Gender differences in the laryngectomee experience.

BACKGROUND: Laryngectomy is a pivotal event in patients. lives, with pervasive and far-reaching effects. Understanding gender differences in these effects may improve care of laryngectomy patients. This paper describes gender differences in the experience after laryngectomy. AIM: To explore the similarities and differences in the laryngectomee experience based on gender. METHODS & PROCEDURES: Four gender-matched focus groups were conducted; dialogue was audio recorded, transcribed and studied using interpretative phenomenological analysis (IPA). OUTCOMES & RESULTS: A total of 17 laryngectomees, eight female and nine male, age range 41-80 years, participated in focus groups. Laryngectomy represented a turning point in the lives of both genders. Four themes emerged: perception of loss, adjusting to alaryngeal communication, finding a positive outlook and re-establishing the self. Themes applied to both genders, with subthemes demonstrating similarities and differences between men and women. CONCLUSIONS & IMPLICATIONS: Men and women experienced destabilization after laryngectomy related to perceived losses and shifts in identity. Men described navigating from physical disability toward recovery of function, while women described an emotional journey concerning loss and rediscovery of meaning in their lives. Understanding the laryngectomee experience in better detail, which includes recognizing gender differences and rejecting a one-size-fits-all approach, may facilitate more effective preoperative counselling and post-operative support from providers. WHAT THIS PAPER ADDS: What is already known on the subject Patients who undergo total laryngectomy often struggle with problems with physical, emotional, and social functioning and decreased quality of life. As the literature currently stands, the understanding of the experience of laryngectomees has primarily focused on the perspective of a singular gender. Thus, this is the first qualitative study specifically investigating differences in the laryngectomee experience between men and women. What this paper adds to existing knowledge This study finds that women and men both endorse significant mental and physical changes following laryngectomy; however, their perception of their experience differed by gender. Women endorsed alteration to meaningful life and men demonstrated distress related to loss of physical functioning; both genders described laryngectomy as a formative event that helped them rediscover joy and redefine themselves for the better. What are the potential or actual clinical implications of this work? Our findings suggest men and women have distinct mental and emotional struggles after laryngectomy despite similar physical changes. This suggests that tailoring care with consideration of these gender differences, including preoperative counselling, post-operative support and gender-matched visitors or support groups, may help beneficial in recovery after laryngectomy.

Quality of life after total laryngectomy: impact of different vocal rehabilitation methods in a middle income country.

INTRODUCTION: The impact of advanced laryngeal cancer and its extensive surgical treatments cause significant morbidity for these patients. Total laryngectomy impacts essential functions such as breathing, communication and swallowing, and may influence the quality of life as well as affecting the social life of laryngeal cancer patients. OBJECTIVE: Describe the quality of life and analyze the factors associated with the reduced quality of life in patients who have undergone total laryngectomy. METHOD: Observational cross-sectional study was carried out to evaluate the quality of life of patients who had undergone total laryngectomy due to laryngeal cancer. The fourth version of the UW-QOL Quality of Life Assessment Questionnaire from Washington University, validated for Portuguese, was used. RESULTS: The study population was 95 patients, and the mean composite score of the QOL was 80.4. In the subjective domains the majority of the patients (38.9%) reported they felt much better at present compared to the month before being diagnosed with cancer. When questioned about how they evaluated their health-related quality of life, there was a predominance of those who considered it good (43.2%), and most considered they had a good quality of life (46.3%) considering personal well-being. The overall quality of life was considered good to excellent by 83.2% of the patients. Patients with tracheoesophageal prosthesis reported a better quality of life, compared to patients using an electrolarynx or esophageal voice. CONCLUSION: The high mean value of the composite score for quality of life revealed that the patients assessed their quality of life positively. The absence of vocal emission was the only variable associated with a lower quality of life within the composite score according to the UW-QOL questionnaire.

Women's perspective on life after total laryngectomy: a qualitative study.

