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Iwai M, Ando S, Sato K. The process of reacquiring new vocalization in total laryngectomy patients with head and neck cancer: A qualitative study. Asia Pac J Oncol Nurs 2024; 11:100362. [PMID: 38433771 PMCID: PMC10904916 DOI: 10.1016/j.apjon.2023.100362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/03/2023] [Indexed: 03/05/2024] Open
Abstract
Objective Speech rehabilitation significantly contributes to the enhanced quality of life for patients who have undergone laryngectomy due to head and neck cancer. The initiation of tracheoesophageal speech early in the rehabilitation process has been associated with improved speech quality. Despite this, voice changes can carry a stigma due to communication challenges, even after successful voice restoration, potentially limiting the overall improvement in quality of life. Thus, our aim was to gain a profound understanding of the transition process from the selection to the adaptation of tracheoesophageal speech in patients with head and neck cancer. Methods Participants, who had undergone laryngectomy for head and neck cancer, were recruited from peer support groups in Japan, resulting in the identification of thirteen tracheoesophageal speakers. The data were analyzed using grounded theory methodology, incorporating open, axial, and selective coding. Semi-structured interviews delved into tracheoesophageal speakers' perceptions of their voices and the adaptive strategies employed for their preferred alternative communication methods. Results During the adaptation process, participants underscored the importance of communicating with their own voices. However, they also experienced anxiety about losing their natural voice, confronted the reality of living without a voice, and coped with their new voice. Eventually, participants came to recognize the changed voice as their own. Conclusions The personal conviction associated with the notion of "communicating with one's own voice" is integral to the adaptation process for patients with head and neck cancer who undergo laryngectomies and utilize tracheoesophageal speech. Some aspects of tracheoesophageal speech can evoke feelings of hopelessness, emphasizing the importance of comprehensive support for professional speech rehabilitation.
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Affiliation(s)
- Miyoko Iwai
- Nursing for Advanced Practice, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya City, Aichi, Japan
| | - Shoko Ando
- Department of Nursing, Ichinomiya Kenshin College, Ichinomiya City, Aichi, Japan
| | - Kazuki Sato
- Nursing for Advanced Practice, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya City, Aichi, Japan
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2
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Weidlich S, Pfeiffer J, Kugler C. Self-management of patients with tracheostomy in the home setting: a scoping review. J Patient Rep Outcomes 2023; 7:101. [PMID: 37823948 PMCID: PMC10570259 DOI: 10.1186/s41687-023-00643-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE The aim of this study was to create a model of patient-centered outcomes with respect to self-management tasks and skills of patients with a tracheostomy in their home setting. METHODS A scoping review using four search engines was undertaken (Medline, CINAHL, PsycINFO, Cochrane Library) to identify studies relevant to this issue and published since 2000. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statements for Scoping Reviews (PRISMA-ScR), the Joanna Briggs Institute (JBI) approach of conducting and reporting a scoping review, and the Participants, Concept, Context (PCC) scheme were employed. The following elements of the framework synthesis study data were screened, and presented based on the self-management model of Lorig and Holman. RESULTS 34 publications from 17 countries met the criteria for study inclusion: 24 quantitative, 8 qualitative and 2 mixed methods designs. Regarding the dimensions of self-management, 28 articles reported on "managing the therapeutic regimen", 27 articles discussed "managing role and behavior changes", and 16 articles explored "managing emotions". A model of self-management of patients with tracheostomy was developed, which placed the patient in the center, since it is this individual who is completing the tasks and carrying out his or her skill sets. CONCLUSION This scoping review represents the first comprehensive overview and modeling of the complex self-management tasks and skills required of patients with tracheostomy in their home setting. The theoretical model can serve as a cornerstone for empirical intervention studies to better support this patient-centered outcome for this population in the future.
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Affiliation(s)
- Sandra Weidlich
- Faculty of Medicine, Department of Oto-Rhino-Laryngology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Jens Pfeiffer
- Center for Oto-Rhino-Laryngology (HNO Center am Theater), Freiburg, Germany
| | - Christiane Kugler
- Faculty of Medicine, Institute of Nursing Science, University of Freiburg, Breisacher Str. 153, Freiburg, 79110, Germany.
