Pre- and post-operative counseling for laryngectomees and their spouses: an update

Quality of Life in Caregivers, Spouses, and Partners of Total Laryngectomees: A Scoping Review

PURPOSE

The purpose of this study was to (a) review methods used to assess quality of life (QOL) in caregivers, partners, and spouses of those who have undergone total laryngectomy (TL); (b) identify patterns in caregiver QOL changes postoperatively; and (c) review previously proposed interventions for caregivers.

METHOD

PubMed, EMBASE, and CINAHL Complete were searched using the Medical Subject Heading terms laryngectomy, spouse, caregiver, and partner. Two reviewers independently screened and identified records meeting inclusion criteria. This scoping review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Initial search returned 143 results and 12 met inclusion criteria. Eight studies assessed postoperative QOL changes in categories such as psychological health, physical health, sexuality, and interpersonal relationships. Four studies proposed interventions for caregivers perioperatively. There were no consistently used inventories, and only one intervention was formally tested.

CONCLUSIONS

The literature available on TL caregiver QOL contains inconsistent inventories and study design. There are few interventions available, and it would be beneficial to develop a standardized QOL inventory for this population to better target caregiver needs.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19287887.

Education, counseling, support groups, and provider knowledge of total laryngectomy: The patient's perspective

PURPOSE

Studies over a 40 year period have reported inadequate education and counseling for persons with laryngectomy; however, several long-term trends, including centralization of laryngectomy surgeries in major teaching hospitals, the rise of the internet, and the increased use of the tracheoesophageal prosthesis (TEP) for voice all have the potential to improve this situation. This study investigated if persons with total laryngectomy reported receiving adequate education and counseling before and after their laryngectomy, and how this varied by gender, geographic setting, communication method, and time. It also examined who participated in in-person and online support groups, and what health care providers and settings are perceived as most knowledgeable about laryngectomy.

METHODS

This research was a cross-sectional study, with 200 participants meeting the inclusion criteria. Results were analyzed via descriptive statistics, Pearson chi-square test, McNemar's test, Fisher's exact test, and one-way ANOVA with post-hoc analysis.

RESULTS

About half of persons with total laryngectomy reported receiving adequate education and counseling pre- and post-surgery, with men being more likely to report adequate education than women, and persons using a TEP for voice more likely to report adequate education than persons using alternate communication methods. Most participants (71%) participated in support groups, with women more likely to participate than men. Participants in rural areas were less likely to participate in in-person support groups than those from suburban or urban areas. Participants using a TEP as a communication method were more likely to participate in in-person support groups than those using other communication methods. Doctors, speech-language pathologists (SLPs), the internet, and support groups were highly rated sources of information. Among health-care providers, ENTs and SLPs were rated as the most knowledgeable, and primary-care physicians, dentists, and emergency medical technicians the least.

CONCLUSIONS

There continues to be a need for adequate education and counseling both before and after surgery. This education and counseling may need to continue for months or years post-surgery, due to the traumatic nature of the laryngectomy procedure. Doctors and SLPs can play a leading part in providing education and counseling, and with other health professions and in-person and online support groups also having a role to play. Frontline health care providers are perceived as having low knowledge of laryngectomy.

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.

Informational and Support Needs of Patients with Head and Neck Cancer: Current Status and Emerging Issues

The objective of this article is to review and summarize the extant literature on head and neck cancer (HNC) patients’ informational needs and to characterize emerging issues in this patient population in order to define priorities for future research. HNC patients may undergo challenging treatment regimens and experience treatment-related alterations in primary daily functions such as speech and eating. These changes often persist following treatment and may lead to significant deficits in quality of life and interpersonal relations. Despite empirical evidence demonstrating that receipt of adequate information and support is predictive of improved outcomes post-treatment, relatively limited attention has been paid to the informational and support needs of HNC patients. This review focuses primarily on three topic domains: (1) managing treatment-related side effects; (2) addressing alcohol and tobacco dependence; and (3) informational needs in the areas of human papillomavirus (HPV) and clinical trials. While there is increasing awareness of the rehabilitation and survivorship needs in this patient population, patients note that the impact of treatment on social activities and interactions is under-discussed and of key concern. In addition, there is a significant gap in addressing communication and informational needs of caregivers and family members who are integral for promoting healthy behaviors and self-care post-treatment. Greater integration of programs that address tobacco or alcohol dependency within a comprehensive treatment and support plan may increase patient motivation to seek help and enhance patient success in maintaining long-term abstinence. Finally, emerging patient-provider communication needs, particularly in the context of decision making about clinical trials or surrounding an HPV-related diagnosis, have been noted among both patients and healthcare providers. Future research on the development of novel programs that offer feasible and acceptable methods for addressing unmet informational and support needs is warranted and may yield benefit for improving patient-reported outcomes.

