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.

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.

Quality of life in patients with larynx cancer in Latin America: Comparison between laryngectomy and organ preservation protocols.

The effect on quality of life (QOL) of laryngectomy and organ preservation protocols is important in decision making. The aim of this cross-sectional study was to evaluate QOL outcomes of patients with advanced laryngeal tumors who were treated with laryngectomy or organ preservation protocols in Latin America. A total of 35 patients from three oncology units were enrolled. Patients with stage III/IV laryngeal cancer who were treated using organ preservation protocols or laryngectomy were assessed with the University of Washington QOL Questionnaire. The most important domains that affected QOL for both groups were speech and activity. In the laryngectomy group, the next most important domains were appearance, taste, pain, and recreation, whereas in the organ preservation group, they were saliva, recreation, mood, and swallowing. There were no statistically or clinically significant differences in the global score or the 7 days of QOL assessments before patients were interviewed. Global QOL assessments were similar when comparing laryngectomy and organ preservation protocols.

Level of anxiety versus self-care in the preoperative and postoperative periods of total laryngectomy patients.

OBJECTIVE: estimate the prevalence of anxiety in laryngectomy patients in the pre and postoperative periods and its relation with the self-care level. METHOD: observational research of 40 patients with stage IV laryngeal cancer. Three observations took place: in the preoperative phase, at seven and at 14 days after the surgery; between June 2010 and December 2012. Two self-care levels were defined: self-sufficient and needing help for activities of daily living and treatment-related activities. To assess the anxiety levels, Zigmond's hospital anxiety scale (1983) was used. RESULTS: in the preoperative and postoperative phases, the patients presented high levels of anxiety. Concerning self-care, on average, self-sufficient patients presented lower levels of anxiety than patients who needed help to accomplish activities of daily living and activities deriving from the surgery, without significant differences. CONCLUSION: anxiety is present at all times in laryngectomy patients and the reduction of the self-care deficit seems to decrease it, without putting a permanent end to it. OBJETIVO: estimar a prevalência de ansiedade do paciente laringectomizado no pré-operatório e pós-operatório e sua relação com o nível de autocuidado. MÉTODO: pesquisa observacional de 40 pacientes com câncer da laringe estágio IV. Foram realizadas 3 observações: no pré-operatório, a 7 e 14 dias pós-operatório, no período de junho de 2010 a dezembro de 2012. Dois níveis de autocuidado foram definidos: autossuficientes e precisar ajuda para as atividades da vida diária e relacionadas ao tratamento. Para avaliar a ansiedade, foi utilizada a escala de ansiedade hospitalar de Zigmond (1983). RESULTADOS: no pré-operatório e pós-operatório, os pacientes apresentaram níveis elevados de ansiedade. Com relação ao autocuidado, os pacientes autossuficientes apresentaram na média níveis inferiores de ansiedades que os pacientes que precisavam de ajuda para realizar as atividades da vida diária y as derivadas da cirurgia, sem chegar a ser significativas estas diferenças. CONCLUSÃO: a ansiedade está presente a todo momento no paciente laringectomizado e a diminuição do déficit de autocuidados parece diminuí-la sem acabar definitivamente com ela. OBJETIVO: estimar la prevalencia de ansiedad del paciente laringectomizado, en el preoperatorio y postoperatorio y su relación con el nivel de autocuidados. MÉTODO: investigación observacional de 40 pacientes con cáncer de laringe estadio IV. Se realizaron 3 observaciones: en el preoperatorio, a los 7 y 14 días del postoperatorio; en el periodo junio 2010 a diciembre de 2012. Se definieron dos niveles de autocuidados: autosuficientes y necesitar ayuda para las actividades de la vida diaria y derivadas del tratamiento; para evaluar la ansiedad se utilizó la escala de ansiedad hospitalaria de Zigmond (1983). RESULTADOS: en el preoperatorio y postoperatorio los pacientes presentaron niveles elevados de ansiedad. En relación a los autocuidados, los pacientes autosuficientes presentaron en media niveles más bajos de ansiedad que los pacientes que necesitaban ayuda para realizar las actividades de la vida diaria y las derivadas de la cirugía, sin llegar a ser significativas estas diferencias. CONCLUSIÓN: la ansiedad está presente en todo momento en el paciente con laringectomia y la disminución del déficit de autocuidados parece disminuirla sin terminar definitivamente con ella.

