Voice-Related Quality of Life in Post-Laryngectomy Rehabilitation: Tracheoesophageal Fistula’s Wellness

Cocuzza, Salvatore; Grillo, Calogero; Ferlito, S; Spinato, Giacomo; Coco, S.; Merlino, Federico; Stilo, Giovanna; Santoro, G; Iannella, Giannicola; Vicini, Claudio; Mantia, Ignazio La

doi:10.3390/ijerph17124605

Cited by 26 publications

(25 citation statements)

References 38 publications

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“…This study demonstrated equivalent 2-year overall survival (OS) in patients with advanced-stage larynx cancer randomized to induction chemotherapy with definitive radiation therapy (CRT) vs surgery. Treatment with CRT for laryngeal preservation was not associated with functional morbidity and quality-of-life limitations associated with surgery, suggesting that nonsurgical therapy may be an equivalent standard of care for advanced laryngeal cancer . With a local recurrence rate of 36% after primary definitive CRT, salvage TL with intent to cure was necessary for persistent or recurrent disease …”

Section: Introductionmentioning

confidence: 99%

Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy

Gross

Patel

Switchenko

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceControversy exists regarding management of the clinically node-negative neck in patients with recurrent larynx or hypopharynx cancers who received total laryngectomy after definitive radiation with or without chemotherapy.ObjectiveTo explore clinical and oncologic outcomes after elective neck dissection vs observation in patients who received clinically node-negative salvage total laryngectomy.Design, Setting, and ParticipantsThis cohort study was performed from January 2009 to June 2021 at a single, high-volume tertiary care center. Follow-up was conducted through June 2021 for all patients. Survival outcomes were based on at least 2 years of follow-up. Patients aged 18 years or older with recurrent, clinically node-negative larynx or hypopharynx tumors after definitive nonsurgical treatment who were treated with a salvage total laryngectomy were included. Data were analyzed from October 2021 through September 2022.ExposuresElective neck dissection.Main Outcomes and MeasuresPresence and location of occult nodal metastasis in electively dissected necks, along with differences in fistula rates and overall and disease-free survival between patients receiving elective neck dissection vs observation.ResultsAmong 107 patients receiving clinically node-negative salvage total laryngectomy (median [IQR] age, 65.0 [57.8-71.3] years; 91 [85.0%] men), 81 patients underwent elective neck dissection (75.7%) and 26 patients underwent observation (24.3%). Among patients with elective neck dissection, 13 patients had occult nodal positivity (16.0%). Recurrent supraglottic (4 of 20 patients [20.0%]) or advanced T classification (ie, T3-T4; 12 of 61 patients [19.7%]) had an occult nodal positivity rate of 20% or more, and positive nodes were most likely to occur in levels II and III (II: 6 of 67 patients [9.0%]; III: 6 of 65 patients [9.2%]; VI: 3 of 44 patients [6.8%]; IV: 3 of 62 patients [4.8%]; V: 0 of 4 patients; I: 0 of 18 patients). There was a large difference in fistula rate between elective neck dissection (12 patients [14.8%]) and observed (8 patients [30.8%]) groups (difference, 16.0 percentage points; 95% CI, −3.4 to 35.3 percentage points), while the difference in fistula rate was negligible between 50 patients undergoing regional or free flap reconstruction (10 patients [20.0%]) vs 57 patients undergoing primary closure (10 patients [17.5%]) (difference, 2.5 percentage points; 95% CI, −12.4 to 17.3 percentage points). Undergoing elective neck dissection was not associated with a clinically meaningful improvement in overall or disease-free survival compared with observation. Recurrent hypopharynx subsite was associated with an increased risk of death (hazard ratio, 4.28; 95% CI, 1.81 to 10.09) and distant recurrence (hazard ratio, 7.94; 95% CI, 2.07 to 30.48) compared with glottic subsite.Conclusions and RelevanceIn this cohort study, patients with recurrent supraglottic or advanced T classification tumors had an increased occult nodal positivity rate, elective neck dissection was not associated with survival, and patients with recurrent hypopharynx subsite were more likely to have a distant recurrence and die of their disease. These findings suggest that underlying disease pathology rather than surgical management may be associated with survival outcomes in this population.