Social support and substitute voice acquisition on psychological adjustment among patients after laryngectomy

The objective is to clarify whether social support and acquisition of alternative voice enhance the psychological adjustment of laryngectomized patients and which part of the psychological adjustment structure would be influenced by social support. We contacted 1445 patients enrolled in a patient association using mail surveys and 679 patients agreed to participate in the study. The survey items included age, sex, occupation, post-surgery duration, communication method, psychological adjustment (by the Nottingham Adjustment Scale Japanese Laryngectomy Version: NAS-J-L), and the formal support (by Hospital Patient Satisfaction Questionnaire-25: HPSQ-25). Social support and communication methods were added to the three-tier structural model of psychological adjustment shown in our previous study, and a covariance structure analysis was conducted. Formal/informal supports and acquisition of alternative voice influence only the "recognition of oneself as voluntary agent", the first tier of the three-tier structure of psychological adjustment. The results suggest that social support and acquisition of alternative voice may enhance the recognition of oneself as voluntary agent and promote the psychological adjustment.

Pre-operative counselling for laryngectomy patients: a systematic review

Objectives:

This study aimed to undertake a systematic review of the literature about pre-operative counselling for laryngectomy patients, identify its practice and patient and (where possible) carer perceptions.

Methods:

A search strategy was formulated using a concept map and a Population, Intervention, Comparative Interaction and Outcomes (‘PICO’) schema. All publications from 1975 to 2015 reporting pre-operative counselling of laryngectomy patients were included. Papers were retrieved and critiqued, and those included were assigned a level of evidence (according to the Joanna Briggs Institute schema).

Results:

Of the 56 papers retrieved, 21 were included in the review. The literature is limited: studies demonstrate bias and are of poor methodological quality. There are clear, persistent reports by patients and carers of shortfalls in clinical practice.

Conclusion:

Studies on pre-operative counselling for laryngectomees are flawed in design and represent weak levels of evidence. Pre-operative counselling has not been operationalised, resulting in differing paradigms being examined. Aggregation of data and/or results is not possible and the veracity of many studies is questioned.

Communication dysfunction, body image, and symptom severity in postoperative head and neck cancer patients: factors associated with the amount of speaking after treatment

PURPOSE

The purpose of this study was to determine the relationships of communication dysfunction, body image, and amount of speaking in patients who were treated for head and neck cancers (HNCs).

METHODS

This was a cross-sectional study of postoperative HNC patients at the otolaryngology outpatient departments of two leading medical centers in northern Taiwan. Data were collected using questionnaires to assess perceived communication dysfunction, body image, symptom severity, and amount of speaking after treatment.

RESULTS

A total of 130 HNC patients were included in the analysis, and 70.8 % of patients reported speaking less after surgery as compared to the period before having HNC surgery. Overall, patients perceived a moderate level of communication dysfunction. Those with higher distress over their body image, higher symptom severity, and with hypopharyngeal and laryngeal cancer reported speaking less. Patients with advanced stage cancer and a tumor in a facial area and those that received reconstructive surgery were more likely to have a negative body image.

CONCLUSIONS

Dissatisfaction with body image, greater symptom severity, and hypopharyngeal and laryngeal cancer are predictive of the amount HNC patients speak, as compared with the amount they spoke before having HNC. Clinicians should be aware of and systematically assess communication problems of HNC patients to promote their social function. Further research on interventions that facilitate the development of a positive body image and communication is strongly suggested.

