehabilitation indicates a cost 60,800 euro (SEK 552,725) per gained QALY. Conclusion From a societal perspective, i.e., including the costs of production loss, voice rehabilitation compared to no voice rehabilitation following radiotherapy for laryngeal cancer seems to be cost-saving. When analyzing only the healthcare costs in relation to health outcomes, voice rehabilitation indicates an incremental cost of 60,800 euro per gained QALY, which is just above the threshold of the maximum willingness to pay level.
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24.
  • Karczewska-Lindinger, Magdalena, 1986, et al. (författare)
  • Low physical activity in patients diagnosed with head and neck cancer
  • 2021
  • Ingår i: Laryngoscope Investigative Otolaryngology. - : Wiley. - 2378-8038. ; 6:4, s. 747-755
  • Tidskriftsartikel (refereegranskat)abstract
    • Background This pilot study aimed to describe physical activity (PA) and self-perceived function, health and quality of life (QoL) prior to oncological treatment in patients with head and neck cancer (HNC). Methods In a prospective study including 49 patients, self-perceived PA (Saltin-Grimby scale) and health-related QoL (European Organization for Research and Treatment of Cancer Quality of Life questionnaire Core 30 and EQ-5D) were assessed. Further, PA was also measured by an accelerometer attached to the thigh for eight consecutive days. The accelerometer PA was compared to the PA of a reference population assessed with the same method. Results presented are from data collected before start of oncological treatment. Results The patients (44-79 years, 65% males) spent most of their time in sedentary behavior: a median of 555 minutes/day in bed (39% of total) and 606 minutes/day sitting (41%). Only 129 minutes/day were spent moving/walking. Patients with higher education, reduced physical function and higher fatigue were less physically active (P <= .01). Further, the different PA measures demonstrated a pattern of being less physically active compared to the reference population. Conclusions Patients diagnosed for HNC may have low PA level. Assessment of PA from accelerometer data may be an important component of oncological treatment to identify patients in need for PA intervention that may enhance treatment outcome.
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25.
  • Karlsson, Therese, 1987, et al. (författare)
  • Effect of voice rehabilitation following radiotherapy for laryngeal cancer - a 3-year follow-up of a randomised controlled trial
  • 2022
  • Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 61:3, s. 349-356
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives This study aims to report on the effectiveness of voice rehabilitation following radiotherapy for laryngeal cancer in a long-term perspective, i.e., up to three years after completion of radiotherapy. Methods The study included a total of 74 patients that were randomised into an intervention group (n = 37) or a control group (n = 37). Voice recordings with blinded assessment of voice quality with the GRBAS protocol (Grade, Roughness, Breathiness, Asthenia, Strain) and acoustic analysis was performed at baseline, 12 and 36 months following radiotherapy. Voice rehabilitation was performed in 10 sessions immediately following completion of radiotherapy. Patients also filled out the Swedish Self-Evaluation of Communication Experiences after Laryngeal cancer. Results The S-SECEL demonstrated statistically significant improvements in the intervention group when comparing baseline and 36 months, and no changes in the control group. Acoustic measures did not reveal any significant changes. The perceptual analysis demonstrated that when comparing the changes within the groups between baseline and 36 months there were statistically significant differences between the intervention and control group regarding the voice qualities Roughness, Breathiness and Strain. In the control group, 50% demonstrated deterioration in roughness, while in the intervention group only 7% deteriorated during this time. In Breathiness and Strain, 57 and 50%, respectively, improved in the intervention group, while only 32% and 23% improved, respectively, in the control group. Conclusion Voice rehabilitation following radiotherapy for laryngeal cancer demonstrate positive effects in patient reported outcomes and perceptual measures of voice quality, and the effects remain up to three years following radiotherapy.
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26.
  • Karlsson, Therese, et al. (författare)
  • Effects of voice rehabilitation after radiotherapy for laryngeal cancer: a longitudinal study.
  • 2017
  • Ingår i: Logopedics, phoniatrics, vocology. - : Informa UK Limited. - 1651-2022 .- 1401-5439. ; 42:4, s. 167-177
  • Tidskriftsartikel (refereegranskat)abstract
    • The study aimed to investigate the effects of voice rehabilitation on health-related quality of life (HRQL) and voice function in patients treated for laryngeal cancer six months post-rehabilitation completion. A secondary aim was to identify factors that predict significant communication improvement.Longitudinal follow-up of randomised controlled trial.In total, 33 patients received voice rehabilitation post-radiotherapy and 32 patients constituted the control group. Outcome measures included patient-reported HRQL, communication and voice function (acoustic measures and perceptual analysis). Outcome measures were analysed one (baseline), six and 12 months post-radiotherapy, where voice rehabilitation was conducted between the first two time-points.Patients improved after voice rehabilitation with regard to communication function and HRQL and remained unchanged after 12 months post-radiotherapy. A significant roughness deterioration in the control group occurred between six and 12 months post-radiotherapy, yet remained unchanged in the intervention group. A factors increasing odds of significant communication improvement 12 months post-radiotherapy was voice rehabilitation. Smoking affected communication negatively.Voice rehabilitation appears to have positive effect on voice function and HRQL, which persist up to 12 months of follow-up and appears to prevent deterioration of perceived roughness. Patients who experience voice and communication problems at baseline are most likely to benefit from voice rehabilitation.