Level of anxiety versus self-care in the preoperative and postoperative periods of total laryngectomy patients / Nível de ansiedade versus autocuidado no pré-operatório e pós-operatório do paciente laringectomizado total / Nivel de ansiedad versus autocuidados en el preoperatorio y postoperatorio del paciente con laringectomía total

Abstract Objective: estimate the prevalence of anxiety in laryngectomy patients in the pre and postoperative periods and its relation with the self-care level. Method: observational research of 40 patients with stage IV laryngeal cancer. Three observations took place: in the preoperative phase, at seven and at 14 days after the surgery; between June 2010 and December 2012. Two self-care levels were defined: self-sufficient and needing help for activities of daily living and treatment-related activities. To assess the anxiety levels, Zigmond's hospital anxiety scale (1983) was used. Results: in the preoperative and postoperative phases, the patients presented high levels of anxiety. Concerning self-care, on average, self-sufficient patients presented lower levels of anxiety than patients who needed help to accomplish activities of daily living and activities deriving from the surgery, without significant differences. Conclusion: anxiety is present at all times in laryngectomy patients and the reduction of the self-care deficit seems to decrease it, without putting a permanent end to it.

Resumo Objetivo: estimar a prevalência de ansiedade do paciente laringectomizado no pré-operatório e pós-operatório e sua relação com o nível de autocuidado. Método: pesquisa observacional de 40 pacientes com câncer da laringe estágio IV. Foram realizadas 3 observações: no pré-operatório, a 7 e 14 dias pós-operatório, no período de junho de 2010 a dezembro de 2012. Dois níveis de autocuidado foram definidos: autossuficientes e precisar ajuda para as atividades da vida diária e relacionadas ao tratamento. Para avaliar a ansiedade, foi utilizada a escala de ansiedade hospitalar de Zigmond (1983). Resultados: no pré-operatório e pós-operatório, os pacientes apresentaram níveis elevados de ansiedade. Com relação ao autocuidado, os pacientes autossuficientes apresentaram na média níveis inferiores de ansiedades que os pacientes que precisavam de ajuda para realizar as atividades da vida diária y as derivadas da cirurgia, sem chegar a ser significativas estas diferenças. Conclusão: a ansiedade está presente a todo momento no paciente laringectomizado e a diminuição do déficit de autocuidados parece diminuí-la sem acabar definitivamente com ela.

Resumen Objetivo: estimar la prevalencia de ansiedad del paciente laringectomizado, en el preoperatorio y postoperatorio y su relación con el nivel de autocuidados. Método: investigación observacional de 40 pacientes con cáncer de laringe estadio IV. Se realizaron 3 observaciones: en el preoperatorio, a los 7 y 14 días del postoperatorio; en el periodo junio 2010 a diciembre de 2012. Se definieron dos niveles de autocuidados: autosuficientes y necesitar ayuda para las actividades de la vida diaria y derivadas del tratamiento; para evaluar la ansiedad se utilizó la escala de ansiedad hospitalaria de Zigmond (1983). Resultados: en el preoperatorio y postoperatorio los pacientes presentaron niveles elevados de ansiedad. En relación a los autocuidados, los pacientes autosuficientes presentaron en media niveles más bajos de ansiedad que los pacientes que necesitaban ayuda para realizar las actividades de la vida diaria y las derivadas de la cirugía, sin llegar a ser significativas estas diferencias Conclusión: la ansiedad está presente en todo momento en el paciente con laringectomia y la disminución del déficit de autocuidados parece disminuirla sin terminar definitivamente con ella.

Annual national direct and indirect cost estimates of the prevention and treatment of cervical cancer in Brazil

OBJECTIVE: To estimate the annual direct and indirect costs of the prevention and treatment of cervical cancer in Brazil. METHODS: This cost description study used a "gross-costing" methodology and adopted the health system and societal perspectives. The estimates were grouped into sets of procedures performed in phases of cervical cancer care: the screening, diagnosis and treatment of precancerous lesions and the treatment of cervical cancer. The costs were estimated for the public and private health systems, using data from national health information systems, population surveys, and literature reviews. The cost estimates are presented in 2006 USD. RESULTS: From the societal perspective, the estimated total costs of the prevention and treatment of cervical cancer amounted to USD $1,321,683,034, which was categorized as follows: procedures (USD $213,199,490), visits (USD $325,509,842), transportation (USD $106,521,537) and productivity losses (USD $676,452,166). Indirect costs represented 51% of the total costs, followed by direct medical costs (visits and procedures) at 41% and direct non-medical costs (transportation) at 8%. The public system represented 46% of the total costs, and the private system represented 54%. CONCLUSION: Our national cost estimates of cervical cancer prevention and treatment, indicating the economic importance of cervical cancer screening and care, will be useful in monitoring the effect of the HPV vaccine introduction and are of interest in research and health care management. .

