Download PDF
Laryngorhinootologie 2016; 95(09): 610-619
DOI: 10.1055/s-0042-102256
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Sprechqualität und psychische Beeinträchtigung nach der Therapie von Mundhöhlentumoren

Speech Ability and Psychological Outcome After Treatment of Oral Cancer
N. Böhm
1   Mund-, Kiefer- und Gesichtschirurgische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
,
C. Knipfer
1   Mund-, Kiefer- und Gesichtschirurgische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
,
A. Maier
2   Lehrstuhl für Informatik 5 (Mustererkennung), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
,
T. Bocklet
3   Intel Corporation, Deutschland, Feldkirchen
,
M. Rohde
1   Mund-, Kiefer- und Gesichtschirurgische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
,
F. W. Neukam
1   Mund-, Kiefer- und Gesichtschirurgische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
,
F. Stelzle
1   Mund-, Kiefer- und Gesichtschirurgische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
,
M. Schuster
4   Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum der Universität München, München
› Author Affiliations
Further Information

Publication History

eingereicht 17 February 2015

akzeptiert 01 February 2016

Publication Date:
18 March 2016 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Hintergrund: In den letzten Jahren werden vermehrt die Beziehungen zwischen operativer Tumortherapie und Inzidenz von Ängstlichkeit und Depressionen diskutiert. Diese prospektive Studie ist ein Vergleich zwischen der Einschränkung der Sprachverständlichkeit nach der Behandlung von Mundhöhlentumoren und der Anzeichen von Depressivität und Ängstlichkeit.

Material und Methoden: Bei 90 Patienten im Alter von 60±12 Jahren nach Behandlung von Mundhöhlenkarzinomen wurde ein Jahr postoperativ der Verständlichkeitsgrad standardisiert mittels automatischer Spracherkennung bestimmt (Worterkennungsrate, WR). Mögliche Anzeichen von Depressivität und Ängstlichkeit wurden mittels des Fragebogens Hospital-Anxiety-and-Depression-Scale (HADS) erfasst. Die Beziehungen zwischen WR und HADS und der Einflussgrößen wurden statistisch analysiert.

Ergebnisse: Der WR-Mittelwert lag bei 53,2±17,2. Der Unterschied in der WR zwischen den Tumorklassen T1 und T4 war signifikant. Frauen zeigten eine höhere WR als Männer. Weitere signifikante Unterschiede gab es bei WR-Vergleichen innerhalb der Gruppen „Tumorlokalisation“, „Transplantatentnahmestelle“, „Transplantatmorphologie“, „Zungenbeweglichkeitsgrade“ und „Tracheostoma“. Für die Zungenbeweglichkeit bestanden Interaktionen mit der Transplantatmorphologie, Transplantatentnahmeregion und Tumorlokalisation. Die HADS-Werte waren im Mittel erhöht: HADS-Total=43,3%, HADS-A=43,3% und HADS-D=51,1%. Es bestand eine Korrelation für die WR mit den HADS-D-Scores, aber nicht mit den HADS-A-Scores.

Schlussfolgerungen: Kommunikationseinschränkungen nach chirurgischer Tumortherapie im Orofazialbereich können von dem Ausmaß der Behandlungsmaßnahmen abhängen und mit depressiver Beeinträchtigung im Zusammenhang stehen. Dies sollte im Rehabilitationskonzept beachtet werden.

Abstract

Background: In recent years interactions between surgical treatment of oral carcinoma and incidence of anxiety or depression have become a subject of discussions. This prospective study is a comparison between the extent of loss of speech intelligibility and presence of depressive symptoms or anxiety as a result of oral carcinoma.

Material and Methods: One year after surgical therapy for oral carcinoma, 90 patients of an average age of 60±12 years were examined. Their speech intelligibility degree was measured using standardized automatic speech recognition (word recognition rate, WR). Symptoms of anxiety and depression were detected by use of HAD-Scales (HADS). Next to the relationship between WR and HADS other influential variables related to WR and HADS were statistically evaluated.