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27.
  • Lindell, Ellen, 1979, et al. (författare)
  • Living with dizziness impacts health-related quality of life among older adults
  • 2024
  • Ingår i: Laryngoscope Investigative Otolaryngology. - 2378-8038. ; 9:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: This study aimed to compare older adults reporting dizziness to those not reporting dizziness regarding health-related quality of life (HRQL), distress due to dizziness, and balance confidence. A secondary aim was to investigate potential association between HRQL, number of falls, balance confidence, and distress due to dizziness. Methods: Patients coming for bone density measurements answered questions regarding occurrence of dizziness. Patients reporting dizziness on a daily or weekly basis were considered eligible and invited for investigation at the Ear, Nose and Throat clinic at Södra Älvsborg Hospital, Sweden. Patients not reporting dizziness were considered eligible as controls. All patients answered the Dizziness Handicap Inventory (DHI), Activity Balance Confidence Scale (ABC-scale), and Euro-QoL-5D-3L questionnaires. Results: A total of 55 dizzy patients came for physical investigation and answered the questionnaires and 47 non-dizzy participants only answered the questionnaires. The dizzy participants reported lower levels of balance confidence, lower HRQL, more prior falls, and higher levels of distress due to dizziness than the non-dizzy controls. Lower levels of balance confidence and higher level of distress due to dizziness were each associated with lower HRQL. Conclusion: Dizziness, unsteadiness, and low balance confidence are associated with HRQL in a negative way. This is important to consider when measuring HRQL in a senior population, since a sensation of unsteadiness may indirectly contribute to low HRQL together with other symptoms. Level of evidence: 2b.
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28.
  • Millgård, Moa, et al. (författare)
  • Voice Quality in Laryngeal Cancer Patients: A Randomized Controlled Study of the Effect of Voice Rehabilitation.
  • 2020
  • Ingår i: Journal of Voice. - : Elsevier BV. - 0892-1997. ; 34:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives The study aimed to investigate the short-term and long-term effects of voice rehabilitation in patients treated with radiotherapy for laryngeal cancer as measured by both the acoustic measure smoothed cepstral peak prominence (CPPS) and perceptual measures. A secondary aim was to investigate the relationship between acoustic and perceptual measures. Methods In total, 37 patients received voice rehabilitation post-radiotherapy and 37 patients constituted the irradiated control group. Outcome measures were mean CPPS for connected speech and ratings with the auditory-perceptual Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Outcome measures were analyzed 1 (baseline), 6, 12, and 24 months post-radiotherapy, where voice rehabilitation was conducted between the first two time-points. Additional recordings were acquired from vocally healthy participants for comparison. Results CPPS values of the voice rehabilitation group and vocally healthy group were not significantly different at 24 months post-radiotherapy. Ten out of 19 patients who received voice rehabilitation yielded a CPPS value above the threshold for normal voice 24 months post-radiotherapy, compared to 11 out of 26 in the irradiated control group. No statistically significant correlations were found between CPPS and perceptual parameters of GRBAS. Conclusion Voice rehabilitation for irradiated laryngeal cancer patients may have positive effects on voice quality up to 24 months post-radiotherapy. The relationship between CPPS and GRBAS as well as the applicability of CPPS for evaluation over several points of measurement needs to be studied further.
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29.