Os papéis ocupacionais de pessoas com câncer de cabeça e pescoço / Occupational roles of people with head and neck cancer

INTRODUÇÃO: O câncer de cabeça e pescoço tem elevada incidência e alta mortalidade e seu diagnóstico etratamento influenciam a vida ocupacional da pessoa adoecida e de seus familiares. OBJETIVO: conhecer a configuração dos papéis ocupacionais de pessoas com este tipo de câncer,submetidas a laringectomia total ou parcial. MÉTODO: Estudo quantitativo, exploratório e transversal, aprovado pelo Comitê de Ética (Proc. nº 1102/2010). Foi utilizado o protocolo “Lista de Identificação dos Papéis Ocupacionais”, validada no Brasil; osdados quantitativos foram analisados pelo teste do Qui quadrado. Dados qualitativos complementares foram coletados por entrevista aberta e analisados pelo método de análise de conteúdo temático. CASUÍSTICA: Grupo de estudo com 30 pessoas atendidas pela Cirurgia de Cabeça e Pescoço (CCP), sendo 15 da enfermaria, no pós-cirúrgico imediato, e 15 do Ambulatório, (no mínimo um ano após a cirurgia). Grupo-controle compostopor 30 pessoas sem diagnóstico de câncer. Foram selecionadas 3 do ambulatório (20% do grupo de estudo) para as entrevistas. RESULTADOS: Demonstrou-se que ocorreram mudanças ou perdas de papéis ocupacionais, principalmente do papel de trabalhador. CONCLUSÃO: As consequências psicossociais e ocupacionais do câncer de cabeça e pescoço devem ser consideradas e cuidadas para um melhor e mais eficaz tratamento prestado a essa população.

The head and neck cancer has a high incidence and high mortality and its diagnosis and treatment influence the occupational life of the diseased personand their family. OBJECTIVE: To know the configuration of the occupational roles of people with this type of cancer,undergoing total or partial laryngectomy. METHODS: A quantitative, exploratory cross-sectional study approved by the Ethics Committee (Proc. No. 1102/2010). We used the protocol “List of Identifi cation of Occupational Roles”, validated in Brazil; quantitative data were analyzed by chi-square test. Additionalqualitative data were collected through open interviews and analyzed by the method of content analysis. PATIENTS: Study group with 30 persons served by Head and Neck Surgery (CCP), with 15 ward in the immediate post-surgical, outpatient and 15, (at least one year after surgery). Control group consisting of 30 people without cancer. Were selected from the outpatient clinic3 (20% of the study group) for interviews. RESULTS: It wasdemonstrated that there were changes or loss of occupational roles, especially the role of worker. CONCLUSION: The psychosocial and occupational consequences of head and neck cancer should be considered and cared for better and more effective treatmentprovided to this population.

Paciente laringectomizado total: perspectivas para a ação clínica do psicólogo / Total laryngectomized patient: perspectives for the psychologist's clinical action / Paciente laringectomizado total: perspectivas para la acción clínica del psicólogo

A cirurgia de laringectomia total implica a necessidade de procedimentos agressivos e provoca lesões estéticas e funcionais irrecuperáveis, acarretando repercussões biopsicossociais. Por meio de pesquisa de natureza qualitativa foram investigadas as repercussões psicossociais na construção subjetiva de pacientes laringectomizados e de seus cuidadores. O percurso do adoecimento é vivido como um momento de crise em que predomina o sentimento de desamparo e desalojamento. A perda da fala pode levar o paciente a isolar-se socialmente, afastar-se de suas funções profissionais, com sentimentos de vergonha e culpa, provocando intensa angústia e sofrimento. Os cuidadores sofrem diante da possibilidade da perda de um ente querido e, também, por tentativas, nem sempre bem sucedidas, de dar suporte e oferecer ambiência para as novas necessidades que se apresentam. Os resultados evidenciam que conhecer as repercussões psicossociais dessa experiência pode fornecer importantes subsídios para a psicologia clínica.(AU)

