Affective symptoms and swallow-specific quality of life in total laryngectomy patients

Decisional Conflict in Patients with Advanced Laryngeal Carcinoma: A Multicenter Study

OBJECTIVES

Decision-making for patients with a locally advanced laryngeal carcinoma (T3 and T4) is challenging due to the treatment choice between organ preservation and laryngectomy, both with different and high impact on function and quality of life (QoL). The complexity of these treatment decisions and their possible consequences might lead to decisional conflict (DC). This study aimed to explore the level of DC in locally advanced laryngeal carcinoma patients facing curative decision-making, and to identify possible associated factors.

METHODS

In this multicenter prospective cohort study, participants completed questionnaires on DC, level of shared decision-making (SDM), and a knowledge test directly after counseling and 6 months after treatment. Descriptive statistics and Spearman correlation tests were used to analyze the data.

RESULTS

Directly after counseling, almost all participants (44/45; 98%) experienced Clinically Significant DC score (CSDC >25, scale 0-100). On average, patients scored 47% (SD 20%) correct on the knowledge test. Questions related to radiotherapy were answered best (69%, SD 29%), whilst only 35% (SD 29%) of the questions related to laryngectomy were answered correctly. Patients' perceived level of SDM (scale 0-100) was 70 (mean, SD 16.2), and for physicians this was 70 (SD 1.7).

CONCLUSION

Most patients with advanced larynx cancer experience high levels of DC. Low knowledge levels regarding treatment aspects indicate a need for better patient counseling.

LEVEL OF EVIDENCE

Level IV Laryngoscope, 2024.

Tracheoesophageal Voice Therapy in Postlaryngectomy Rehabilitation: A Systematic Review

BACKGROUND

Following total laryngectomy, surgical voice restoration is considered the optimal modality for re-establishing communication via tracheoesophageal voice. Yet beyond the insertion of a voice prosthesis to elicit voice production, there is suboptimal clinical knowledge of how to rehabilitate the perceptual quality of tracheoesophageal voice. This systematic review will identify and critically evaluate the quality and effectiveness of therapeutic interventions for tracheoesophageal voice. The findings of this review will inform the development of a novel tracheoesophageal voice therapy intervention.

STUDY DESIGN

Systematic literature review carried out in accordance with PRISMA guidelines.

METHODS

The review protocol was registered with PROSPERO. Eight electronic databases were searched using a prespecified search strategy. Records were independently screened by two reviewers against inclusion and exclusion criteria. Eligible studies were assessed for quality using the PEDro, ROBIN-T, and NHLBI critical appraisal tools. Data was extracted pertaining to participant characteristics and the content, dosage, intensity and outcomes of interventions.

RESULTS

6344 records were identified, of which 38 were included for full-text review. Six studies met the eligibility criteria for inclusion. Voice rehabilitation was not the primary focus in the majority of studies, and the risk of bias was identified across studies. There was significant heterogeneity in the interventions and outcome measures used within studies with insufficient detail provided on intervention content for tracheoesophageal voice. Evidence for the effectiveness of interventions was limited and inconsistent across studies.

CONCLUSIONS

This review found that tracheoesophageal voice therapy is an under-researched area of clinical practice. Evidence from the small body of existing studies was not sufficiently robust to inform clinical practice at this time. This review highlights the necessity to develop and test interventions aimed at improving the perceptual quality of tracheoesophageal voice.

Quality of life in dysphagia and anxiety and depression symptoms pre and post-thyroidectomy

PURPOSE

To correlate the dysphagia quality of life and symptoms of anxiety and depression before and after thyroidectomy.

METHODS

Observational, longitudinal, prospective, and experimental study. Twenty patients participated, with a mean age of 54 years, prevalence of females (n=17; 85%) and partial thyroidectomy (n=14; 70%). All subjects underwent laryngeal visual examination and answered the MD Anderson Dysphagia Questionnaire (MDADI) and the Hospital Anxiety and Depression Scale (HADS) in three different moments: preoperatively, immediately postoperatively (maximum one week) and three months after surgery.