  • Olsson, C. E., et al. (författare)
  • Feasibility of Mastication-Structure-Sparing Radiotherapy for Head and Neck Cancer
  • 2021
  • Ingår i: International journal of radiation oncology, biology, physics. - : Elsevier BV. - 1879-355X .- 0360-3016. ; 111:3
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE/OBJECTIVE(S): Although radiation-induced side-effects affecting mastication functionality have been studied in head and neck cancer (HNC) radiotherapy (RT), dose constraints for the associated structures are rarely included during treatment plan optimization. Previous research has identified several radiation dose relationships with mean dose thresholds around 30-40 Gy for masseter muscles, 40-50 Gy for pterygoid muscles, and 15-60 Gy for temporomandibular joint (TMJ) relating to a 10% trismus risk post RT. The purpose of this work was to use a multi-criteria optimization (MCO) approach to investigate to what extent doses to these structures can be lowered without violating existing clinical treatment goals in inverse planning of HNC RT. MATERIALS/METHODS: This exploratory treatment planning study used data from 22 HNC patients treated to 68 Gy without mastication-structure-sparing intent in 2017-2019 at one institute in Sweden. Original volumetric-modulated arc therapy (VMAT) plans were re-activated in the treatment planning system and masseter muscles, pterygoid muscles (medial and lateral), and TMJ were consistently delineated according to a previously reported delineation manual4. Re-planning was done using the MCO function of the treatment planning system with the resulting dose distribution normalized to match the clinical target volume (CTV T) mean dose of the clinical treatment plan. Dose differences between MCO and clinical plans were not allowed to exceed 2 Gy for any original clinical treatment goal unless tolerance doses had been substantially exceeded in the clinical treatment plan. To what extent dose to mastication structures could be lowered without violating existing clinical treatment goals were quantified by group and by patient. RESULTS: Altogether, there were 334 clinical treatment goals in the clinical treatment plans (median=15, range: 7-24 per patient, depending on tumor location), which easily could be met in the corresponding MCO plans. Mean doses to the mastication structures were in most cases below proposed tolerance doses in the clinical plan but could on average be further reduced between 3-5 Gy in the MCO plans (Table). Of the 25/88 patient reductions below 5 Gy (28%), 18/25 (72%) were for the masseter (n=8) and medial pterygoid (n=10) muscles. CONCLUSION: With modern RT, it seems possible to reduce the dose to mastication structures below proposed trismus dose tolerance thresholds for most HNC patients without violating clinical treatment goals. Focusing on masseter and medial pterygoid muscle doses may prove to give the largest benefit in individual cases. Copyright © 2021. Published by Elsevier Inc.
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30.
  • Osbeck Sandblom, H., et al. (författare)
  • Characterization of dysphagia and laryngeal findings in COVID-19 patients treated in the ICU-An observational clinical study
  • 2021
  • Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:6
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Dysphagia appears to be common in patients with severe COVID-19. Information about the characteristics of dysphagia and laryngeal findings in COVID-19 patients treated in the intensive care unit (ICU) is still limited. Objectives The aim of this study was to evaluate oropharyngeal swallowing function and laryngeal appearance and function in patients with severe COVID-19. Method A series of 25 ICU patients with COVID-19 and signs of dysphagia were examined with fiberendoscopic evaluation of swallowing (FEES) during the latter stage of ICU care or after discharge from the ICU. Swallowing function and laryngeal findings were assessed with standard rating scales from video recordings. Results Pooling of secretions was found in 92% of patients. Eleven patients (44%) showed signs of silent aspiration to the trachea on at least one occasion. All patients showed residue after swallowing to some degree both in the vallecula and hypopharynx. Seventy-six percent of patients had impaired vocal cord movement. Erythema of the vocal folds was found in 60% of patients and edema in the arytenoid region in 60%. Conclusion Impairment of oropharyngeal swallowing function and abnormal laryngeal findings were common in this series of patients with severe COVID-19 treated in the ICU. To avoid complications related to dysphagia in this patient group, it seems to be of great importance to evaluate the swallowing function as a standard procedure, preferably at an early stage, before initiation of oral intake. Fiberendoscopic evaluation of swallowing is preferred due to the high incidence of pooling of secretion in the hypopharynx, silent aspiration, and residuals. Further studies of the impact on swallowing function in short- and long-term in patients with COVID-19 are warranted.
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31.
  • Petersson, Kerstin, et al. (författare)
  • A randomized controlled study evaluating the head-lift exercise in head and neck cancer patients with radiation-induced dysphagia: effect on swallowing function and health-related quality of life over 12 months
  • 2023
  • Ingår i: European Archives of Oto-Rhino-Laryngology. - 0937-4477. ; 280:12, s. 5445-5457
  • Tidskriftsartikel (refereegranskat)abstract
    • PurposeDysphagia is common after radiotherapy for head and neck cancer (HNC) and can affect health-related quality of life (HRQL). This randomized controlled trial aimed to evaluate the effect of the head-lift exercise (HLE) over 12 months in HNC patients with radiation-induced dysphagia.MethodsSixty-one patients with dysphagia were randomized to intervention group (n = 30) and control group (n = 31) at 6-36 months after completion of radiotherapy for HNC. Dysphagia-specific HRQL was measured with the MD Anderson Dysphagia Inventory (MDADI); general and HNC-specific HRQL was measured with the European Organization for Research and Treatment of Cancer Quality of Life questionnaire Core 30 (EORTC QLQ-C30) and QLQ-H & N35. Measurements were made at baseline, and at 8 weeks and 12 months after start of intervention.ResultsAdherence to the intervention was good throughout the year. When comparing change from baseline reports to each follow-up no statistically significant differences between the groups were found in any of the HRQL instruments. There were some statistically significant changes within groups compared to baseline. The intervention group improved self-rated swallowing function on the MDADI at 8 weeks (emotional domain, p = 0.03; functional domain, p = 0.007; total score, p = 0.01) and the control at twelve months (emotional domain, p = 0.03; functional domain, p = 0.02; physical domain, p = 0.004; total score, p = 0.002).ConclusionIn this randomized control study, no effect was observed short term or at 12 months on HRQL after use of the HLE as rehabilitation for radiation-induced dysphagia.