BACKGROUND: Physical and psychosocial challenges are common after total laryngectomy. The surgery leads to lifelong changes in communication, airway, swallowing and appearance. As we move towards health models driven by patient-centred care, understanding the differential impacts of surgical procedures on subgroups of patients can help improve our care models, patient education and support systems. This paper discusses the experiences of women following total laryngectomy. AIMS: To gain an insight into the impact of total laryngectomy on women's daily life while identifying their specific rehabilitation needs. METHODS & PROCEDURES: This paper is based on in-depth, semi-structured interviews with eight women who had undergone total laryngectomy. These interviews were conducted with women at least 1 year after they had undergone total laryngectomy, and the participants did not have recurrent disease. Using an interview guide, participants were encouraged to discuss their everyday experiences, while also focusing on issues typical to women. The transcribed interview data were analysed by thematic analysis, taking interpretative phenomenological analysis as a lead. OUTCOMES & RESULTS: The interviews revealed three main themes: disease and treatment as a turning point, re-establishing meaningful everyday activities, and persistent vulnerability. Participants reported experiencing challenges in their rehabilitation process due to physical disabilities, dependency on others and experienced stigma. Women-specific challenges arose in dealing with the altered appearance and voice, performing care activities, and the spousal relationship (including intimacy). CONCLUSIONS & IMPLICATIONS: Women who undergo total laryngectomy are likely to experience issues in returning to work, the performance of informal care-work, the spousal relationship, intimacy and social interaction due to stigmatization. Medical pretreatment counselling and multidisciplinary rehabilitation programmes should help patients form realistic expectations and prepare them for the changes they will face. A gender- and age-matched laryngectomized patient visitor can contribute to this process. Rehabilitation programmes should incorporate the partner and offer psychosocial support for women following total laryngectomy to return to their former roles in family life, social life and work-related activities.

Integrated rehabilitation after total laryngectomy: a pilot trial study.

BACKGROUND: Acquisition and acceptance of the alaryngeal voice, psychological state, and Quality of Life (QoL) of laryngectomized patients. METHODS: Thirty-two patients who underwent total laryngectomy were included in the study; 17 of them were treated by a psychologist and a speech therapist (experimental group); 15 performed only speech therapy (control group). RESULTS: The experimental group showed a significant improvement in all parameters of the INFVo scale, in the score of the Environment subscale and in the total score of the I-SECEL (Self-Evaluation of Communication Experiences after Laryngeal Cancer); in the Depression, Obsession-Compulsion and Paranoia areas of the SCL-90-R (Symptom Check List-90-Revised); and in the Social area (REL) of the WHOQOL-B (World Health Organization Quality of Life Scale-Brief). CONCLUSIONS: An integrated rehabilitative approach to laryngectomized patients improves emotional state and psychosocial aspects and promotes acceptance and use of the new voice and recovery of a better quality of life.

Effects of occupational status on social adjustment after laryngectomy in patients with laryngeal and hypopharyngeal cancer.

PURPOSE: This study was performed to examine the relationship of social adjustment with occupation and life changes in patients with laryngeal and hypopharyngeal cancer, from before laryngectomy to 1 year after hospital discharge. METHODS: The subjects were 27 patients with laryngeal and hypopharyngeal cancer who were admitted to hospital for laryngectomy and provided informed consent for participation in the study. The patients answered questionnaire surveys before surgery, and 3, 6, and 12 months after hospital discharge. Regarding social adjustment, social functioning (SF) and mental health (MH) in SF-36V2 were used as dependent variables, and time, occupation status, age, family structure, and sex as independent variables. Repeated measures analysis of variance was used to examine the main effect, and second- and third-order interactions were also examined. RESULTS: The age of the subjects was 62.9 ± 6.4 years and about 30% had an occupation. Loss of voice was the reason for 30% leaving work. In an examination of the main effects of the four variables, only age was significant regarding SF, and SF was favorable in subjects aged ≥ 64 years old. Regarding MH, age and family structure were significant, and MH was higher in older subjects who lived alone. The interaction between time and the other 3 variables was not significant. Only time/age/occupation was significant for MH. Regarding SF, a weak interaction was suggested, but it was not significant. CONCLUSION: Older subjects showed better social adjustment, and those who lived alone had better MH. These findings may have been due to a reduced environmental influence. MH of subjects with an occupation decreased more at 3 months or later after hospital discharge, compared to those without an occupation. Especially for younger patients, development of new approaches is required to allow families and colleagues of patients to understand the difficulties of patients with laryngeal and hypopharyngeal cancer.

Self-expression and identity after total laryngectomy: Implications for support.