Total laryngectomy surgery implies aggressive procedures that cause irretrievable esthetic and functional injuries, causing a series of biopsychosocial implications. Through a qualitative research, we have investigated psychosocial repercussions in the subjective construction of laryngectomized patients and their caregivers. The path through illness is experienced as a moment of crisis in which abandonment and destitution feelings prevail. The loss of speech may lead patients to social isolation, deviation from professional functions, with feelings of shame and guilt, leading to anguish and suffering. Caregivers suffer not only due to the possibility of a loss, but also because of their attempts, nor always successful, to give support and offer ambience for new necessities that appear. Results show that knowing psychosocial repercussions of this experience may provide important subsidies to clinical psychology.(AU)

La cirugía de laringectomía Total implica la necesidad de procedimientos agresivos que causan lesiones estéticas y funcionales irrecuperables y una serie de consecuencias biopsicosociales. Por una metodología cualitativa investigamos las repercusiones psicosociales posibles en la construcción subjetiva de pacientes laringectomizados y sus cuidadores. Todo el pasaje alrededor de la enfermedad es vivido como un momento de crisis donde el sentimiento de abandono predomina. La pérdida de la habla asume prioridad, conduciendo el paciente para aislarse de su cordialidad social, marcharse de sus funciones profesionales, con sentimientos inadecuados, estima propia baja, vergüenza y culpa. La familia sufre doblemente: de un lado por la percepción de la fragilidad y el temor de la pérdida y de otro por tentativas, ni siempre exitosas, para dar apoyo y ofrecer el ambiente para las nuevas necesidades que se presentan. Conocer las repercusiones psicosociales de esa experiencia puede traer importantes subsidios para la psicología clínica.(AU)

Paciente laringectomizado total: perspectivas para a ação clínica do psicólogo / Total laryngectomized patient: perspectives for the psychologist's clinical action / Paciente laringectomizado total: perspectivas para la acción clínica del psicólogo

A cirurgia de laringectomia total implica a necessidade de procedimentos agressivos e provoca lesões estéticas e funcionais irrecuperáveis, acarretando repercussões biopsicossociais. Por meio de pesquisa de natureza qualitativa foram investigadas as repercussões psicossociais na construção subjetiva de pacientes laringectomizados e de seus cuidadores. O percurso do adoecimento é vivido como um momento de crise em que predomina o sentimento de desamparo e desalojamento. A perda da fala pode levar o paciente a isolar-se socialmente, afastar-se de suas funções profissionais, com sentimentos de vergonha e culpa, provocando intensa angústia e sofrimento. Os cuidadores sofrem diante da possibilidade da perda de um ente querido e, também, por tentativas, nem sempre bem sucedidas, de dar suporte e oferecer ambiência para as novas necessidades que se apresentam. Os resultados evidenciam que conhecer as repercussões psicossociais dessa experiência pode fornecer importantes subsídios para a psicologia clínica.

Total laryngectomy surgery implies aggressive procedures that cause irretrievable esthetic and functional injuries, causing a series of biopsychosocial implications. Through a qualitative research, we have investigated psychosocial repercussions in the subjective construction of laryngectomized patients and their caregivers. The path through illness is experienced as a moment of crisis in which abandonment and destitution feelings prevail. The loss of speech may lead patients to social isolation, deviation from professional functions, with feelings of shame and guilt, leading to anguish and suffering. Caregivers suffer not only due to the possibility of a loss, but also because of their attempts, nor always successful, to give support and offer ambience for new necessities that appear. Results show that knowing psychosocial repercussions of this experience may provide important subsidies to clinical psychology.