Results: The WR average was 53.2±17.2. Female WR was better than male. The difference between tumor classifications T1 and T4 compared to the WR reached statistical significance. Significant differences were detected between WR and “tumor localization”, “graft donor site”, “graft morphology”, “tongue motility”, and “tracheostoma” groups. There was a relationship between tongue motility and graft morphology, graft donor site and tumor localization. HAD-Scores in the mean were elevated: HADS-Total=43.3%, HADS-A=43.3% und HADS-D= 51.1%. WR correlates with HADS-D-Subscale, but not with HADS-A-Subscale.

Conclusion: Communication disorders as a result of neoplasmic orofacial surgery may be related to extent of the treatment and to affective impairments. This should receive attention in the concept of rehabilitation.

Schlüsselwörter

Mundhöhlenkarzinom - Angst - Depressivität - automatische Spracherkennung - Sprechverständlichkeit

Key words

oral cancer - anxiety and depression - automatic speech recognition - speech intelligibility
 

  • Literatur

  • 1 Chandu A, Sun KGV, Smith ACH. The assessment of quality of life in patients who have undergone surgery for oral cancer: A preliminary report. J Oral Maxillofac Surg 2005; 63: 1606-1612
    CrossrefPubMedGoogle Scholar
  • 2 Fingeret MC, Vidrine DJ, Reece GP, Gillenwater AM, Gritz ER. Multidimensional analysis of body image concerns among newly diagnosed patients with oral cavity cancer. Head Neck 2010; 32: 301-309
    PubMedGoogle Scholar
  • 3 Sambale M, Schuster M, Bocklet T, Maier A, Eysholdt U, Ströbele A, Stelzle F. Speech Intelligibility degree and coping after multimodal therapy of oral squamous carcinoma. Laryngo-Rhino-Otol 2011; 90: 151-156
    PubMedGoogle Scholar
  • 4 Kollbrunner J, Zbären P, Quack K. Lebensqualitätsbelastung von Patienten mit großen Tumoren der Mundhöhle. Eine deskriptive Studie der psychosozialen Auswirkungen von Krankheit und primär chirurgischer Therapie. Teil 1: Quantität und Qualität des Lebens. HNO 2001; 49: 985-997
    CrossrefPubMedGoogle Scholar
  • 5 Schuster M, Stelzle F. Outcome measurements after oral cancer treatment: speech and speech-related aspects – an overview. J Oral Maxillofac Surg 2012; 16: 291-298
    CrossrefPubMedGoogle Scholar
  • 6 Borggreven PA, Verdonck-de Leeuw IM, Muller MJ, Heiligers ML, de Bree R, Aaronson NK, Leemans CR. Quality of life and functional status in patients with cancer of the oral cavity and oropharynx: pretreatment values of a prospective study. Eur Arch Otorhinolaryngol 2007; 264: 651-657
    CrossrefPubMedGoogle Scholar
  • 7 Kohler R. Quantitative Bewertung der Verständlichkeit nach der Behandlung kleiner Mundhöhlenkarzinome. 2009. Erlangen, Nürnberg, Univ., unv; Diss: 2008
    Google Scholar
  • 8 Rhemrev R, Rakhorst HA, Zuidam JM, Mureau MAM, Hovius SER. Hofer SOP. Long-term functional outcome and satisfaction after radial forearm free flap reconstructions of intraoral malignancy resections. J Plast Reconstr Aesthet Surg 2007; 60: 588-592
    CrossrefPubMedGoogle Scholar
  • 9 Suarez-Cunqueiro MM, Schramm A, Schoen R, Seoane-Lestón J, Otero-Cepeda XL, Bormann KH, Kokemueller H, Metzger M, Diz-Dios P, Gellrich NC. Speech and swallowing impairment after treatment for oral and oropharyngeal cancer. Arch Otolaryngol Head Neck Surg 2008; 134: 1299-1304