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Section: Introductionmentioning

confidence: 99%

Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy

Gross

Patel

Switchenko

et al. 2023

JAMA Otolaryngol Head Neck Surg

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“…A further assessment by Agarwal et al found long-term outcomes of the V-RQoL reported higher patient satisfaction with the crucial contribution of social support (about 80% V-RQoL excellent score and >75% minimal VHI score). The quality-of-life questionnaire discovered significantly better outcomes in both socio-emotional and functional domains in the tracheoesophageal patient group compared to the esophageal group (p = 0.01; p = 0.01, respectively) in post-laryngectomy rehabilitation [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Short and Long-Term Voice and Swallowing-Related Quality of Life in Patients Who Underwent Total Laryngectomy and Tracheoesophageal Puncture

Marzouki¹,

Taylouni²,

Tonkal³

et al. 2022

Cureus

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Background Voice and swallowing disorders can create a profound psychosocial impact on the patient’s quality of life. The focus of this study is to assess the psychosocial disabling effects on patients after total laryngectomy (TLP) using pre-validated surveys called the Voice Handicap Index 10 (VHI) for voice disorders and the Dysphagia Handicap Index (DHI) for swallowing disorders. Methodology This is a retrospective cohort study that was done on a total of 21 patients. The study was conducted at King Abdulaziz University Hospital between 2017 and 2022. The Cronbach’s alpha value was used to evaluate internal consistency reliability. The relationship between DHI, VHI, and demographic and clinical variables was analyzed by correlation analysis. A p-value of <0.05 was considered statistically significant, and all the tests were two-sided. Results The Cronbach’s alpha coefficient satisfied the internal consistency reliability for VHI and DHI for both total and their subscale scores. For DHI, the total score and emotional subscale obtained an alpha of greater than 0.9, indicating excellent internal consistency, whereas both physical and functional alpha scores indicated good internal consistency (α = 0.888 and α = 0.863, respectively). For VHI, the total score and physical subscale of the VHI had excellent internal consistency (α = 0.957 and α = 0.937, respectively), while the functional and emotional subscales had good internal consistency (α = 0.865 and α = 0.894, respectively). The total DHI scores, as well as the functional subscale scores, were significant (p = 0.033, p = 0.025, respectively) in terms of self-reported dysphagia severity. A moderately severe group (69.00 ± 19.17) had higher mean total scores, whereas severe individuals had higher subscale mean scores according to self-reported dysphagia severity. Self-reported dysphagia severity was as follows: normal (n = 3, 14.3%), mild (n = 4, 19%), moderate (n = 8, 38.1%), and severe (n = 6, 28.6%). Conclusions The disability caused by voice and swallowing disorders can be evaluated by VHI and DHI which have been statistically validated as reliable tools to assess the effects of dysphagia and dysphonia on quality of life. Patients after laryngectomy have higher mean DHI and VHI overall and functional subscale scores. However, this study failed to establish any relationship between clinical and demographical characteristics of the patients with DHI and VHI index.

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“…More importantly, most healthcare services considered not urgent or elective (such as the SLP clinics) have experienced a considerable interruption or fragmentation of their activities [18]. Therefore, the COVID-19 pandemic has obliged the healthcare system to significantly transform its service offer and delivery modality, thus promoting a rapid expansion of the telehealth and TRH [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Post-stroke aphasia at the time of COVID-19 pandemic: a telerehabilitation perspective

Cassarino¹,

F²,

Gelardi³

et al. 2022

J. Integr. Neurosci.

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We report on our remote speech therapy experience in post-stroke aphasia. The aim was to test the feasibility and utility of telerehabilitation to support future randomized controlled trials. Post-stroke aphasia is a common and disabling speech disorder, which significantly a fects patients' and caregivers' health and quality of life. Due to COVID-19 pandemic, most of the conventional speech therapy approaches had to stop or ''switch'' into telerehabilitation procedures to ensure the safety of patients and operators but, concomitantly, the best rehabilitation level possible. Here, we planned a 5-month telespeech therapy programme, twice per week, of a patient with non-luent aphasia following an intracerebral haemorrhage. Overall, treatment adherence based on the operator's assessments was high, and incomplete adherence for technical problems occurred very rarely. In line with the patient's feedback, acceptability was also positive, since he was constantly motivated during the sessions and the exercises performed autonomously, as confirmed by the speech therapist and caregiver, respectively. Moreover, despite the sequelae from the cerebrovascular event, evident in some writing tests due to the motor deficits in his right arm and the disadvantages typical of all telepractices, more relevant results were achieved during the telerehabilitation period compared to those of the ''face-to-face'' therapy before the COVID-19 outbreak. The telespeech therapy performed can be considered successful and the patient was able to return to work. Concluding, we support it as a feasible approach o fering patients and their families the opportunity to continue the speech and language rehabilitation pathway, even at the time of pandemic.

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Voice-Related Quality of Life in Post-Laryngectomy Rehabilitation: Tracheoesophageal Fistula’s Wellness

Cited by 26 publications

References 38 publications

Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy

Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy

Short and Long-Term Voice and Swallowing-Related Quality of Life in Patients Who Underwent Total Laryngectomy and Tracheoesophageal Puncture

Post-stroke aphasia at the time of COVID-19 pandemic: a telerehabilitation perspective

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