Trade-off between survival and laryngeal preservation in advanced laryngeal cancer: the otorhinolaryngology patient's perspective.
ABSTRACT We performed a prospective study to evaluate, from the patient's perspective, the trade-off between speech and survival that individuals face when given a diagnosis of advanced-stage laryngeal cancer amenable to either total laryngectomy or a laryngeal preservation protocol using chemotherapy and radiotherapy.
Volunteers (309) consecutively seen at the otorhinolaryngology clinic of a university teaching hospital in France completed an anonymous questionnaire designed to determine their position if they faced the diagnosis of an advanced-stage laryngeal cancer. Univariate analysis was performed for potential statistical relationships with various variables.
We found that 12.9% of patients were unable to determine their position regarding the two treatment options offered, and this group had a significant statistical relationship with four variables (age, education, professional status, and history of cancer among relatives). We found that 24.6% of patients made survival their main consideration and would not consider any trade-off. Among the 62.5% who considered the trade-off, the percentage of cure that patients were ready to lose in order to preserve their larynx varied from 5% to 100% (mean, 33%; SD, 23%). Aside from the undecided group, none of the variables analyzed was related either to the decision as to whether to consider a trade-off or to the percentage of c re that patients agreed to trade to preserve their larynx.
In patients with advanced-stage laryngeal cancer, treatment should be initiated only after careful evaluation of the patient's attitude toward both laryngeal preservation and survival.
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ABSTRACT: Objective To analyse, based on an anonymous questionnaire, the treatment decision envisaged and the impact of the medical information delivered in patients facing the diagnosis of an advanced laryngeal cancer amenable to total laryngectomy or a laryngeal preservation protocol. Material and methods Prospective study conducted in a French teaching hospital based on questionnaires filled in by 269 patients attending the otorhinolaryngology clinic. Results A total of 28.6% of patients would not consider any trade-off of cure to preserve their larynx; 1.4% of patients were willing to trade all chances of cure in order to avoid total laryngectomy. The median percentage of cure that patients were ready to loose in order to preserve their larynx was 33% (range: 5 to 100%); 47.9% of patients wanted to receive additional information before making their decision with a significant increase among patients with a level of education beyond secondary school (P = 0.0006) and among patients with a family history of cancer (P = 0.038). The additional information most frequently requested concerned the complications related to the laryngeal preservation protocol (34.1%) and the cure rate (28.6%). After receiving information about the risk of tracheostomy and permanent gastrostomy following the laryngeal preservation protocol, the percentage of subjects who would not consider any trade-off in order to preserve their larynx increased to 31.2% and 56.1%, respectively. Conclusion Laryngeal preservation is not a major objective of treatment shared by patients filling a questionnaire devoted to the choice of treatment when facing an advanced laryngeal cancer. Specific information concerning the expected results and the inherent risks involved in the various treatment options must be provided in every case.European Annals of Otorhinolaryngology, Head and Neck Diseases 04/2014; DOI:10.1016/j.anorl.2013.06.001
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ABSTRACT: Objective: To assess the survival outcomes of a homogeneous group of pT4a laryngeal cancer patients treated, at our institution, by primary total laryngectomy and neck dissection with adjuvant therapy when indicated and to systematically review studies reporting overall survival outcomes in T4a laryngeal cancer. Data Sources: Pubmed and Embase databases Review Methods: Records of 108 laryngeal cancer patients treated by total laryngectomy were reviewed. pT4a cases treated by primary total laryngectomy between 1998 and 2010 were included. Overall and disease free survival at 2 and 5 years are reported. A systematic review was performed including all published studies reporting overall survival outcomes by treatment modality in T4 laryngeal cancer patients. Results: 30 cases met the inclusion criteria. At 2 years, overall and disease free survival were 81.3% and 78% respectively. The 5-years overall and disease free survival rates were 60%. The systematic review retrieved 24 articles. Overall survival at 2 years ranged from 12 to 21.2% with radiotherapy, <30% to 65% with chemoradiotherapy and from 30 to 100% with surgery. At 5 years, it ranged from 0 to 75% with radiotherapy, 16 to 50.4% with chemoradiotherapy and 10 to 80.9% with surgery. Conclusion: Primary total laryngectomy provides a high survival rate for pT4a laryngeal cancer patients. Randomized controlled trials including homogenous patients are still needed before shifting to organ preservation protocols in these patients.The Laryngoscope 07/2014; 124(7). DOI:10.1002/lary.24557 · 2.03 Impact Factor
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ABSTRACT: PurposeThe mortality rate of laryngeal cancer has been trending downward with the use of more effective surgical, radiation, and systemic therapies. Although the best treatment for this disease is not entirely clear, there is a growing consensus on the value of primary radiotherapy as an organ preservation strategy. This study examines urban-rural differences in the use of radiotherapy as the primary treatment for early stage laryngeal cancer in Pennsylvania.Experimental DesignThe sample was drawn from the Pennsylvania tumor registry, which lists 2,437 laryngeal cancer patients diagnosed from 2001 to 2005. We selected 1,705 adults with early stage squamous cell carcinoma of the larynx for our analysis. Demographic data and tumor characteristics were included as control variables in multivariate analyses. Rurality was assigned by ZIP code of patient residence.ResultsControlling for demographic and clinical factors, rural patients were less likely than urban patients to receive radiotherapy as the primary treatment modality for early stage larynx cancer (OR 0.740, 95% CI 0.577-0.949, P = .0087). No other associations between rural status and treatment choice were statistically significant.Conclusions Relatively fewer rural patients with larynx cancer are treated primarily with radiation therapy. Further investigations to describe this interaction more thoroughly, and to see if this observation is found in larger population data sets, are warranted.The Journal of Rural Health 03/2014; 30(4). DOI:10.1111/jrh.12069 · 1.77 Impact Factor