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32.
  • Petersson, Kerstin, et al. (författare)
  • Predictors of severe dysphagia following radiotherapy for head and neck cancer
  • 2021
  • Ingår i: Laryngoscope Investigative Otolaryngology. - : Wiley. - 2378-8038. ; 6:6, s. 1395-1405
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To investigate if severe dysphagia following radiotherapy for head and neck cancer (HNC) could be predicted by patient and tumor characteristics, feeding tube use, weight factors, jaw opening function, and saliva secretion. Methods Data was collected from 94 HNC patients 6 to 36 months post radiotherapy. Swallowing function was assessed by videofluroscopy (VFS). Severe dysphagia was defined by Penetration Aspiration Scale (PAS) as PAS >= 5 or a total score <= 60 on the M. D. Anderson Dysphagia Inventory (MDADI). Results Thirty-three patients (35%) had PAS >= 5 and 19 (20%) a MDADI <= 60, that is, presented with severe dysphagia. Univariable logistic regression analysis (UVA) gave that tumor of the tonsil, overweight at time of VFS and each unit increase in Body Mass Index (BMI) predicted less risk of PAS >= 5. Dependency of feeding tube at time of VFS and each month's continued use and weight loss >= 7.5% since treatment to time of VFS predicted increased risk of PAS >= 5. Predictive variables from the UVA of PAS >= 5 (tumor of the tonsil, overweight, and total duration of feeding tube), were analyzed by multivariate logistic regression analysis. All retained power as independent predictors. UVA for MDADI showed that use of feeding tube at time of VFS predicted MDADI <= 60 with the risk increasing each month. Each increasing unit of BMI decreased risk of MDADI <= 60. Conclusion Long time users of feeding tube and higher weight-loss are at risk of severe dysphagia. This makes collaboration between professionals working with dysphagia an important step in detecting severe dysphagia. Level of Evidence: 3.
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33.
  • Risberg-Berlin, Birgit, 1945, et al. (författare)
  • Effectiveness of olfactory rehabilitation according to a structured protocol with potential of regaining pre-operative levels in laryngectomy patients using nasal airflow-inducing manoeuvre.
  • 2014
  • Ingår i: European Archives of Oto-Rhino-Laryngology. - : Springer Science and Business Media LLC. - 0937-4477 .- 1434-4726. ; 271:5, s. 1113-1119
  • Tidskriftsartikel (refereegranskat)abstract
    • This pilot study aims to evaluate the effectiveness of the Nasal Airflow-Inducing Manoeuvre (NAIM) when employing a structured protocol as well as investigate if early rehabilitation has the potential to return olfaction to pre-operative levels in patients undergoing laryngectomy following laryngeal cancer. Prospective study of cases conducted during 1year, 2009-2010, at the Department of Ear-, Nose and Throat at Sahlgrenska University Hospital, Gothenburg, Sweden. Ten patients with laryngeal cancer and about to undergo laryngectomy were identified, of which four were included in the study. The remaining six patients were unfit to participate (n=4) or declined participation (n=2). Testing was conducted pre- and post-operatively and at each NAIM training session. Patients received three initial NAIM sessions followed by reinforcement training at 3, 6 and 12months. Measures included Scandinavian Odour-Identification Test (SOIT), a semi-structured interview and questionnaires including European Organisation for Research and Treatment of Cancer, QLQ-C30 and QLQ-H&N35. All patients were normosmic smellers according to SOIT at the study end-point. One patient reported higher SOIT scores at 12months follow-up compared to pre-operatively. Remaining patients had scores close to that reported pre-operatively. Using subjective measures, olfaction improved in all patients with one patient's final score surpassing pre-operative scores. By implementing a structured protocol consisting of three training sessions early following laryngectomy with additional reinforcement sessions at 3, 6 and 12months, NAIM is effective in terms of improving smelling ability. There also appears to be potential for restoring olfaction to a patient's pre-operative level as reflected by both olfactory testing and PRO instruments. However, larger studies are needed to further explore the findings highlighted by this study.
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34.