OBJECTIVE: To explore how individuals with a laryngectomy (IWL) from diverse backgrounds make meaning and adjust to the physical and functional changes from a total laryngectomy. To examine the extent primary supporters (PS) and health professionals (HP) are able to support IWL with the psychosocial and existential challenges rendered by a surgery that significantly impacts a person's talking, breathing, swallowing, and appearance. METHODS: A constructivist grounded theory approach and symbolic interactionism were used to guide data collection and analysis. Semi-structured interviewing occurred. RESULTS: Twenty-eight participants (12 IWL, 9 PS, and 7 HP) were interviewed. The findings suggest that IWL experience significant change to their self-identity and there is evidence of a range of passive and active reframing patterns (destabilised, resigned, resolute, and transformed). The loss of self-expression included changes to communicative participation, personal style, food preferences, and social roles. Short and longer-term supports appear to influence outcomes but are often ill-equipped to manage the psychosocial needs of IWL. CONCLUSIONS: Loss of self-expression after total laryngectomy influences self-identity and adjustment. How individuals reframe their identity appears to be tied with how they view their disabilities and disfigurement. These perceptions also appear to be influenced by the reactions of others and the support available. Further resourcing, education, and training are needed so that PS and HP can provide holistic care.

Postsurgical Disfigurement Influences Disgust Recognition: A Case-Control Study.

BACKGROUND: Little is known about how emotion recognition may be modified in individuals prone to elicit disgust. OBJECTIVE: We sought to determine if subjects with total laryngectomy would present a modified recognition of facial expressions of disgust. METHODS: A total of 29 patients presenting with a history of advanced-stage laryngeal cancer were recruited, 17 being surgically treated (total laryngectomy) and 12 treated with chemoradiation therapy only. Based on a validated set of images of facial expressions of fear, disgust, surprise, happiness, sadness and anger displayed by 6 actors, we presented participants with expressions of each emotion at 5 levels of increasing intensity and measured their ability to recognize these emotions. RESULTS: Participants with (vs without) laryngectomy showed a higher threshold for the recognition of disgust (3.2. vs 2.7 images needed before emotion recognition, p = 0.03) and a lower success rate of correct recognition (75.5% vs 88.9%, p = 0.03). CONCLUSION: Subjects presenting with an aesthetic impairment of the head and neck showed poorer performance in disgust recognition when compared with those without disfigurement. These findings might relate either to some perceptual adaptation, habituation phenomenon, or to some higher-level processes related to emotion regulation strategies.

Costs from a healthcare and societal perspective among cancer patients after total laryngectomy: are they related to patient activation?

PURPOSE: The aim of this study is to investigate the associations between patient activation and total costs in cancer patients treated with total laryngectomy (TL). METHODS: All members of the Dutch Patients' Association for Laryngectomees were asked to participate in this cross-sectional study. TL patients who wanted to participate were asked to complete a survey. Costs were measured using the medical consumption and productivity cost questionnaire and patient activation using the Patient Activation Measure (PAM). Sociodemographic and clinical characteristics were self-reported, and health status measured using the EQ-5D. The difference in total costs from a healthcare and societal perspective among four groups with different PAM levels were compared using (multiple) regression analyses (5000 bootstrap replications). RESULTS: In total, 248 TL patients participated. Patients with a higher (better) PAM (levels 2, 3, and 4) had a probability of 70, 80, and 93% that total costs from a healthcare perspective were lower than in patients with the lowest PAM level (difference €-375 to €-936). From a societal perspective, this was 73, 87, and 82% (difference €-468 to €-719). After adjustment for time since TL, education, and sex, the probability that total costs were lower in patients with a higher PAM level compared to patients with the lowest PAM level changed to 62-91% (healthcare) and 63-92% (societal). After additional adjustment for health status, the probability to be less costly changed to 35-71% (healthcare) and 31-48% (societal). CONCLUSIONS: A better patient activation is likely to be associated with lower total costs from a healthcare and societal perspective.

Support following total laryngectomy: Exploring the concept from different perspectives.

Adjustment after total laryngectomy is complex, and the resultant support needs are extensive. Current practice is often guided by health-related quality of life measures. While useful, many of these tools were developed without considering the perspectives of people who have experienced the surgery. To improve understanding of the support needs after total laryngectomy, multiple viewpoints were examined, for example individuals with a laryngectomy (IWL), significant others (SO) and health professionals (HP). A qualitative study explored the perspectives of 28 individuals (IWL-seven men and five women, nine SO and seven HP). Data were collected through in-depth, semi-structured interviews and analysed using constructivist grounded theory and symbolic interactionism. The data suggested that the construct "being supported to develop competence and resilience" is a multidimensional and nonlinear phenomenon underpinned by the interactive processes "perceiving influencing factors," "building trusting relationships" and "sharing and balancing the care." The findings highlight the significant contribution the care triad (i.e., IWL, SO and HP) plays and the factors influencing care, safety and dignity for IWL. Furthermore, support is optimised when all stakeholders are competent with the care. In turn, reduced competence increases the burden for one or all in the triad.