RESULTS

There was a significant difference in dysphagia quality of life for the physical and total domains in the three different moments. Regarding anxiety and depression, a statistically significant difference was observed between the scores in all domains, with a greater difference observed between the preoperative period and after 1 week. Higher values were observed in the preoperative period for mild anxiety traits, being more frequent in relation to depression, with a reduction after 1 week and an increase after three months of surgery. There was no significant correlation between the MDADI and HADS protocols.

CONCLUSION

Patients undergoing thyroidectomy self-report better quality of life in dysphagia and reduced anxiety/depression scores after three months of surgery. There was no correlation between anxiety, depression and quality of life in dysphagia at the moments evaluated.

Laryngeal Cancer and the End of Life (As We Know It)

Patients with laryngeal cancer undergo life-changing interventions that impact their individual and social well-being. There remains to be an in-depth characterization of the multidimensional symptom burden faced by patients with laryngeal cancer at the end of life. Care at end of life must attend to symptoms that manifest earlier in the course of illness. This article characterizes the suffering experienced by patients with laryngeal cancer, including societal shame, poor mental health, and inequitable outcomes. For patients with advanced laryngeal cancer, surgical palliative care provides a necessary and helpful paradigm for caregiver support, goals-of-care conversations, and treatment counseling.

Swallowing outcomes following division of pseudo-epiglottis resulting from vertical pharyngeal closure in laryngectomy

BACKGROUND

Vertical closure of the pharynx after laryngectomy can result in an outpouch of the anterior wall of the neopharynx below the tongue base, called a pseudo-diverticulum. The prolapsed mucosa that separates the rest of the neopharynx from the pseudo-diverticulum is termed a pseudo-epiglottis.

METHODS

Prospective study of patients with pseudo-epiglottis. M. D. Anderson Dysphagia Inventory (MDADI) scores were used to assess swallowing outcomes pre- and post-pseudo-epiglottis division, including minimally clinically important difference (MCID) assessment.

RESULTS

Of 16 patients with a pseudo-epiglottis, 12 had dysphagia (75%). Symptomatic patients had significantly worse global MDADI and subscale scores. After division, the mean composite MDADI increased from 48.3 to 64.7 (p = 0.035), including a high MCID (16.4) with a similar improvement in the global question rating findings (31.1 vs. 60, p = 0.021). The MCID was significant for all MDADI subscales.

CONCLUSIONS

Pseudo-epiglottis formation is associated with significantly worse global and subscale MDADI scores. A clinically- and statistically-significant improvement in the MDADI scores was found following surgical division.

Affective Symptoms and Oropharyngeal Dysphagia in Head-and-Neck Cancer Patients: A Systematic Review

Oropharyngeal dysphagia (OD) is a high impact morbidity in head-and-neck cancer (HNC) patients. A wide variety of instruments are developed to screen for affective symptoms and OD. The current paper aims to systematically review and appraise the literature to obtain insight into the prevalence, strength, and causal direction of the relationship between affective symptoms and OD in HNC patients. This review was conducted in accordance with the PRISMA statement. A systematic search of the literature was performed using PubMed, PsycINFO, Cochrane, and Embase. All available publications reporting on the relationship between affective conditions and swallowing function in HNC patients were included. Conference papers, tutorials, reviews, and studies with less than 5 patients were excluded. Fifteen studies met the inclusion criteria. The level of evidence and methodological quality were assessed using the ABC-rating scale and QualSyst critical appraisal tool. Eleven studies reported a positive relationship between affective symptoms and OD. The findings of this paper highlight the importance of affective symptom screening in dysphagic HNC patients as clinically relevant affective symptoms and OD seems to be prevalent and coincident in this population. Considering the impact of affective symptoms and OD on patients' daily life, early detection and an integrated interdisciplinary approach are recommended. However, due to the heterogeneity of study designs, outcomes, and outcome measures, the generalization of study results is limited.