    CrossrefPubMedGoogle Scholar
  • 10 Cnossen IC, de Bree R, Rinkel RN, Eerenstein SE, Rietveld DH, Doornaert P, Buter J, Langendijk JA, Leemans CR, Verdonck-de Leeuw IM. Computerized monitoring of patient-reported speech and swallowing problems in head and neck cancer patients in clinical practice. Support Care Cancer 2012; 20: 2925-2931
    CrossrefPubMedGoogle Scholar
  • 11 Stelzle F, Maier A, Nöth E, Bocklet T, Knipfer C, Schuster M, Neukam FW, Nkenke E. Automatic quantification of speech intelligibility in patients after treatment for oral squamous cell carcinoma. J Oral Maxillofac Surg 2011; 69: 1493-1500
    CrossrefPubMedGoogle Scholar
  • 12 Riemann M, Knipfer C, Rohde M, Adler W, Schuster M, Noeth E, Oetter N, Shams N, Neukam FW, Stelzle F. Oral squamous cell carcinoma of the tongue: Prospective and objective speech evaluation of patients undergoing surgical therapy. Head Neck. 2015 DOI: 10.1002/hed.23994
    PubMedGoogle Scholar
  • 13 Maier A, Haderlein T, Stelzle F, Nöth E, Nkenke E, Rosanowski F, Schützenberger A, Schuster M. Automatic speech recognition systems for the evaluation of voice and speech disorders in head and neck cancer. EURASIP Journal on Audio, Speech, and Music Processing 2010 2010; 926951
    CrossrefPubMedGoogle Scholar
  • 14 Windrich M, Maier A, Kohler R, Nöth E, Nkenke E, Eysholdt U, Schuster M. Automatic quantification of speech intelligibility of adults with oral squamous cell carcinoma. Folia Phoniatr Logop 2008; 60: 151-156
    CrossrefPubMedGoogle Scholar
  • 15 Stelzle F, Knipfer C, Schuster M, Bocklet T, Nöth E, Adler W, Schempf L, Vieler P, Riemann M, Neukam FW, Nkenke E. Factors influencing relative speech intelligibility in patients with oral squamous cell carcinoma: a prospective study using automatic, computer-based speech analysis. Int J Oral Maxillofac Surg 2013; 42: 1377-1384
    CrossrefPubMedGoogle Scholar
  • 16 Mancha de la Plata M, Gías LN, Díez PM, Muñoz-Guerra M, González-García R, Lee GY, Castrejón-Castrejón S, Rodríguez-Campo FJ. Osseointegrated implant rehabilitation of irradiated oral cancer patients. J Oral Maxillofac Surg 2012; 70: 1052-1063
    CrossrefPubMedGoogle Scholar
  • 17 Nelson K, Heberer S. Glatzer. Survival analysis and clinical evaluation of implant-retained prostheses in oral cancer resection patients over a mean follow-up period of 10 years. J Prosthet Dent 2007; 98: 405-410
    CrossrefPubMedGoogle Scholar
  • 18 Dwivedi St RC, Rose S, Chisholm EJ, Bisase B, Amen F, Nutting CM, Clarke PM, Kerawala CJ, Rhys-Evans PH, Harrington KJ, Kazi R. Evaluation of speech outcomes using English version of the Speech Handicap Index in a cohort of head and neck cancer patients. Oral Oncol 2012; 48: 547-553
    CrossrefPubMedGoogle Scholar
  • 19 Liénard A, Merckaert I, Libert Y, Delvaux N, Marchal S, Boniver J, Etienne AM, Klastersky J, Reynaert C, Scalliet P, Slachmuylder JL, Razavi D. Factors that influence cancer patients’ anxiety following a medical consultation: impact of a communication skills training programme for physicians. Ann Oncol 2006; 17: 1450-1458
    CrossrefPubMedGoogle Scholar
  • 20 Hassanein KAAM, Musgrove BT, Bradbury E. Psychological outcome of patients following treatment of oral cancer and its relation with functional status and coping mechanisms. J Cranio Maxill Surg 2005; 33: 404-409