Can temperament and character features of patients predict alcohol use after laryngectomy?

AIM: Patients with larynx cancer usually use alcohol besides tobacco. It has been reported earlier that nearly half of the patients who have undergone laryngectomy after larynx cancer diagnosis still continue to consume alcohol after the operation. The aim of this study was to compare the mood and character features of patients who do or do not consume alcohol during the postoperative period and thus to be able to predict the patients who will continue their alcohol use at the postoperative period. MATERIALS AND METHODS: The patients who have undergone partial or total laryngectomy operation were included in this study. To avoid early period treatment stress, it was required that the patients have completed their 6 months of postoperative period. The interviews made with the patients included filling out of the sociodemographic data form, TCI (temperament and character inventory), BDI (Beck depression inventory), BAI (Beck anxiety inventory), AUDIT (alcohol use disorders identification test) and CAGE (cut-down, annoyed, guilty, eye-opener) inquiry forms. RESULTS: 80 patients who admitted alcohol consumption at the time of larynx cancer diagnosis were divided in to two groups and, 40% (n = 32) of this patients continued alcohol consumption after laryngectomy (Group 1) and 60% (n = 48) cut down on their alcohol use (Group 2). A statistically significant difference was observed between Group 1 and Group 2 at AUDIT and CAGE score averages (P < 0.001, P < 0.001, respectively). When TCI data were compared between Group 1 and Group 2, patients who continued their alcohol use at the postoperative period had significantly higher novelty seeking scores compared to others (P = 0.03). CONCLUSION: Our data suggest that it may be possible in the preoperative period to predict the patients who will continue their alcohol use in the postoperative period and take precautions.

How do voice restoration methods affect the psychological status of patients after total laryngectomy?

OBJECTIVE: This study investigated the relationship between psychological well-being and different voice rehabilitation methods in total laryngectomy patients. METHODS: The study enrolled 96 patients who underwent total laryngectomy. The patients were divided into three groups according to the voice rehabilitation method used: esophageal speech (24 patients); a tracheoesophageal fistula and Provox 2 voice prosthesis (57 patients); or an electrolarynx (15 patients). The participants were asked to complete the Turkish version of the Voice Handicap Index-10 (VHI-10) to assess voice problems. They were also asked to complete the Turkish version of the Perceived Stress Scale (PSS), and the Hospital Anxiety and Depression Scale (HADS). The test scores of the three groups were compared statistically. RESULTS: Patients who used esophageal speech had a mean VHI-10 score of 10.25 ± 3.22 versus 19.42 ± 5.56 and 17.60 ± 1.92 for the tracheoesophageal fistula and Provox 2 and electrolarynx groups respectively, reflecting better perception of their voice. They also had a PSS score of 11.38 ± 3.92, indicating that they felt less stressed in comparison with the tracheoesophageal fistula and Provox 2 and electrolarynx groups, which scored 18.84 ± 5.50 and 16.20 ± 3.49 respectively. The HADS scores of the groups were not different, indicating that the patients' anxiety and depression status did not vary. CONCLUSION: Patients who used esophageal speech perceived less stress and were less handicapped by their voice.

Psychological distress and need for psycho-oncological support in spouses of total laryngectomised cancer patients-results for the first 3 years after surgery.