  • Rogers, Simon N., et al. (författare)
  • Variations in concerns reported on the patient concerns inventory in patients with head and neck cancer from different health settings across the world
  • 2020
  • Ingår i: Head and Neck. - : Wiley. - 1043-3074 .- 1097-0347. ; 42:3, s. 498-512
  • Tidskriftsartikel (refereegranskat)abstract
    • Background The aim was to collate and contrast patient concerns from a range of different head and neck cancer follow-up clinics around the world. Also, we sought to explore the relationship, if any, between responses to the patient concerns inventory (PCI) and overall quality of life (QOL). Methods Nineteen units participated with intention of including 100 patients per site as close to a consecutive series as possible in order to minimize selection bias. Results There were 2136 patients with a median total number of PCI items selected of 5 (2-10). "Fear of the cancer returning" (39%) and "dry mouth" (37%) were most common. Twenty-five percent (524) reported less than good QOL. Conclusion There was considerable variation between units in the number of items selected and in overall QOL, even after allowing for case-mix variables. There was a strong progressive association between the number of PCI items and QOL.
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35.
  • Shao, Chia-Hui, et al. (författare)
  • Trismus in head and neck cancer: translation and validation of the Chinese version of the Gothenburg Trismus Questionnaire-2 (C-GTQ-2)
  • 2024
  • Ingår i: CLINICAL ORAL INVESTIGATIONS. - 1432-6981 .- 1436-3771. ; 28:2
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesTrismus, marked by restricted mouth opening, significantly affects patients with temporomandibular disorder (TMD) and head and neck cancer (HNC). Despite its prevalence, specialized questionnaires for trismus assessment are scarce. This study aims to fill this gap by translating and validating the Gothenburg Trismus Questionnaire version 2 (GTQ-2) into Chinese (C-GTQ-2), enhancing the evaluation of trismus in HNC and TMD patients.Materials and MethodsThe study involved 78 HNC patients, 75 TMD patients, and a control group of 150 individuals without trismus symptoms. Participants were asked to complete the C-GTQ-2 and other health-related quality of life (HRQL) instruments. A subset of 30 individuals retook the questionnaire within two weeks to assess test-retest reliability.ResultsThe C-GTQ-2 demonstrated remarkable reliability, with Cronbach's alpha values exceeding 0.70 in three of the four domains, indicating high internal consistency. The instrument also showcased high intra-class correlations in the test-retest, affirming its reliability. Furthermore, it exhibited strong convergent validity, aligning well with other HRQL instruments, and effectively discriminated between patients with and without trismus, establishing its discriminant validity.ConclusionsThe C-GTQ-2 emerges as a valid and reliable tool for assessing trismus in HNC and TMD patients, promising to significantly enhance both clinical and research approaches to managing trismus-related complications in the Chinese-speaking demographic.Clinical relevanceC-GTQ-2 proves effective for trismus assessment in head and neck cancer and temporomandibular disorder patients, offering enhanced clinical and research utility.
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36.
  • Tuomi, Lisa, 1985, et al. (författare)
  • A longitudinal study of the Swedish MD Anderson Dysphagia Inventory in patients with oral cancer
  • 2020
  • Ingår i: Laryngoscope Investigative Otolaryngology (LIO). - : John Wiley & Sons. - 2378-8038. ; 5:6, s. 1125-1132
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The aim of this study was to investigate whether the Swedish MD. Anderson Dysphagia Inventory (MDADI) is able to detect changes in dysphagia symptoms over time for patients with head and neck cancer (HNC).Methods: One hundred and forty‐two patients with resectable tumors of the oral cavity were included prior to treatment. The patients filled out the MDADI, European Organization for Research and Treatment of Cancer Quality of Life questionnaire Core 30 (EORTC QLQ‐C30) and the HNC module (H&N35) at baseline and at least one follow‐up at 6 and/or 12 months after oncologic treatment. A control group without dysphagia (n = 115) was included.Results: Self‐perceived swallowing function decreased in all domains at 6 months, and improved between 6 and 12 months. The changes were similar to the changes of the EORTC domains, indicating a sensitivity to change. However, even if improvements were seen at 12 months, the values were still inferior compared to baseline values, and the values of a control group without dysphagia. Convergent validity was found with values of the MDADI and EORTC domains producing similar results, and moderate correlations as hypothesized. Patients with moderate‐severe dysphagia according to the MDADI (<60 points) demonstrated inferior values of the EORTC domains compared to patients with scores above 60 points.Conclusion: The Swedish MDADI was found to be sensitive to change, and showed convergent results when compared to other established instruments. The threshold value for the MDADI (<60 points) indicating moderate‐severe dysphagia may be a valuable addition in the clinical use.
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37.