La cirugía de laringectomía Total implica la necesidad de procedimientos agresivos que causan lesiones estéticas y funcionales irrecuperables y una serie de consecuencias biopsicosociales. Por una metodología cualitativa investigamos las repercusiones psicosociales posibles en la construcción subjetiva de pacientes laringectomizados y sus cuidadores. Todo el pasaje alrededor de la enfermedad es vivido como un momento de crisis donde el sentimiento de abandono predomina. La pérdida de la habla asume prioridad, conduciendo el paciente para aislarse de su cordialidad social, marcharse de sus funciones profesionales, con sentimientos inadecuados, estima propia baja, vergüenza y culpa. La familia sufre doblemente: de un lado por la percepción de la fragilidad y el temor de la pérdida y de otro por tentativas, ni siempre exitosas, para dar apoyo y ofrecer el ambiente para las nuevas necesidades que se presentan. Conocer las repercusiones psicosociales de esa experiencia puede traer importantes subsidios para la psicología clínica.

[The experience of elderly submitted to complete laryngectomy]. / Experiências de idosos após laringectomia total.

Laryngectomy causes functional and esthetic lesions on the patients, and therefore they need emotional support to resume their activities. This exploratory descriptive study, with a qualitative approach, was developed with 16 elderly patients of Rio Grande do Sul, Brazil, submitted to complete laryngectomy, with the aim of collecting their experience after the surgery. Data were collected using semi-structured interviews. The thematic analysis allowed building the following categories possible to be built: identity loss, social isolation, and communication dfficulties. The change in body image and communication difficulties contribute for the elderly perception of social exclusion, being a burden to the family, and concern with the future. Limitations resulting from surgery and from changes in body image result in emotional and social fragility, which can be minimized by the support of interdisciplinary interventions.

Relação entre qualidade de vida e auto-percepção da qualidade vocal de pacientes laringectomizados totais: estudo piloto / Relation between life quality and self-perception of vocal quality in total laryngectomized patients: pilot study

Objetivo: investigar os indicativos da qualidade de vida em indivíduos submetidos a laringectomiatotal e a relação destes com os aspectos perceptivo-auditivos da qualidade vocal. Métodos: a populaçãoestudada foi constituída por seis indivíduos laringectomizados totais com idades compreendidasentre 40 e 60 anos, de ambos os gêneros, falantes por meio da fala esofágica ou traqueoesofágica.Foram aplicados o protocolo Qualidade de Vida e Voz (QVV) (Behlau et al., 2001) e um roteiro escalade fluência (Robe et al.,1956) para julgamentos de estudantes de graduação e pós-graduação emFonoaudiologia; e roteiro de auto-percepção da voz para julgamentos dos laringectomizados totais.Resultados: os valores do Domínio Físico do QVV foram em média 63.19 e no Domínio Sócio-Emocional80.20, tendo como máximo 100. Os sujeitos que apresentaram um escore global baixo sãoaqueles que sentem um maior desconforto na voz, referido como tensão e rouquidão e os juízesclassificaram como sujeitos com limitações para se comunicar. Os sujeitos com valores do escoreglobal alto possuem uma melhor percepção de sua voz e fizeram fonoterapia, tendo sido classificadospelo grupo de juízes como bons falantes que conseguem emitir sentenças ou possuem uma falafluente, sem hesitação. Conclusão: o escore no Domínio Físico foi maior do que no Domínio Sócio-Emocional, e tais dados revelam que o desconforto maior apresenta-se no Domínio Físico. Os julgamentosefetuados pelos profissionais e pelos laringectomizados totais correlacionaram-se entre si ecom o QVV.

Purpose: to investigate life quality indications in individuals that underwent a total laryngectomy andtheir relationship with the vocal quality hearing-perceptive aspects. Methods: the studied populationwas made up by six total laryngectomized individuals between 40 and 60-year old, of both genders,esophageal or tracheae-esophageal speech speakers. Life and Voice Quality (QVV) protocol (Behlauet al., 2001) and a fluency scale guide (Robe et al. ,1956) were applied for trials of Speech Therapygraduation and post-graduation students; and voice self-perception guide for trials of total laryngectomizedindividuals. Results: the values for Physical Dominion of QVV were on average 63.19 and in the Social-Emotional Dominion 80.20, considering 100 as threshold. The subjects that showed a low global scoreare those that feel a major voice discomfort, referred to as tension and hoarseness and that theexaminers classified as subjects with limitations to communicate. The subjects with values within theglobal high score have a better perception of their voice and underwent speech therapy, having beenclassified by the group of examiners as good speakers who get to give out sentences or have a fluentspeech, with no hesitation. Conclusion: the score in the Physical Dominion was higher than in theSocial-Emotional Dominion, and such data show that the major discomfort appears in the PhysicalDominion. The trials carried through by the professionals and by the total laryngectomized individualswere correlated amongst themselves and with QVV.