PURPOSE: A total laryngectomy (TLE) leads to a variety of functional restrictions, which reduce the quality of life of cancer patients as well as their spouses. However, to date, there is little research focusing on the psychological distress of spouses of total laryngectomised cancer patients. The current study assesses psychological distress, need for psycho-oncological treatment and use of professional psychological care among spouses of total laryngectomised cancer patients. METHODS: A prospective multi-centre cohort study was conducted. Participants were interviewed in person 1, 2 and 3 years subsequent to their spouses' TLE with standardised questionnaires (HADS, Hornheide Screening) and self-designed items. RESULTS: One year after their partners' TLE, 154 spouses were interviewed. Over half of spouses (57 %) reported a high level of psychological distress and 33 % reported restlessness. Majority of spouses (21 %) reported wanting to learn relaxation methods and eight (5 %) had received psychological treatment in the past. Sixty-two spouses took part in the complete study. Over all three time points, psychological distress, the need for psycho-oncological support and the use of professional support among spouses remained stable. The need for additional professional counselling was low. CONCLUSIONS: In view of the stability of psychological distress among half of the spouses within 3 years after TLE and their refusal of professional support, there is a need for the development and evaluation of new treatment strategies to help spouses cope with psychological distress. Our results indicated the most common additional professional need was learning relaxation methods, which may be used as a starting point for the investigation of new coping strategies in future studies.

Quality of life after total laryngectomy: functioning, psychological well-being and self-efficacy.

BACKGROUND: Quality of life (QoL) is an important construct when assessing treatment outcomes. AIMS: To examine the relative contributions of functioning, psychological well-being and self-efficacy on self-perceived QoL with a sample of total laryngectomy patients in Australia who had surgery for advanced laryngeal cancer. METHODS & PROCEDURES: In a cross-sectional study, 113 members of the Laryngectomy Associations of New South Wales and of Victoria, Australia, were recruited, and each was sent a series of questionnaires for postal return. Four psychometrically validated measures were used for participants to document their QoL, functioning (speech, swallowing), psychological well-being and general self-efficacy. OUTCOMES & RESULTS: Eighty-six (77%) questionnaires were returned and 83 were analysed. The cohort consists of 70 men and 13 women aged between 46 and 88 years. Overall, this sample of total laryngectomy survivors demonstrated significantly reduced physical health QoL (p < 0.001) and social relationship QoL (p = 0.011) and higher levels of depression (p = 0.008) and anxiety (p = 0.001) when compared with normative samples. This was in the context of them having higher than normal self-efficacy scores and, at worst, mild (self-rated) impairment of speech and of swallowing. Psychological well-being (sr(2) = 0.43, p < 0.001) had a stronger association than functioning (speech, swallowing, sr(2) = 0.08, p < 0.05) for their psychological QoL. Psychological well-being (sr(2) = 0.17, p < 0.001) and not functioning (sr(2) = 0.05, p > 0.05) were significantly associated with social relationship QoL. Self-efficacy scores were significantly higher than norms in this cohort, but were not associated with either their psychological QoL or social relationship QoL, after controlling for psychological well-being and functioning. CONCLUSIONS & IMPLICATIONS: For survivors of laryngeal cancer treated by total laryngectomy, it is important to be aware of the impact of psychological well-being (depression, anxiety, stress) on self-perceived QoL. In addition to rehabilitating function (speech, swallowing), specific interventions to assist these individuals better manage their psychological well-being will likely improve their perceived life satisfaction/QoL.

[Fear of Recurrence (FoR) after Partial Laryngectomy (PA)]. / Progredienzangst (PA) nach Kehlkopfteilresektion (KTR).

BACKGROUND: Fear of recurrence (FoR) is a common problem in cancer patients. However, it is quite unknown in which extent patients who underwent a PL have FoR. This pilot study examines the extent of FoR and coping strategies in cancer patients after PL as well as associations between FoR and medical, treatment-related, psychosocial and demographic parameters. MATERIAL AND METHODS: In a multicentre cross-sectional study, data was taken from 154 cancer patients after PL. Data was collected in personal interviews and with standardised questionnaires (e. g., PA-F; HADS; EORTC H&N-C35). RESULTS: The study participants had a low level of FoR (MW=6.67; SD=2.43) and a high level of coping strategies (MW=3.24; SD=0.83). FoR was higher in young patients (r=-0.265; p=0.002) and in users of medical rehabilitation programs (U=1 480; p=0.025). Patients who thought smoking (r=0.197; p=0.029) or/and inner conflicts (r=0.177; p=0.050) was/were the reason(s) for their cancer and who reported more swallowing problems, had a significantly higher level of FoR (r=0.496; p<0.001). There was a negative correlation between the extent of FoR and time passing by since the last surgery of the larynx (r=- 0.322; p<0.001). CONCLUSIONS: Frequently occurring swallowing problems as well as internal causal attributions for the development of cancer as smoking increase the level of FoR. Since internal causal attributions may cause feelings of guilt, psycho-oncological treatment can be indicated for patients with higher levels of FoR. Furthermore, younger individuals and patients with more swallowing problems need more attention by physicians and therapists.

