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The effectiveness of voice rehabilitation in patients treated with radiotherapy because of advanced cancer of the oropharynx, larynx and hypopharynx

Grant number: 12/16787-7
Support Opportunities:Scholarships in Brazil - Doctorate (Direct)
Effective date (Start): November 01, 2012
Effective date (End): April 30, 2014
Field of knowledge:Health Sciences - Speech Therapy
Principal Investigator:Elisabete Carrara-Angelis
Grantee:Aline Nogueira Gonçalves
Host Institution: Diretoria. Fundação Antonio Prudente (FAP). São Paulo , SP, Brazil


There are studies that prove vocal following radiotherapy without the focus of radiation has been the region of the larynx. So far, we know of the evolution of speech therapy in the rehabilitation of sequels of surgical oncology treatment. However, the effects of voice rehabilitation in vocal sequelae resulting from radiotherapy alone or combined with chemotherapy are poorly described especially when dealing with advanced cancers of the oropharynx, larynx and hypopharynx. Objective: To evaluate the results of vocal rehabilitation in patients treated for advanced cancer of the oropharynx, larynx and hypopharynx with radiotherapy alone or combined with chemotherapy potentiator. Methods: A prospective cohort study, randomized, inter-institutional. Included patients with tumors of the oropharynx, larynx and hypopharynx, the advanced stage (stage III and IV) therapy with proposed radiotherapy with curative intent (exclusive or concurrent chemotherapy), independent of sex and / or histochemical type of tumor, which have older than 18 years with vocal complaints following radiotherapy. Patients should answer the questionnaire vocal handicap IDV pre radiotherapy. After 1 month of treatment completion, undergo an evaluation vocal home. Performed after initial evaluation, the patients belonging to group 1 (G1) will be referred to speech therapy, remaining in this for 1 month in vocal rehabilitation. Patients in group 2 (G2) after the initial assessment, waiting for 1 month without speech therapy, the spontaneous vocal improvement that may occur within this period. After this period the patients from group G2 are undergoing new voice evaluation and then referred to speech therapy for a period of 1 month. All patients in both the G1 and G2 are undergoing a final assessment after the period of therapy. Individuals G1 undergo a new reassessment after 1 month of completion of therapy. The ratings are multidimensional voice in both groups at the three time, including: perceptual analysis, acoustic analysis, assessment of quality of life in voice and laryngological. The laryngological is performed by an otolaryngologist in the larynx during breathing is evaluated and sustained emission of vowels "is" and "i" and observe the presence or absence of structural lesions on the vocal folds and glottal closure during emission , paralysis position, presence or absence of bending and uneven, and anteroposterior median constriction. Regarding the rehabilitation program speech, addressing guidelines are performed vocal hygiene, hidratoterapia, physiology of oral communication and acute and late sequelae, which can manifest in different degrees of severity and exercises themselves. Statistical analysis will be calculating measures of central tendency (mean and median) for quantitative variables and absolute and relative frequencies for qualitative variables. Will be inter-subject analyzes determined by tumor histology, as well as intra-crossing and crossing-over groups. To compare the numerical data will be conducted analysis of variance with repeated measures (ANOVA with repeated measures). To compare the clinical and demographic data and the variables of interest between the two groups will be used chi-square and Fisher exact tests as the case of qualitative variables. For quantitative variables without normal distribution, will be used nonparametric Mann-Whitney U-Test and T Studant. For all statistical tests will be established an alpha error of 5%, ie, the results are considered statistically significant when the p value <0.05 (AU)

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