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3
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Beckett M, Gaudet M, Bourque JM, Dennis K, Abdel-Wahab M. Equity in adjuvant radiotherapy utilization in locally advanced head and neck cancer: A SEER-data based study. Head Neck 2023; 45:921-930. [PMID: 36797802 DOI: 10.1002/hed.27319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/19/2023] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Not all patients with locally advanced head and neck cancer (HNC) who are eligible for adjuvant radiotherapy (RT) following upfront surgery appear to receive it. METHODS Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Selected patients from 2009 to 2018 had locally advanced HNC, underwent upfront surgery, and were eligible for adjuvant RT. Multivariable logistic regression and chi-squared test were used to analyze available patient and tumor characteristics. RESULTS Of 12 549 patients, 84.5% underwent adjuvant RT, 15.5% did not. Characteristics associated with lowest adjuvant RT utilization included cancers of the larynx (p < 0.0001) and gingivae (p < 0.0001), age 80 and above (p < 0.0001), unpartnered status (p < 0.0001), and residence within a nonmetropolitan area (p < 0.0024). CONCLUSIONS Tumor subsite, age, partnered status, and rural/urban residence correlate with omission of adjuvant RT in locally advanced HNC.
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Affiliation(s)
- Matthew Beckett
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Marc Gaudet
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Jean-Marc Bourque
- Département Radio-Oncologie, Centre Hospitalier de l'Universite de Montreal, Montreal, Québec, Canada
| | - Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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Bodd MH, McCammon SD. Laryngeal Cancer and the End of Life (As We Know It). Otolaryngol Clin North Am 2023; 56:403-412. [PMID: 37030951 DOI: 10.1016/j.otc.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
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.
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Bernstein RT, Garner-Purkis A, Gallagher JE, Newland-Pedley, Scambler S. A systematic review of social impacts of treatment and rehabilitation of head and neck cancer patients. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2023. [DOI: 10.1016/j.adoms.2023.100409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Zheng L, Luo Z, Wang H, Liu S, Li X, Peng D, Liu Y, Ye S, Lu Y, Chen J, Mei Z, Wei L, Qian Y, Lin X, Xu C. Effectiveness of a nurse-led coaching of self-care agency intervention for elderly patients with total laryngectomy: study protocol for a randomised controlled trial. BMJ Open 2022; 12:e061238. [PMID: 36008060 PMCID: PMC9422826 DOI: 10.1136/bmjopen-2022-061238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Due to functional defects and structural destruction after total laryngectomy, patients experienced the poor quality of life, especially for elderly. The barriers to accessing self-care in elderly patients were considered to result from complex and multifaceted interactions of biologic and social factors. Therefore, specific efforts to improve elderly patients' quality of life are needed. The purpose of our study is to verify nurse-led coaching of elderly patient self-care approaches, which can reduce logistic burden of patients and obtain the successful functional rehabilitation ultimately. METHODS AND ANALYSIS Elderly patients (n=60) scheduled for total laryngectomy will be randomly divided into the intervention group and the control group. Patients in the control group received routinely nursing during hospitalisation and thereby at home after discharge received conventional family care without regular supervision of nurses. Patients in the intervention group will receive a series of self-care intervention based on the transtheoretical model during hospitalisation. During home after discharge, nurses will additionally evaluate and supervise the self-care effect of patients. The two groups of patients' self-care agency, self-efficacy, quality of life and nutritional status will be recorded separately at different time points. Primary outcome is the improvement of patients' self-care agency, and secondary outcome is the improvements of patients' self-efficacy, quality of life, nutritional states and 3-month unplanned readmission rate. ETHICS AND DISSEMINATION The Ethics Committee of Hubei Cancer Hospital has approved this protocol (KYLLBA2020006). The findings of the trial will be disseminated through peer-reviewed journals, national or international conferences. TRIAL REGISTRATION NUMBER ChiCTR2100043731.