    CrossrefPubMedGoogle Scholar
  • 21 Hammerlid E, Ahlner-Elmqvist M, Bjordal K, Biörklund A, Evensen J, Boysen M, Jannert M, Kaasa S, Sullivan M, Westin T. A prospective multicentre study in Sweden and Norway of mental distress and psychiatric morbidity in head and neck cancer patients. Br J Cancer 1999; 80: 766-774
    CrossrefPubMedGoogle Scholar
  • 22 Espie CA, Freedlander E, Campsie LM, Soutar DS, Robertsons AG. Psychological distress at follow-up after major surgery for intra-oral cancer. J Psychosom Res 1989; 33: 441-448
    CrossrefPubMedGoogle Scholar
  • 23 Kollbrunner J, Zbären P, Quack K. Lebensqualitätsbelastung von Patienten mit großen Tumoren der Mundhöhle. Teil 2: Krankheitsverarbeitung: Coping, Angst und Depressivität. HNO 2001; 49: 998-1007
    CrossrefPubMedGoogle Scholar
  • 24 Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr 2004; 32: 57-71
    PubMedGoogle Scholar
  • 25 Joseph A, Routledgea JA, Burnsa MP, Swindella R, Sykesa AJ, Slevina NJ, Davidsona SE. Value of the Hospital Anxiety and Depression Scale in the follow up of head and neck cancer patients. J Laryngol Otol 2013; 127: 285-294
    CrossrefPubMedGoogle Scholar
  • 26 Neilson KA, Pollard AC, Boonzaier AM, Corry J, Castle DJ, Mead KR, Gray MC, Smith DI, Trauer T, Couper JW. Psychological distress (depression and anxiety) in people with head and neck cancers. Med J Aust 2010; 193: 48-51
    PubMedGoogle Scholar
  • 27 Kelly C, Paleri V, Downs C, Shah R. Deterioration in quality of life and depressive symptoms during radiation therapy for head and neck cancer. Otolaryngol Head Neck Surg 2007; 136: 108-111
    CrossrefPubMedGoogle Scholar
  • 28 Rabbels J, Wyzisk M, Siessegger M, Klesper B, Reuther T, Kübler AC. Die Veränderung der Lebensqualität während und nach der Behandlung von Mundhöhlenkarzinomen. Mund Kiefer GesichtsChir 2005; 9: 300-305
    CrossrefPubMedGoogle Scholar
  • 29 Olssøn I, Mykletun A, Dahl AA. The Hospital Anxiety and Depressionrating Scale: A cross-selectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry 2005; 5: 46
    CrossrefPubMedGoogle Scholar
  • 30 Humphris GM, Rogers SN. The association of cigarette smoking and anxiety, depression and fears of recurrence in patients following treatment of oral and oropharyngeal malignancy. Eur J Cancer Care 2004; 13: 328-335
    CrossrefPubMedGoogle Scholar
  • 31 Glas K, Hoppe U, Eysholdt U, Rosanowski F. Smoking, carcinophobia and Voice Handicap Index. Folia Phoniatr Logop 2008; 60: 195-198
    CrossrefPubMedGoogle Scholar
  • 32 Maier A, Haderlein T, Eysholdt U, Rosanowski F, Batliner A, Schuster M, Nöth E. PEAKS – a system for the automatic evaluation of voice and speech disorders. Speech Commun 2009; 51: 425-437
    CrossrefPubMedGoogle Scholar
  • 33 Schuster M, Haderlein T, Nöth E, Lohscheller J, Eysholdt U, Rosanowski F. Intelligibility of laryngectomees’ substitute speech: automatic speech recognition and subjective rating. Eur Arch Otorhinolaryngol 2006; 263: 188-193
    CrossrefPubMedGoogle Scholar
  • 34 Maier A, Hönig F, Bocklet T, Nöth E, Stelzle F, Nkenke E, Schuster M. Automatic detection of articulation disorders in children with cleft lip and palate. J Acoust Soc Am 2009; 126: 2589-2602
    CrossrefPubMedGoogle Scholar
  • 35 Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67: 361-370