  • Tuomi, Lisa, 1985, et al. (författare)
  • A pilot study using pre-treatment physical activity level to predict long-term health-related quality of life in patients with head and neck cancer
  • 2023
  • Ingår i: Head and Neck-Journal for the Sciences and Specialties of the Head and Neck. - : Wiley. - 1043-3074 .- 1097-0347. ; 45:5, s. 1288-1298
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Pre-treatment levels of physical activity (PA) in head and neck cancer (HNC) are rarely evaluated using accelerometry. This study aimed to investigate whether pre-treatment PA level in HNC predicts aspects of long-term health-related quality of life (HRQL) at 12 months after end of treatment. Methods: This pilot study included 48 patients diagnosed with HNC, 41 participants remaining at 12 months post-treatment. Pre-treatment PA was objectively assessed by an accelerometer. Self-perceived PA and HRQL were assessed pre-treatment and at 6- and 12-months post-treatment. Results: Patients with a higher pre-treatment PA level scored higher on physical function and role function and less fatigue and pain at the 12 months follow-up compared to patients with a lower pre-treatment PA. At 6 months the groups differed only on physical functioning. When comparing changes over time, there were statistically significant differences comparing high and low pre-treatment PA in the fatigue and pain domains between 6 and 12 months. Exploratory multiple regression analyses also indicated that higher pre-treatment PA levels were associated with greater favorable change in the four HRQL measures. ConclusionsHigher levels of PA assessed with accelerometer before oncologic treatment associated favorably with aspects of self-perceived HRQL and PA over time in patients with HNC.
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38.
  • Tuomi, Lisa, 1985, et al. (författare)
  • Effects of voice rehabilitation after radiation therapy for laryngeal cancer: a randomized controlled study.
  • 2014
  • Ingår i: International journal of radiation oncology, biology, physics. - : Elsevier BV. - 1879-355X .- 0360-3016. ; 89:5, s. 964-72
  • Tidskriftsartikel (refereegranskat)abstract
    • Patients treated with radiation therapy for laryngeal cancer often experience voice problems. The aim of this randomized controlled trial was to assess the efficacy of voice rehabilitation for laryngeal cancer patients after having undergone radiation therapy and to investigate whether differences between different tumor localizations with regard to rehabilitation outcomes exist.
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39.
  • Tuomi, Lisa, 1985, et al. (författare)
  • Health-related quality of life and voice following radiotherapy for laryngeal cancer - a comparison between glottic and supraglottic tumours.
  • 2015
  • Ingår i: Acta oncologica (Stockholm, Sweden). - 1651-226X. ; 54:1, s. 73-79
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. To provide further information about short-term effects on voice quality and health-related quality of life (HRQL) following radiotherapy for laryngeal cancer, comparing glottic and supraglottic tumours. Material and methods. Sixty-seven male patients who received radiotherapy for glottic and supraglottic tumours were included. Voice recordings were performed and patient reported outcome questionnaires filled in before radiotherapy and one-month post-completion. Acoustic and temporal measures were produced from the recordings and compared to an age-matched, vocally healthy control group (n = 23). Results. Deterioration of HRQL post-radiotherapy was noted for both the glottic and supraglottic cohort. Pre- radiotherapy the glottic cohort demonstrated acoustic and temporal measures that were statistically different from healthy controls, with improvements post-radiotherapy where several measures showed no statistically significant differences compared to healthy controls. The supraglottic cohort revealed voice measures comparable to the healthy controls but demonstrated statistically significant impairments in HRQL compared to the glottic cohort following radiotherapy. Conclusion. Patients with supraglottic tumours may experience more eating and swallowing related problems prior to radiotherapy compared to glottic tumours and demonstrate a more significant reduction in HRQL following treatment. However, in terms of voice measurements, subjective measures correlate poorly with objective acoustic parameters, thereby emphasising the importance of patient-reported outcomes as part of treatment evaluation.
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40.
  • Tuomi, Lisa, 1985, et al. (författare)
  • Interpretation of the Swedish Self Evaluation of Communication Experiences after Laryngeal cancer (S-SECEL): Cut-off levels and minimum clinically important differences.
  • 2016
  • Ingår i: Head & neck. - : Wiley. - 1097-0347 .- 1043-3074. ; 38:5, s. 689-695
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: To establish minimum clinically important difference (MCID) scores for the Swedish Self Evaluation of Communication Experiences after Laryngeal Cancer (S-SECEL) in order to facilitate clinical interpretation and identify cut-off values for voice rehabilitation. Method: 119 laryngeal cancer patients completed the S-SECEL instrument and an anchor question regarding acceptability of speech in a social context pre and 12 months post oncologic treatment. Receiver operating characteristic curves analysis was used for calculation of cut-off values. Results: Voice rehabilitation cut-off values were identified for all domains (Total 20; General 4; Environmental 16, Attitudinal 5), presenting acceptable sensitivity and specificity. Initial MCID estimates were obtained for all domains; improvement of -13 points (p<0.0001) or a deterioration of +8 points (p=0.035) for the Total domain. Conclusion: MCID and cut-off scores for the S-SECEL have been identified and may be used in clinical practice to help identify laryngeal cancer patients in need of voice rehabilitation. This article is protected by copyright. All rights reserved.
