Relating speech and swallow function to dropout in a longitudinal study ofhead and neck cancer

The relation between functional outcome and drop-out from a 12-month follow -up period was examined in a longitudinal study whose objective was to defi ne and quantify the functional effects of oral surgical resection and recon struction on speech and swallowing in patients with head and neck cancer. I n a group of 150 patients recruited to a surgical study in the Cancer Contr ol Science Program in Head and Neck Cancer Rehabilitation, dropout from all causes and dropout from specific causes (medical, patient, and administrat ive specific) were assessed in relation to longitudinal speech and swallow function. In univariate analysis, better speech articulation was associated with decreased risk of dropout from all causes and from medical-specific c auses. Better swallow performance was associated with decreased risk of med ical-specific dropout. Multivariate analysis revealed the following: (1) on ly articulation function was associated with dropout from all causes; (2) t he association of speech articulation function with medical dropout was dim inished after adjusting for advanced age and surgical resection variables; (3) the association of speech articulation function became significant for patient-specific dropout after adjusting for advanced age and surgical rese ction variables and indicated that better function decreased the risk of th is type of dropout; and (4) swallowing function was not related to dropout. Patients treated for oral or oropharyngeal cancer who have poorer speech o utcomes are more likely to drop out from a longitudinal study. Basing study results on only patients who complete a longitudinal study will understate the level of dysfunction experienced.