Apprehensions and problems after laryngectomy: Patients' perspective.

OBJECTIVE: To evaluate the apprehensions, social, sexual and financial problems in patients with advanced laryngeal cancer after total laryngectomy and the impact of attending laryngeal club on these problems. METHODS: The analytical study was conducted at the Dow Medical College and Civil Hospital Karachi from January 1996 to December 2011. Patients with total laryngectomy, operated for advanced laryngeal cancer at various centres of Sindh and Balochistan, attending Laryngeal Club of Pakistan, situated at Civil Hospital Karachi, were included. All the patients were evaluated through a questionnaire covering their apprehensions regarding social, sexual and financial impact on their lives after total laryngectomy. Data was analysed using SPSS 16. RESULTS: Of the 125 patients, 120(96%) were males, and 5(4%) were females; all housewives. The overall mean age was 54.8±0.5 years (range: 31-65 years). Further, 92(74%) participants were worried about financial uncertainty, while 84(67%) had regrets over loss of their voice; patients worried about losing family support and facing social rejection were 23(18%) and 15(12%) respectively. Only 7(5%) patients feared losing sexual relationship with their spouse. All these apprehensions were subdued after attending the Laryngeal Club of Pakistan. Severe financial impact was faced by 55(44%) patients due to loss of job, while 05(4%) had moderate impact due to change of job with lower income and 60(48%) patients had no financial problem. A good 102(82%) participants thought the support from their friends and family was upto their expectations; 98(78%) enjoyed satisfactory sex life although with reduced frequency of 1 to 2 intercourses per month; 21(17%) were having the frequency of 3-10 per month; and 3(2%) had more than 10 per month. Only 16(13%) patients were not involved in sexual relations with their spouses due to various reasons. CONCLUSIONS: Majority of laryngectomised patients expressed apprehensions and showed some social problems after laryngectomy, especially in the initial phase which improved either with passage of time or after attending Laryngectomy Club. The main problem was financial constraints; majority had good friends and family support and enjoyed satisfactory sexual relationship with their spouse.

Physical activity and quality of life in head and neck cancer survivors: a literature review.

The head and neck region is highly complex in terms of its anatomy and physiology. Head and neck cancer (HNC) and the treatment thereof can significantly affect both the structure and function of this area, especially in terms of swallowing, breathing and speaking. This may lead to a significant reduction in quality of life (QOL), and present challenges to both patients and their caregivers. There is increasing evidence that physical activity (PA) after a diagnosis of cancer is associated with improved overall mortality. This is well established in colon, prostate, ovarian and breast cancer. 2 recent metanalyses have determined that exercise interventions following cancer diagnosis are associated with a 41% reduction in risk of all-cause mortality, and an improvement in QOL. PA has also been found to be valuable in counteracting symptoms that reduce QOL, including depression, fatigue, worry and anxiety. Given that HNC patients face their own unique set of challenges, and may have different needs than other cancer patients, we have reviewed the available literature on the interactions between exercise and QOL in HNC patients.

The influence of the 'patient-to-patient model' on swallowing problems in patients with supraglottic laryngeal cancer.

AIMS: To evaluate the patient-to-patient model and swallowing problems in Chinese patients with supraglottic laryngeal cancer (SLC), and to find a solution to help SLC patients with swallowing problems. METHODS: Eighty-nine patients who had undergone operation for horizontal partial laryngectomy were chosen and divided randomly into two groups. The European Organization for Research and Treatment of Cancer (EORTC), Swallow Quality-of-Life (SWAL-QOL) and Visual Analogue Scale (VAS) questionnaires were used to measure the quality of life and swallowing situation of those patients. RESULTS: At 0.5 and 1 months after eating, the scores of the EORTC QLQ-C30 and SWAL-QOL of the participant group were significantly higher than those of the nonparticipant group (p < 0.05). One week after eating, the VAS score for swallowing improved significantly from 4.9 to 7.9 in the participant group. However, in the nonparticipant group, the VAS score showed no obvious change (from 4.5 to 4.1). CONCLUSIONS: We concluded that the patient-to-patient model may be utilized in clinical cases to solve swallowing problems of SLC patients, and infered that swallowing problems mainly appeared in 60 to 70-year-olds, and 1 week after eating was a critical time point of communication.

