Identifying Velopharyngeal Dysfunction in Head and Neck Cancer Patients

OBJECTIVE(S): To characterize the clinical features and risk factors associated with velopharyngeal dysfunction (VPD) following head and neck cancer (HNC) treatment. METHODS: Patients with HNC and subsequent VPD-related symptoms were identified through electronic query and manual chart review across three tertiary centers. Demographic, oncologic, and treatment variables, including tumor subsite, T stage, treatment modality, and radiation dose, were collected. VPD-related outcomes included hypernasality, nasal regurgitation, reduced intelligibility, and evidence of velopharyngeal insufficiency on endoscopy. Associations were evaluated using univariate tests and logistic regression, with radiation dose modeled as a continuous variable. RESULTS: A total of 142 patients met inclusion criteria. The most common primary tumor subsites in this cohort were oropharyngeal and oral cavity. Advanced-stage disease (T3-T4) was more common than early-stage disease (Tis-T2) and was associated with nasal regurgitation. Higher radiation dose was associated with increased likelihood of endoscopic VPD, with a dose-response relationship observed; however, this association was not observed for clinical outcomes. Latency to VPD onset varied by treatment modality, with shorter latency following surgery and longer latency following radiation-based therapies. Speech-language pathology (SLP) evaluation was commonly performed; however, standardized symptom outcome metrics and instrumental assessments were inconsistent and underutilized across institutions. CONCLUSION: VPD is an underrecognized sequela of HNC treatment, and may be associated with primary tumor subsite, advanced disease, and radiation dose. Treatment modality contributes to latency in VPD diagnosis. Variability in SLP evaluation and outcome measurement highlights the need for more standardized assessment approaches to improve identification and management of VPD in this population.