Quality of Life Following Robotic Transaxillary Versus Conventional Hemithyroidectomy: A Comparative Analysis

Background: Robotic technology has proven safe and effective for thyroidectomy procedures. Few studies have addressed the quality-of-life outcomes of robotic thyroidectomy compared with conventional thyroidectomy. Materials and Methods: The database of a tertiary medical center was retrospectively reviewed for all patients with thyroid disease who had undergone robotic hemithyroidectomy in 2012-2020. All patients treated by transaxillary robotic surgery and a similar number of randomly selected patients treated by conventional cervical surgery completed a standardized self-administered thyroid disease-specific quality-of-life (QOL) questionnaire (ThyPRO). Clinical data were derived from the medical files. The results were compared using mean comparison tests and multivariate logistic regression models. Results: The cohort consisted of 131 patients: 63 after robotic thyroidectomy and 68 after conventional thyroidectomy. The mean age was 38.87 ± 14.11 and 58.85 ± 14.1 years, respectively (P < .0001). The robotic hemithyroidectomy group reported better QOL outcomes in physical and mental health parameters, including decreased anxiety, depression, lower sex life impairment, and cognitive impairment scores (P < .0001). Furthermore, after adjusting for age, gender, malignancy status, and surgical approach, we found that patients undergoing robotic hemithyroidectomy had a lower probability of experiencing depressive symptoms than the conventional hemithyroidectomy group (odds ratio = 0.31; 95% confidence interval, 0.11-0.88). Of interest, no significant difference in cosmetic outcomes was found. Conclusions: Patients who underwent robotic thyroidectomy report better postoperative QOL after surgery than patients operated by the conventional approach in terms of anxiety, depression, cognitive and sex-life scores.

Inhibition and Removal of Mature Mixed-Bacteria Biofilms on Voice Prostheses by Sodium Selenite

Purpose

Biofilms on voice prostheses are important factors shortening their service life. Sodium selenite has been used to prevent and treat various diseases. Whether sodium selenite can inhibit and remove mature biofilms on voice prostheses is still unknown.

Methods

To verify the effects of sodium selenite on mature mixed-bacteria biofilms (Staphylococcus aureus, Candida albicans, and Streptococcus faecalis) on voice prostheses, we used quantitative and qualitative methods, eg, real-time fluorescence quantitative PCR, crystal violet staining, 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide) (XTT) reduction assays, and scanning electron microscopy, to measure the effects of sodium selenite on the number of bacterial colonies, biofilm formation ability, metabolic activity, and ultrastructure in a model of mature mixed-bacteria biofilms on voice prostheses and validated the effects in vitro on mature biofilms on voice prostheses from patients.

Results

When exploring the possible mechanism of biofilm inhibition and removal by sodium selenite, we found that it significantly inhibited and removed biofilms on voice prostheses and effectively destroyed the spatial structure of the biofilms. The inhibition and removal effects became more significant with increasing sodium selenite concentrations.

Conclusion

We demonstrated that sodium selenite can inhibit and remove biofilms of mature mixed strains on voice prostheses, providing a novel basis for treating patients' voice prosthesis biofilms.

Is There any Association Between Total Laryngectomy and Sexual Disorders in Men?

Introduction

According to the prevalence of sexual enjoyment reduction in total or partial laryngectomy patients, the present study aimed to evaluate sexual disorders among men who had undergone total laryngectomy.

Materials and Methods

In this cross-sectional case-control study, purposive sampling was carried out to select all the samples that had experienced total laryngectomy. The control group was selected among the male patients who were referred for a routine checkup. In order to compare the groups, the international index of erectile function (IIEF) was performed, and the data were statistically analyzed in SPSS software (version 21).