[Social integration and its relevance for quality of life after laryngectomy]. / Soziale Integration und deren Bedeutung für die Lebensqualität nach Laryngektomie.

BACKGROUND: Social networks and social participation generally have positive effects on health. Yet, little is known about how patients after total laryngectomy (TLE) are integrated into the society. Aim of this study was to investigate how patients are socially integrated after a TLE and if social integration is associated with certain areas of quality of life. PATIENTS AND METHODS: In a longitudinal multi-centred study 161 laryngectomees were interviewed 1 year after the total laryngectomy. Social integration was measured on the basis of an index formed by the questionnaire "Psychosocial Adjustment after Laryngectomy" and questions about social support. To assess quality of life, we used the questionnaire from the European Organisation for Research and Treatment of Cancer EORTC QLQ-C30. RESULTS: 58% of all patients are well integrated 1 year after surgery. Well integrated persons have less problems in different components of quality of life. They report higher levels of social (OR 4.07; CI: 1.96-8.47) and role functioning (OR 3.59; CI: 1.61-8.02). Successful social integration is also associated with higher emotional well-being (OR 8.57; CI: 3.59-20.46). CONCLUSIONS: There is evidence that 1 year after TLE only about half of the patients feel socially integrated. Because of the negative association of poor social integration with social, emotional and role functioning, patients should be supported in their attempts to take actively part in social life.

Evolution of the quality of life of total laryngectomy patients using electrolarynx.

OBJECTIVE: Therapy and vocal rehabilitation in laryngeal cancer impact patients' quality of life. The objective of this study was to evaluate the evolution of the quality of life of patients with laryngeal cancer submitted to total laryngectomy and using electrolarynx. METHODS: This is an observational study with a cross-sectional design and a quantitative approach. It was conducted between April 2022 and January 2023 in a Brazilian cancer hospital. For data collection, a quality of life questionnaire, validated for patients with head and neck cancer at the University of Washington, was applied in two phases: from 7 days after total laryngectomy and, subsequently, from 70 days after surgery using electronic larynx for at least 60 days. The inclusion criteria were patients undergoing total laryngectomy included on the Aldenora Bello Cancer Hospital's election list to receive the electronic larynx. Patients who did not sign the informed consent form were not included. RESULTS: The sample consisted of 31 patients, of which approximately 84% were men and approximately 93% at the age of 50 years or older. When comparing the phases, it is possible to observe that the item speech had the greatest progress, while chewing had the least. Only the item recreation, swallowing, taste, and saliva did not show any statistical significance. The score for the general quality of life questions increased. CONCLUSION: Electronic larynx is a viable and useful method of voice rehabilitation. Our data suggest that the use of the electrolarynx as a postlaryngectomy method of verbal communication is responsible for positive effects on patients' quality of life.

Long-term use of heat and moisture exchangers among laryngectomees: medical, social, and psychological patterns.

OBJECTIVES: After laryngectomy, pulmonary protection is mostly acquired by means of a heat and moisture exchanger (HME) that is placed on an airtight seal around the stoma. The effects of HMEs on the tracheal climate have been well described, and the filtration effect of an HME with an electrostatic filter has been described in vitro. The effects of HME use in patients have been documented in several trials in different countries. The follow-up time of the patients in these trials, however, is limited. Less is known about long-term use of HMEs, and studies describing long-term compliance with HME use are scarce. This study investigated the long-term use of HMEs in laryngectomees. METHODS: Questionnaires were sent to 195 laryngectomees, and 75 questionnaires were returned. RESULTS: More than 85% of the respondents used an HME, of whom 77% were compliant users (ie, use for more than 20 hours per day). The incidence of pulmonary illnesses (either before or after surgery) was about 25%. More than 90% of the respondents were heavy smokers before laryngectomy. One third of the respondents are regularly exposed to dusty environments. Compliant HME users tend to make less use of external humidifiers and vaporizers, and have better pulmonary status and lower health-care costs. Regarding quality of life, patients who use a FreeHands device tended to have more frequent social contacts (r = 0.251; p = 0.030). The prevalence of depression is high, pointing to an urgent need to recognize and treat psychiatric problems such as depression and suicidal ideation in this patient group. CONCLUSIONS: These findings have implications for any postlaryngectomy research that uses pulmonary parameters.