SPEECH AND LANGUAGE DISORDERS IN PATIENTS WITH HIGH-GRADE GLIOMA AND ITS INFLUENCE ON PROGNOSIS

One hundred and sixteen patients wiht high grade glioma were entered i nto a prospective phase two study and treated with accelerated radioth erapy from 1988 to 1993. In this cohort of patients we analysed speech deficit as a subdivision of global functional status in terms of inci dence, category and prognosis for survival. Forty three patients (37%) had a speech deficit at presentation. Eighty percent of these had a c omponent of expressive dysphasia, associated with considerable degree of awareness and distress. The overall median survival was 9.5 months. On univariate analysis, median survival in patients with speech diffi culties (6 months) was worse than patients with normal speech (10.5 mo nths) (log rang p = 0.005). Multivariate analysis established independ ent significance from age, Karnofsky Performance Status (KPS), gender, histological grade, extent of surgery and seizures. This paper highli ghts the importance of assessing individual categories of functional d isability which in patients with high grade glioma include mobility, c ognitive function and communication. Each of these factors may serious ly affect an individual's activities of daily living, hence quality of life and separate analysis has a number of clinical implications. Fir stly, with over a third of patients suffering speech difficulties, ade quate speech therapy facilities should be freely available to score th e degree of deficit, devise coping strategies and institute communicat ion therapy. Secondly, an understanding of prognostic factors aids the critical analysis of phase two studies and the design and stratificat ion of future prospective trials which should include an analysis of s peech deficit. Thirdly, separating individual patients into good and b ad prognostic groups can assist strategic management decisions.