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Affiliation(s)
- Liyuan Zheng
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Luo
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huifen Wang
- Department of Nursing, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu'e Liu
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xue Li
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Danxia Peng
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Liu
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sanxia Ye
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuchen Lu
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Chen
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhidan Mei
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lai Wei
- Department of Radiotherapy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Qian
- Department of Thoracic Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Lin
- Department of Thoracic Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Xu
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Smith BD, Osazuwa-Peters OL, Cannon TY, Reed WT, Puscas L, Osazuwa-Peters N. Nonsurgical Risk Factors Associated With Pharyngocutaneous Fistula in Patients Who Have Undergone Laryngectomy. JAMA Otolaryngol Head Neck Surg 2021; 147:966-973. [PMID: 34591065 DOI: 10.1001/jamaoto.2021.2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pharyngocutaneous fistula (PCF) is a serious complication after total laryngectomy. Despite the well-described clinical risk factors for PCF and its association with poor quality of life, there is a paucity of data on the nonclinical factors that may be associated with this complication. Objective To determine whether nonclinical risk factors (eg, age, sex, race and ethnicity) are associated with an increased risk of developing a PCF after total laryngectomy, and whether or not the method of reconstruction explains any differences found. Design, Setting, and Participants This retrospective multicenter cohort study used data from a nationally validated, risk-adjusted, outcomes-based, surgical quality improvement database (the National Surgical Quality Improvement Program) to examine outcomes in patients who underwent a total laryngectomy from 2005 to 2018. The database was queried from January 1, 2005, to December 31, 2018; data analyses were performed from September 1, 2020, to March 31, 2021. Main Outcomes and Measures The primary outcome was development of a PCF within 30 days of a total laryngectomy. Patient characteristics, including age, sex, race and ethnicity, comorbidities, and mode of reconstruction, were analyzed. Results A cohort of 1573 adult patients (median age [IQR], 63 [56-71] years; 1280 [81.4%] men; 293 [18.6%] women; 1001 [63.6%] non-Hispanic White individuals) had undergone a total laryngectomy during the study period and were included in the analyses. The overall rate of PCF formation was 4.3% (68 of 1573 patients). Hispanic patients had the highest rate (9.5%; 9 of 95 patients) of PCF formation, which was more than twice the rate among non-Hispanic White patients (3.8%; 38 of 1001) and non-Hispanic Black patients (4.7%; 11 of 236). After adjusting for clinical and other covariates, women were 1.9 times more likely to develop a PCF compared with men (adjusted odds ratio, 1.90; 95% CI, 1.08-3.35). We also found that the odds of developing a PCF were 3-fold higher among Hispanic patients compared with non-Hispanic White patients (adjusted odds ratio, 2.96; 95% CI, 1.36-6.47). The type of reconstruction did not differ across age or race and ethnicity after controlling for clinical risk factors. Conclusions and Relevance This multicenter cohort study found that 2 nonclinical risk factors-Hispanic ethnicity and female sex-were associated with an increased risk of PCF formation. Knowledge of these risk factors should be included in patient-physician decision-making as well as future interventions to decrease the rate of PCF formation after laryngectomy.
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Affiliation(s)
- Blaine D Smith
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Oyomoare L Osazuwa-Peters
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Trinitia Y Cannon
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - William T Reed
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Liana Puscas
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Duke Cancer Institute, Durham, North Carolina
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van Sluis KE, Kornman AF, Groen WG, van den Brekel MWM, van der Molen L, Hoffman-Ruddy B, Stuiver MM. Expiratory Muscle Strength Training in patients After Total Laryngectomy; A Feasibility Pilot Study. Ann Otol Rhinol Laryngol 2020; 129:1186-1194. [PMID: 32527195 DOI: 10.1177/0003489420931889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Expiratory muscle strength training (EMST) is a threshold based device-driven treatment for improving expiratory pressure. EMST proved to be effective in different patient groups to improve cough function. To date, EMST has not been tested in the total laryngectomy population (TL). METHODS This prospective, randomized case-series study examined feasibility, safety, and compliance of EMST in a group of TL participants and its effects on pulmonary function, physical exertion, fatigue, and vocal functioning. Ten TL participants were included in the study to perform a 4 till 8 weeks of EMST. Objective and subjective outcome measures included manometry, spirometry, cardio pulmonary exercise testing (CPET), voice recordings, and patient reported outcome measures. Group means were reported and estimates of the effect are shown with a 95% confidence interval, using single sample t-tests. RESULTS Nine participants completed the full study protocol. Compliance to the training program was high. All were able to perform the training, although it requires adjustments of the device and skills of the participants. Maximum expiratory pressure (MEP) and vocal functioning in loudness improved over time. After EMST no changes were seen in other objective and subjective outcomes. CONCLUSIONS EMST appears to be feasible and safe after total laryngectomy. MEP improved over time but no improvement in the clinically relevant outcome measures were seen in this sample of relatively fit participants. Further investigation of the training in a larger group of participants who report specifically pulmonary complaints is recommended to investigate if the increase in MEP results in clinical benefits. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Klaske E van Sluis
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Noord-Holland, The Netherlands
- Amsterdam Center for Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne F Kornman
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Noord-Holland, The Netherlands
| | - Wim G Groen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Noord-Holland, The Netherlands
- Amsterdam Center for Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
- Department of Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Noord-Holland, The Netherlands
| | - Bari Hoffman-Ruddy
- School of Communication Sciences and Disorders, University of Central Florida, Orlando, FL, USA
| | - Martijn M Stuiver
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Noord-Holland, The Netherlands
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
- ACHIEVE, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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