    CrossrefPubMedGoogle Scholar
  • 36 Herrmann C. International experiences with the Hospital Anxiety and Depression Scale – a review of validation data and clinical results. J Psychosom Res 1997; 42: 17-41
    CrossrefPubMedGoogle Scholar
  • 37 Snaith RP. The Hospital Anxiety And Depression Scale. Health Qual Life Outcomes 2003; 1: 29
    CrossrefPubMedGoogle Scholar
  • 38 Singer S, Kuhnt S, Götze H et al. Hospital Anxiety and Depression scale cut-off scores for cancer patients in acute care. Br J Cancer 2009; 100: 908-912
    CrossrefPubMedGoogle Scholar
  • 39 Singer S, Krauss O, Keszte J, Siegl G, Papsdorf K, Severi E, Hauss J, Briest S, Dietz A, Brähler E, Kortmann RD. Predictors of emotional distress in patients with head and neck cancer. Head Neck 2012; 34: 180-187
    CrossrefPubMedGoogle Scholar
  • 40 Bolzoni Villaret A, Cappiello J, Piazza C, Pedruzzi B, Nicolai P. Quality of life in patients treated for cancer of the oral cavity requiring reconstruction: a prospective study. Acta Otorhinolaryngol Ital 2008; 28: 120-125
    PubMedGoogle Scholar
  • 41 McDonough EM, Boyd JH, Varvares MA, Maves MD. Relationship between psychological status and compliance in a sample of patients treated for cancer of the head and neck. Head Neck 1996; 18: 269-276
    CrossrefPubMedGoogle Scholar
  • 42 Karnell LH, Funk GF, Christensen AJ, Rosenthal EL, Magnuson JS. Persistent post-treatment depressive symptoms in patients with head and neck cancer. Head Neck 2006; 28: 453-461
    CrossrefPubMedGoogle Scholar
  • 43 Zeller JL. High suicide risk found for patients with head and neck cancer. J Am Med Assoc 2006; 296: 1716-1717
    CrossrefPubMedGoogle Scholar
  • 44 Dingman C, Hegedus PD, Likes C, McDowell P, McCarthy E, Zwilling C. A coordinated, multidisciplinary approach to caring for the patient with head and neck cancer. J Support Oncol 2008; 6: 125-131
    PubMedGoogle Scholar
  • 45 Llewellyn CD, McGurk M, Weinman J. How satisfied are head and neck cancer (HNC) patients with the information they receive pre-treatment? Results from the satisfaction with cancer information profile (SCIP). Oral Oncol 2006; 42: 726-734
    CrossrefPubMedGoogle Scholar
  • 46 Archer J, Hutchison I, Korszun A. Mood and malignancy: head and neck cancer and depression. J Oral Pathol Med 2008; 37: 255-270
    CrossrefPubMedGoogle Scholar
  • 47 Samlan RA, Webster KT. Swallowing and speech therapy after definitive treatment for laryngeal cancer. Otolaryngol Clin North Am 2002; 35: 1115-1133
    CrossrefPubMedGoogle Scholar
  • 48 Okada N, Sasaguri K, Otsuka T, Fujita A, Ito H, Noguchi T, Jinbu Y, Kusama M. Effect of articulatory rehabilitation after oral cancer surgery on higher brain activation. Int J Oral Maxillofac Surg 2014; 43: 933-940
    CrossrefPubMedGoogle Scholar
  • 49 de Maddalena H. The influence of early speech rehabilitation with voice prostheses on the psychological state of laryngectomized patients. Eur Arch Otorhinolaryngol 2002; 259: 48-52
    CrossrefPubMedGoogle Scholar
  • 50 Stelzle F, Schuster M, Nkenke E, Neukam FW, Nöth E. Automatische, objektive Analyse von Sprechstörungen bei Patienten mit Plattenepithelkarzinomen der Mundhöhle. Arbeitsberichte des Departments Informatik Friedrich-Alexander-Universitat Erlangen-Nürnberg 2008; 40/8: 142-143
    PubMedGoogle Scholar