Quality of life and depression in patients undergoing total and partial laryngectomy.

PURPOSE: The surgical treatment of head and neck cancer, primarily laryngeal cancer, causes sequelae and can change the patient's quality of life. The purpose of this study was to investigate the impact of laryngectomy on the quality of life regarding the functional, physical, psychological, and social aspects. METHODS: Fourteen patients underwent total laryngectomy and 16 underwent vertical partial laryngectomy. The Quality of Life Core Questionnaire (QLQ-C30) and Head and Neck (H&N35) questionnaire from the European Organization for Research and Treatment of Cancer (EORTC) were used for quality of life evaluation, while the Beck Depression Inventory questionnaire was used for the depression screen. RESULTS: In the total laryngectomy group, reported adverse effects were worsened, social and emotional function (21.3%), olfaction and taste changes (85.6%), cough (71.3%), speech difficulty (100%), and dysphagia (64.3%). Most of the patients (85.5%) judged their quality of life to be reasonable. In the partial laryngectomy group, reported adverse effects were worsened, emotional function (71.4%), speech difficulty (100%), and dysphagia (31.3%). However, most of the patients judged their quality of life to be above the general average. CONCLUSION: Despite being different surgeries, both groups experienced similar difficulties but at different levels. The quality of life was judged worse in the patients who underwent total laryngectomy.

Quality of life and depression in patients undergoing total and partial laryngectomy

OBJETIVO: O tratamento cirúrgico para o câncer de cabeça e pescoço, especificamente para o câncer de laringe, deixa seqüelas nos pacientes podendo alterar sua qualidade de vida. O objetivo deste estudo foi pesquisar o impacto na qualidade de vida, no que diz respeito aos aspectos funcionais, físicos, psicológicos, sociais e o rastreamento da depressão. MÉTODO: Foram estudados 14 pacientes submetidos a laringectomia total e 16 pacientes submetidos a laringectomia parcial vertical. Para a avaliação da qualidade de vida utilizamos os questionários da Organização Européia de Pesquisa e Tratamento do Câncer (EORTC), Quality of Life Core Questionnarie (QLQ-C30) e Head and Neck 35 (H&N35) e, para o rastreamento da depressão, o questionário Beck Depression. RESULTADOS: As funções social e emocional foram as mais afetadas no grupo de laringectomia total. 21,3% dos pacientes julgaram mediana sua qualidade de vida global. Dentro dos sintomas específicos, 85,5% referiram alteração no olfato e paladar, 71,3% tosse, 100% algum grau de dificuldade na fala e 64,3% dificuldades com a deglutição. No grupo de laringectomia parcial encontramos a função emocional afetada em 71,4%, a maioria julgou sua qualidade de vida global acima da média, 100% demonstraram algum grau de dificuldade com a fala e 31,3% referiram disfagia. CONCLUSAO: Embora sendo cirurgias diferentes, ambos os grupos passaram por dificuldades similares em maior ou menor grau. Os resultados demonstraram piora nos parâmetros de qualidade de vida dos pacientes submetidos a laringectomia total.

Transpondo a barreira do silência e da solidão do cliente laringectomizado através das ações de enfermagem / Transporting the obstacle of silence and loneliness of the client with laryngectomy through nursing care actions / Transponiendo la barrera del silencio y de la soledad del cliente sometido à retirada quirúrgica de la laringe a través de los cuidados de enfermería

Relato de experiência baseado na prática cotidiana da ações de enfermagem desenvolvidas junto a clientes laringectomizados em um ambulatório de pós-operatório, cujo principal obejtivo é enumerar essas ações, analisando-as de acordo com a sua singularidade, tendo em vista o caráter mutilador físico e funcional dessa cirurgia. Entre as disfunções citadas, é enfatizada a afonia, que interfere na comunicação oral do cliente, fato que contribui para o seu isolamento social. A metodologia utilizada para a consecução do obejtivo proposto baseou-se na consulta de enfermagem, considerando que é durante este procedimento que a aproximação do cliente e sua família é realizada junto a esta equipe...