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41.
  • Tuomi, Lisa, 1985, et al. (författare)
  • The effect of the Shaker head-lift exercise on swallowing function following treatment for head and neck cancer: Results from a randomized, controlled trial with videofluoroscopic evaluation
  • 2022
  • Ingår i: Head and Neck-Journal for the Sciences and Specialties of the Head and Neck. - : Wiley. - 1043-3074 .- 1097-0347. ; 44:4, s. 862-875
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Dysphagia is common following treatment for head and neck cancer (HNC) and intervention to improve swallowing function is warranted. This study aimed to evaluate the efficacy of the Shaker head-lift exercise (HLE) to improve dysphagia in HNC patients. Methods Patients treated for HNC with radiochemotherapy and with subsequent dysphagia were randomly assigned to intervention (HLE, n = 25) and control (standard dysphagia management, n = 27) groups. Videofluoroscopic evaluation of penetration-aspiration, initiation, residue, movement of selected structures, and self-perceived swallowing function, before and after 8 weeks of treatment, were compared. Results Although adherence to training was high, no statistically significant differences in objectively measured swallowing function between the groups or within-group changes were found. Self-perceived swallowing function improved in the intervention group. Conclusions In this HNC population, neither HLE nor standard dysphagia management improved objectively measured swallowing function as evaluated after 8 weeks. Future research focusing on finding effective interventions for dysphagia is warranted.
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42.
  • Tuomi, Lisa, 1985, et al. (författare)
  • Voice Outcome in Patients Treated for Laryngeal Cancer: Efficacy of Voice Rehabilitation.
  • 2014
  • Ingår i: Journal of voice : official journal of the Voice Foundation. - : Elsevier BV. - 1873-4588. ; 28:1, s. 62-68
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To investigate the efficacy of voice rehabilitation regarding acoustically measured voice quality as well as self-perceived function after radiotherapy for laryngeal cancer. STUDY DESIGN: Prospective intervention study. METHODS: Twenty male patients irradiated for laryngeal cancer participated in the study. Voice recordings and self-assessment of voice function (hoarseness, vocal fatigue, and vocal loudness) were made one and 6 months after completion of radiotherapy. The recordings were analyzed with the program Praat. Ten of the patients received 10 sessions of structured voice rehabilitations between the recordings and 10 worked as a control group. RESULTS: Jitter and shimmer improved for both groups. Harmonics-to-noise-ratio and maximum phonation time improved for the patients who received voice rehabilitation while it deteriorated for the control group. The self-assessment questions about vocal fatigue and vocal loudness showed improvement for both groups while hoarseness showed no change. CONCLUSION: General improvement was seen for both the study group and the control group. Despite the lack of statistical significant difference, there are trends where greater improvement in perturbation and self-assessment measures are noted in the study group. The results suggest positive effects of voice rehabilitation in both voice quality and self-perceived function.
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43.
  • Tuomi, Lisa, 1985, et al. (författare)
  • Voice Quality, Function, and Quality of Life for Laryngeal Cancer: A Prospective Longitudinal Study Up to 24 Months Following Radiotherapy
  • 2021
  • Ingår i: Ear, Nose and Throat Journal. - : SAGE Publications. - 0145-5613 .- 1942-7522. ; 100:10 (Suppl.)
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To study the potential changes of health-related quality of life (HRQL), voice quality, and communicative function up to 24 months following radiotherapy for patients with laryngeal cancer. Methods: A total of 28 patients with laryngeal cancer, treated by curatively intended radiotherapy were included in this prospective longitudinal descriptive study. Patients were followed pre-radiotherapy, 12 months, and 24 months post-radiotherapy. At each time point, voice recordings and patient-reported outcome instruments (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core30, Head and Neck35, Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer) were completed. Perceptual analysis using the Grade-Roughness-Breathiness-Asthenia-Strain was performed using the voice recordings. Results: Voice quality remains inferior to the voices of healthy controls both before and up to 24 months post-radiotherapy, demonstrating no statistically significant changes during the study period. Self-perceived communicative function revealed a trend toward improvement. Health-related quality of life remains mostly at stable levels, however, with statistically significant deterioration regarding dry mouth and sticky saliva. Generally, patients reported inferior scores compared to a normal population. Conclusion: This study demonstrated no statistically significant changes over time in HRQL and perceptual voice quality at pre-radiotherapy compared to 24 months post-radiotherapy. However, the values remain inferior to the voices of healthy controls or a normal population. © The Author(s) 2020.
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44.
