Validation of the French Versions of the Speech Handicap Index and the Phonation Handicap Index in Patients Treated for Cancer of the Oral Cavity or Oropharynx

Abstract

<b><i>Context:</i></b> Nowadays, clinical tools are available to evaluate the functional impact of speech disorders in neurological conditions, but few are validated in oncology. Because of their location, cancers of the upper aerodigestive tract directly impact patients’ communication skills. Two questionnaires exist in French, the Speech Handicap Index (SHI) and the Phonation Handicap Index (PHI), but none are specifically validated for the head and neck cancer population. Our aim is to evaluate the validity of these 2 questionnaires in a population of patients treated for oral cavity or oropharyngeal cancer. <b><i>Material and Method:</i></b> Eighty-seven patients treated for cancer of the oral cavity or oropharynx, and 21 controls filled in the questionnaires during a consultation or 1-day hospitalization. Validation was studied by the analysis of convergent and discriminant validity, clinical validity, criterion validity, and internal consistency. <b><i>Results:</i></b> The 2 questionnaires present a coherent structure in 2 distinct dimensions for the SHI, and in 3 dimensions for the PHI. Both tools discriminate patients and healthy subjects (<i>p</i> value &#x3c;0.001, Mann-Whitney test). The comparison of the SHI and PHI scores with the “social role functioning” dimension of the Medical Outcome Study Short Form 36 chosen as a reference shows similar performances for the 2 questionnaires (ρ &#x3e; 0.42). Lastly, the internal consistency is good (Cronbach’s α &#x3e; 0.71). <b><i>Conclusion:</i></b> In patients treated for oral cavity or oropharyngeal cancer, the SHI and PHI are 2 valid and reliable tools for the self-assessment of speech disability. A limitation can be found about criterion validity, because a true gold standard does not exist at the moment. However, the reduced number of questions of the PHI, which implies a shorter completion, leads to prefer this tool over the SHI.