[Quality of life assessment in laryngectomized patients: a systematic review]. / Avaliação da qualidade de vida em pacientes laringectomizados: uma revisão sistemática.

Laryngectomy is the main sequela in patients with cancer of the larynx. The authors conducted a systematic review to evaluate the relationship between quality of life and laryngectomy. Ninety-six articles published in scientific journals were identified, and 35 were selected whose main focus was laryngectomy and quality of life in laryngectomized patients. Each article was evaluated by way of systematic review. Evaluation of the qualitative attributes of articles used the Qualitative Assessment Questionnaire (QAQ), a validated and tested instrument. Most articles lacked consistency and methodological rigor in measuring quality of life among laryngectomized patients. The relationship between quality of life and laryngectomy also fell far short of the multidimensional approach of the quality of life construct as suggested by the WHO/QOL (World Health Organization/Quality of Life) group.

Paciente con carcinoma de laringe / Laryngeal neoplasm

La autora describe la clínica del paciente con un cáncer de laringe. Expone las formas de presentación, las manifestaciones clínicas, diagnóstico y tratamiento, como asimismo las complicaciones, para luego diseñar un plan de cuidados de acuerdo a las necesidades alteradas en base a la presentación de un caso (AU)

Qualidade de vida do paciente laringectomizado / Quality of life after total laryngectomy

Introduçäo: Como cerca de 60 por cento dos portadores de câncer de laringe globalmente sobrevivem após cinco anos, resulta um importante problema social devido ao impacto funcional, estético e emocional do tratamento. Objetivos: Com o objetivo de avaliar a qualidade de vida em portadores de câncer laríngeo avançado, a 22 pacientes submetidos a laringectomia total nos anos de 1995 a 1997 foram pedidas respostas a um questionário em que se indagou quanto a: dor e uso de analgésicos; alteraçäo na aparência e desfiguraçäo; atividades, lazer e entretenimento; repercussäo profissional; deglutiçäo; fala; relacionamento familiar e social; sensaçäo de ansiedade e depressäo. Resultados: Os pacientes que sofreram maior impacto com o tratamento foram os que evoluíram com recidiva ou complicaçäo. O estigma da perda da voz foi parcialmente compensado pelos métodos de reabilitaçäo disponíveis e um adequado esclarecimento dos pacientes. Os pacientes convivem razoavelmente com as sequelas do tratamento

[Voice rehabilitation of laryngectomized patients: cultural characteristics in the process]. / Reabilitação vocal do laringectomizado: características culturais do processo.

The objective of this study was to identify the characteristics of the process of vocal rehabilitation among laryngectomees focusing on culture. The study included four laryngectomees who attend the GARPO-Laryngectomees (Support Group For The Rehabilitation of Ostomized Patients--Laryngectomees) and communicate with esophageal or pharyngeal voice. The theme that emerged from the data was "to be born again", in agreement with the cultural value of the voice in our society. The study revealed as well the difficulties of the process, the importance of family participation and the stigma of the altered body image.

[Interprofessional assistance in the rehabilitation of communication skills of laryngectomized patients]. / Assistência multiprofissional na reabilitação da comunicação da pessoa laringectomizada.

The purpose of this study was to bring basic information about the work of a multiprofessional group involved with the laryngectomees rehabilitation and vocal rehabilitation. Those patients take part in the GARPO-Laryngectomees. The authors describe the different possibilities of vocal rehabilitation for the patients and the framework of the activities and steps of the process. They emphasize the laryngectomees characteristics, the surgical results, and the meaning of being a laryngectomee, as the basis to direct the nurses and the speech therapeutists assistance.

O significado cultural de ser laringectomizado / The cultural meaning of being laryngectomized

O objetivo deste estudo exploratório é apreender o significado cultural de ser laringectomizado. O estudo envolve a análise indutiva do conteúdo das falas dos 24 participantes do GARPO nos anos de 1991 a 1994, fundamentada nos elementos da cultura. Os significados culturais que emergiram foram classificados em categorias: ser diferente, ser dependente, ter baixa auto-estima e ter esperança. A análise dos significados culturais mostrou como esses participantes lidam com sua condiçäo dentro do seu contexto sócio-cultural. Conseqüentemente, as atividades desenvolvidas pelo grupo podem ser redimensionadas, facilitando a reabilitaçäo dessas pessoas.