From the Guidelines
Hoarseness during chemotherapy is a common side effect that can be managed with several approaches, and the most effective management strategy is to try vocal rest, maintain adequate hydration, and use a humidifier in the sleeping area, as recommended by the clinical practice guideline: hoarseness (dysphonia) 1. For immediate relief, patients can try vocal rest, maintain adequate hydration (at least 2 liters of water daily), and use a humidifier in their sleeping area. Over-the-counter options include throat lozenges containing benzocaine or menthol, and warm salt water gargles (1/4 teaspoon salt in 8 ounces of warm water) 3-4 times daily. For persistent hoarseness, the oncologist may prescribe medications like proton pump inhibitors such as omeprazole 20mg daily if reflux is contributing, or recommend speech therapy techniques, as suggested by the clinical practice guideline: hoarseness (dysphonia) 1. Chemotherapy can cause hoarseness through direct irritation of the vocal cords, mucositis affecting the throat, or by weakening the immune system leading to infections, and some specific chemotherapy agents like platinum compounds (cisplatin, carboplatin) and taxanes (paclitaxel, docetaxel) are more commonly associated with this side effect, as noted in the evidence-based recommendations for cancer nausea and vomiting 1. If hoarseness persists beyond two weeks, becomes severe, or is accompanied by difficulty breathing or swallowing, patients should contact their healthcare provider immediately as this could indicate a more serious condition requiring prompt evaluation, as emphasized in the clinical practice guideline: hoarseness (dysphonia) 1. Additionally, recent studies have highlighted the importance of considering the potential long-term effects of chemotherapy on cognitive function and overall quality of life, as discussed in the review of cognitive impairment after cancer treatment: mechanisms, clinical characterization, and management 1.
Some key points to consider in managing hoarseness during chemotherapy include:
- Maintaining adequate hydration to prevent dryness and irritation of the vocal cords
- Avoiding irritants such as smoke and dust
- Getting plenty of rest to help the body recover from the effects of chemotherapy
- Considering speech therapy to help improve vocal technique and reduce strain on the vocal cords
- Monitoring for signs of infection or other complications that may require prompt medical attention.
It is essential to note that the management of hoarseness during chemotherapy should be individualized and based on the specific needs and circumstances of each patient, as recommended by the clinical practice guideline: hoarseness (dysphonia) 1.
From the Research
Hoarseness from Chemotherapy
- Hoarseness, or voice changes, can be a side effect of chemotherapy, particularly when used in conjunction with anti-angiogenic agents 2.
- Anti-angiogenic agents, such as bevacizumab, can cause dysphonia, or voice changes, due to their inhibition of vascular endothelial growth factor (VEGF) signaling 2.
- A case report of a patient with metastatic ovarian cancer treated with bevacizumab and gemcitabine found that the patient experienced intermittent hoarseness and softness in her voice after chemotherapy 2.
- Laryngoscopic examination of the patient showed normal vocal cord movement and no lesions or necrosis, suggesting that the hoarseness was not due to a physical obstruction or damage to the vocal cords 2.
- Medications, including those used in chemotherapy, can have direct and indirect effects on laryngeal hydration, vocal fold mucosal integrity, laryngeal muscle function, and laryngeal sensation, leading to alterations in vocal function 3.
- Other potential causes of hoarseness, such as metastatic calcification of the true vocal cords, have been reported in patients with chronic renal failure 4.
- However, not all studies are directly relevant to the topic of hoarseness from chemotherapy, such as those focusing on the ultrastructural study of pineal germinoma 5 or the effects of prostaglandin synthetase and receptor inhibitors on guinea pig longitudinal muscle 6.