  • Tuomi, Lisa, 1985, et al. (författare)
  • Voice Range Profile and Health-related Quality of Life Measurements Following Voice Rehabilitation After Radiotherapy; a Randomized Controlled Study
  • 2017
  • Ingår i: Journal of Voice. - : Elsevier BV. - 0892-1997 .- 1873-4588. ; 31:1
  • Tidskriftsartikel (refereegranskat)abstract
    • © 2016 The Voice Foundation.Purpose: The aim of the present study was to investigate the effects of voice rehabilitation in patients treated with radiotherapy for laryngeal cancer. Method: A total of 42 patients with laryngeal cancer who are treated with radiotherapy with curative intent participated in a randomized controlled study. The collected data were voice range profiles (VPRs) and patient-reported outcome (PRO) instruments for measurement of self-perceived communication function (Swedish Self-Evaluation for Communication Experiences after Laryngeal cancer (S-SECEL)) and health related quality of life (HRQL) (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30/Head and Neck module). Data were collected 1 month (pre voice rehabilitation), 6 months, and 12 months postradiotherapy. Of the patients, 19 received voice rehabilitation, whereas 23 constituted a control group. Results: There were several statistically significant improvements in the study group concerning the HRQL and self-perceived communication function. The largest improvements occurred between occasions 1 (prevoice rehabilitation) and 2 (6-month postradiotherapy) and then remained constant. VRP area demonstrated a statistically significant difference when comparing changes over time, where the study group improved more than the control group. Conclusion: HRQL and self-perceived communication function showed improvement in the study group and trends of impairment in the control group. This result might suggest that it would be beneficial for the patients as well as in a health economic perspecitve, to receive voice rehabilitatiom to make a faster improvement of the HRQL and self-perceived communication function.
  •  
45.
  • Tuomi, Lisa, 1985 (författare)
  • Voice Rehabilitation and Functional Outcomes Following Radiotherapy for Laryngeal Cancer
  • 2014
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall aim of this thesis was to evaluate the effects of radiotherapy and voice rehabilitation on voice function and Health Related Quality of Life (HRQL) following treatment for laryngeal cancer. Patients treated for laryngeal cancer were prospectively studied pre-radiotherapy and 1, 6 and 12 months post-radiotherapy. Patients were randomized into a voice rehabilitation group, in which they received voice rehabilitation between 1 and 6 months post-radiotherapy, or a control group. Patient Reported Outcome (PRO) measures included the S-SECEL (Swedish Self-Evaluation of Communication Experiences after Laryngeal cancer), EORTC QLQ (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) and questions regarding hoarseness and vocal loudness. Acoustic, perceptual and temporal analyses were performed. The patients were also compared to a vocally healthy control group. After radiotherapy, a general deterioration of HRQL was observed in all patients treated for laryngeal cancer, the supraglottic cohort generally had inferior scores compared to the glottic cohort. Regarding voice quality, the glottic cohort appeared inferior to the vocally healthy control group both pre- and post-radiotherapy, while the supraglottic cohort was comparable to the vocally healthy control group. According to the S-SECEL results, improvement was seen in the voice rehabilitation group, results were maintained at the follow-up six months later. The control group had no statistically significant change in S-SECEL results. No statistically significant changes regarding acoustically measured voice quality were present in the short- or long-term follow-up. HRQL measures according to the EORTC improved after voice rehabilitation and remained at follow-up 6 months later. The control group showed no statistically significant change except for the Social function domain, which improved from baseline to 6 months post radiotherapy. Perceptually assessed roughness did not change during voice rehabilitation, however, a statistically significant deterioration was present for the control group between 6 and 12 months post-radiotherapy. Factors increasing the likelihood of communication improvement 12 months post radiotherapy were voice rehabilitation, poor speech scores and experiencing less voice use one month post-radiotherapy compared to pre-radiotherapy. Smoking affected communication negatively. In order to facilitate clinical interpretation of the S-SECEL, cut-off values as well as estimates of Minimum Clinically Important Differences (MCID) were identified for the instrument. Laryngeal cancer patients filled out the S-SECEL instrument and a question about acceptability of speech in a social context pre- and 12-months post oncologic treatment. Results at 12 months as well as the change between pre-treatment and 12-months follow-up were used for identification of cut-off values and estimates of MCID for each domain of the S-SECEL. When using the cut-off value, 36% of the participants scored above the value indicating the need for vocal rehabilitation at the 12-month follow-up. The results of this thesis demonstrated that voice function and HRQL is affected after radiotherapy. A large proportion had communication functioning indicating the need for vocal rehabilitation. Voice rehabilitation prevented voice deterioration and improved the self-perceived communication function and HRQL. The effects remained in the long-term. The findings suggest that voice rehabilitation could be beneficial to patients after radiotherapy for laryngeal cancer. Additionally it raises the importance of monitoring the communication and voice function through self-assessment and voice recordings.
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