Psychisches Befinden und psychische Morbidität der Partner kehlkopfloser Karzinompatienten

Zusammenfassung. Theoretischer Hintergrund: Die vollständige Entfernung des Kehlkopfes (Laryngektomie) stellt Patienten und deren Familien vor viele Herausforderungen. Das psychische Befinden der Partner kehlkopfloser Karzinompatienten wurde bisher kaum wissenschaftlich erforscht. Fragestellung: Die Studie untersucht das psychische Befinden, die psychische Morbidität sowie die Inanspruchnahme psychosozialer Unterstützungsangebote der Partner laryngektomierter Karzinompatienten. Methode: Die Daten wurden in einer multizentrischen Querschnittstudie an 106 Partnern mittels eines strukturierten Interviews (SKID) und standardisierter Fragebögen (HADS, KFA) erfasst. Ergebnisse: Die Partner waren signifikant ängstlicher als die laryngektomierten Patienten und die Allgemeinbevölkerung, bei gleicher Ausprägung von Depressivität. Trotz der hohen Belastung wiesen nur 14% der Partner eine psychische Erkrankung auf. Psychosoziale Unterstützungsangebote werden von einem Bruchteil der Befragten genutzt. Schlussfolgerungen: Die Ergebnisse indizieren eine psychosoziale Unterversorgung der Partner laryngektomierter Karzinompatienten. Zukünftige Forschungsprojekte sollten die Ursachen für diese Unterversorgung detailliert erfragen, um bedarfsgerechte Behandlungsmöglichkeiten anbieten zu können.

Psychosocial and economic impact of cancer

This article explores the psychosocial and economic implications of cancer and their relevance to the clinician. After a general overview of the topic, the authors focus on aspects of particular importance to the dental professional, including the psychosocial and economic implications of the oral complications of cancer and its therapy, head and neck cancers, and special issues among children with cancer and cancer survivors.

[The analysis of the quality of life in laryngectomized patients]

Total laryngectomy, as extremely mutilating surgical intervention, results in drastic changes of the style and quality of life. The trauma of laryngectomy is huge, both to patients and their environment. The most pronounced changes of the quality of life of laryngectomized patients are seen at marital, familial, professional, business and communication aspects. Malignant disease and total laryngectomy significantly reduce working capacity, producing, besides professional, the economical difficulties. Psychological implications associated with total laryngectomy are the most severe, comprehensive ones and require multidisciplinary approach. The study analyzes the frequency and distribution of factors affecting the quality of life of laryngectomized patients (sex, age, psychic status, probable history of chronic diseases, impairment of hearing and social-family environment of patients). Significant improvement of the quality of life of laryngectomized patients is achieved by systemic, planned and multidisciplinary rehabilitation of patients as well as their immediate environment. The need for the association of laryngectomized patients is stressed.

Speech rehabilitation after total laryngectomy

The outcome of speech therapy for 65 laryngectomees at Kitasato University Hospital is reported and what needs to be done in order to establish a better system for laryngectomee rehabilitation in Japan is discussed. Of the 65 patients, 53 were trained for both esophageal and electrolarynx speech, 8 for electrolarynx speech only and 4 for esophageal speech only. Of the 57 patients who were trained for esophageal speech, 38 continued the training for a period of > 6 months. Of these 38, 36 (94.7%) could produce one-syllable sounds at the first session. For the production of 5-6 syllables, a median of 6 sessions was necessary for the total laryngectomee group and 10 sessions were necessary for the pharyngo-laryngo-esophagectomee group but the difference was not significant. The study showed that for the production of a single esophageal sound the training period in our hospital was much shorter than that reported in other Japanese studies. Of the 65 patients, 27 (41.5%) acquired practical esophageal speech and 59 (90.8%) acquired either esophageal or electrolarynx speech. Six (9.2%) could not acquire any alaryngeal speech and this percentage was lower than that reported in other studies from Japan (12.5-33%) and from other countries (8.5-40%).

Laryngectomy: beyond loss of voice--caring for the patient as a whole

For patients with laryngeal cancer, rehabilitation following laryngectomy may be difficult. However, significant variability in coping skills and adaptation of this patient population exists. Healthcare providers commonly perceive disfigurement, alteration in function (i.e., loss of natural voice), and disease control as the most relevant issues in the postoperative period, yet patients and their families may not share these same priorities. Management of physical symptoms, social reintegration, participation in enjoyed activities, and vocational issues following laryngectomy may present significant barriers to achieving optimal quality of life. Comprehensive preoperative counseling that includes patients and their caregivers is an important aspect of preparation for surgery. This review examines dimensions of adaptation, rehabilitation, and quality of life following laryngectomy.