Results

Based on the obtained results, laryngectomy patients had experienced problems with sexual problems, especially in the field of erectile function, sexual desire, and intercourse satisfaction (P<001).

Conclusions

According to various studies, sexual dissatisfaction negatively impacts the Quality of life. This problem, commonly observed in total laryngectomy patients, needs to be considered.

Prosthetic voice rehabilitation after laryngoesophagectomy: surgical and functional outcomes

PURPOSE

Quality of Life (QoL) after extensive head and neck resections is of paramount importance, especially after pharyngolaryngectomy or pharyngolaryngoesophagectomy where complex digestive tract reconstruction is required (with gastric pull-up or colon transposition). Tracheodigestive puncture (TDP) is the only vocal restoration option in this group of patients. The aim of this study is to evaluate postoperative complications, vocal outcomes, voice-related and swallowing-related QoL after secondary TDP in this cohort of patients.

METHODS

A retrospective study was conducted in the tertiary referral center of Verona Hospital between June 2014 and June 2020. Patient demographics, clinical and surgical data were assessed. Speech objective and subjective evaluation was performed. QoL was assessed with Voice Handicap Index-10 (VHI-10) and M.D. Anderson Dysphagia Inventory (MDADI) questionnaires.

RESULTS

Seven patients met the inclusion criteria, but two had died before questionnaires were administered. No intraoperative complications were noted after TDP surgery. There were delayed complications in four cases (57.1%) and all were treated with restoration. Intelligible voice was restored in all patients. Maximum phonation time and maximal voice intensity recorded were 5.42 ± 3.27 s and 65.20 ± 5.45 dB, respectively. Acceptable average VHI-10 and MDADI scores were obtained in all patients.

CONCLUSIONS

Secondary TDP performed after gastric pull-up or colon transposition reconstructions are feasible and effective procedures. An intelligible voice was restored in all patients, with satisfactory patient-perceived voice-related and dysphagia-related quality-of-life outcomes.

Adherence to Home-Based Swallowing Therapy Using a Mobile System in Head and Neck Cancer Survivors

Purpose A large knowledge gap related to dysphagia treatment adherence was identified by a recent systematic review: Few existing studies report on adherence, and current adherence tracking relies heavily on patient self-report. This study aimed to report weekly adherence and dysphagia-specific quality of life following home-based swallowing therapy in head and neck cancer (HNC). Method This was a quasi-experimental pretest-posttest design. Patients who were at least 3 months post-HNC treatment were enrolled in swallowing therapy using a mobile health (mHealth) swallowing system equipped with surface electromyography (sEMG) biofeedback. Participants completed a home dysphagia exercise program across 6 weeks, with a target of 72 swallows per day split between three different exercise types. Adherence was calculated as percent trials completed of trials prescribed. The M. D. Anderson Dysphagia Inventory (MDADI) was administered before and after therapy. Results Twenty participants (75% male), with an average age of 61.9 years (SD = 8.5), completed the study. The majority had surgery ± adjuvant (chemo)radiation therapy for oral (10%), oropharyngeal (80%), or other (10%) cancers. Using an intention-to-treat analysis, adherence to the exercise regimen remained high from 84% in Week 1 to 72% in Week 6. Radiation therapy, time since cancer treatment, medical difficulties, and technical difficulties were all found to be predictive of poorer adherence at Week 6. A statistically significant improvement was found for composite, emotional, and physical MDADI subscales. Conclusions When using an mHealth system with sEMG biofeedback, adherence rates to home-based swallowing exercise remained at or above 72% over a 6-week treatment period. Dysphagia-specific quality of life improved following this 6-week treatment program.

Associations between markers of social functioning and depression and quality of life in survivors of head and neck cancer: Findings from the Head and Neck Cancer 5000 study

OBJECTIVE

To investigate associations between markers of social functioning (trouble with social eating and social contact), depression and health-related quality of life (QOL) among head and neck cancer survivors.

METHODS

This cross-sectional analysis included individuals with oral cavity, oropharynx, larynx, salivary gland and thyroid cancers from Head and Neck 5000 alive at 12 months. Trouble with social eating and social contact were measured using items from EORTC QLQ-H&N35 and QOL using EORTC QLQ-C30; responses were converted into a score of 0-100, with a higher score equalling more trouble or better QOL. A HADS subscale score of ≥8 was considered significant depression. Associations between tertiles of trouble with social eating and social contact and depression and QoL were assessed using multivariable logistic and linear regression (with robust errors), respectively.

RESULTS

Of 2561 survivors, 23% reported significant depression. The median QOL score was 75.0 (interquartile range 58.3-83.3). For trouble with social eating, after confounder adjustment, those in the intermediate and highest tertiles had higher odds of depression (intermediate: OR = 4.5, 95% CI 3.19-6.45; high: OR = 21.8, 15.17-31.18) and lower QOL (intermediate:β = -8.7, 95% CI -10.35 to -7.14; high: β = -24.8, -26.91 to -22.77). Results were similar for trouble with social contact.

CONCLUSION

We found strong clinically important associations between markers of social functioning and depression and QOL. More effective interventions addressing social eating and contact are required. These may help survivors regain their independence, reduce levels of isolation and loneliness, and depression, and improve QOL outcomes generally.

Health-Related Quality of Life, Dysphagia, Voice Problems, Depression, and Anxiety After Total Laryngectomy

OBJECTIVES/HYPOTHESIS

The aims were to determine health-related quality of life (HRQoL), including voice problems, dysphagia, depression, and anxiety after total laryngectomy (TL), and investigate the associations between HRQoL and the late effects.

STUDY DESIGN

Cross-sectional study.

METHODS

172 participants having received a TL 1.6 to 18.1 years ago for laryngeal/hypopharyngeal cancer filled in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, Core and Head and Neck module (EORTC QLQ-C30, EORTC QLQ-H&N35), Voice-Related Quality of Life questionnaire (V-RQOL), M.D. Anderson Dysphagia Inventory (MDADI), and Hospital Anxiety and Depression Scale (HADS) questionnaires.

RESULTS

Participants scored worse than normative reference populations on all scales/items of the EORTC questionnaires, except one, and almost half of the scales/items showed a clinically relevant difference. Moderate/severe dysphagia was present in 46%, moderate/severe voice problems in 57%, depression in 16%, and anxiety in 20%. Decreasing age, increasing numbers of comorbidities, increasing voice problems, increasing dysphagia, and increasing depression symptoms, were associated with a lowered EORTC QLQ-C30 summary score.

CONCLUSION

A substantial proportion of participants experienced clinically significant late effects and increasing levels of these were associated with a lowered HRQoL.

LEVEL OF EVIDENCE

3 Laryngoscope, 2021.

Affective symptoms and swallow-specific quality of life in total laryngectomy patients

Background

The aim of this study is to determine the prevalence of clinically relevant affective symptoms and level of swallow‐specific quality of life (QoL) in dysphagic patients with total laryngectomy (TL) and to explore the relationship between affective symptoms and swallow‐specific QoL.

Methods

Thirty‐five TL patients completed the Hospital Anxiety and Depression Scale (HADS) and the MD Anderson Dysphagia Inventory (MDADI). Student's t test and linear regression were used.

Results

Eight (23%) patients showed clinically relevant symptoms of anxiety, 8 (23%) of depression, and 11 (31%) showed either one. These groups had significantly lower mean MDADI scores. One‐point increase in HADS‐anxiety or HADS‐depression subscale score corresponds with a decrease of 2.7 or 3.0 points, on average, respectively, of the MDADI total score.

Conclusions

Clinically relevant affective symptoms were present in approximately one‐third of the TL patients. These preliminary results show that increased affective symptom scores correlate with a decreased swallow‐specific QoL.