A prospective study of long-term dysphagia following total laryngectomy.
ABSTRACT To evaluate the degree of dysphagia in patients before and after total laryngectomy using the Performance Status Scale for Head and Neck Cancer Patients (PSS) and to determine the effects of post-operative radiation therapy, neck dissection, and pharyngoesophageal spasm on PSS scores.
We performed a controlled, prospective study at a tertiary referral university hospital. Twenty consecutive patients undergoing laryngectomy were included. Patients were followed for at least two years post-operative, without evidence of local, regional, or distant disease. Only patients with squamous cell carcinoma limited to the endolarynx requiring total laryngectomy with or without elective neck dissection for surgical management of cancer and with no pre-operative treatment were included. Dysphagia was evaluated by PSS prior to surgery and again two years postoperatively with an emphasis on eating in public and normalcy of diet domains. Video fluoroscopic evaluation of swallowing was performed one year after treatment.
The relative number of patients with low mean scores in PSS (i.e. usually swallow paste of fluid food in presence of some selected persons or alone; < or = 50) increased after total laryngectomy (p = 0.04). Patients with lower scores reported more frequent spasm of the pharyngoesophageal segment (p = 0.005). Mean scores of both domains decreased after surgery (p < 0.05).
Eating in public and normalcy of diet scores decreased in 50% of patients after total laryngectomy.
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ABSTRACT: INTRODUÇÃO: A laringectomia total pode ocasionar sequelas na deglutição e comprometer a qualidade de vida do paciente, em virtude dos impactos negativos na fisiologia e na vida social. OBJETIVO: Descrever o impacto da deglutição na qualidade de vida de laringectomizados totais. MÉTODO: Foi aplicado o questionário Swallowing Quality of Life, composto por 44 perguntas que avaliam 11 domínios relacionados à qualidade de vida (fardo, duração, desejo, frequência de sintomas, seleção de alimentos, comunicação, medo, saúde mental, função social, sono e fadiga). A análise foi realizada através de estatística descritiva, com medidas de tendência central e de variabilidade. Estudo de séries. RESULTADOS: A amostra foi composta por 15 voluntários submetidos à laringectomia total e radioterapia adjuvante. 66,7% consideraram a saúde boa e 73% não referiram restrições à consistência dos alimentos. Os domínios "comunicação" e "medo" representaram impacto severo e a "duração da alimentação" exerceu impacto moderado na qualidade de vida. Os itens com menores escores foram: maior tempo para comer do que outras pessoas (domínio "duração da alimentação"), tosse e tosse para retirar o líquido ou a comida para fora da boca quando estes estão parados (domínio "frequência dos sintomas"), dificuldades em entender (domínio "comunicação") e medo de engasgar e ter pneumonia (domínio "medo"). CONCLUSÃO: Em laringectomizados totais, a deglutição exerceu impacto severo a moderado nos domínios "comunicação", "medo" e "duração da alimentação".12/2012; 16(4):460-465. DOI:10.7162/S1809-97772012000400006
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ABSTRACT: PURPOSE OF REVIEW: Total laryngectomy rehabilitation (TLR) in Europe is not uniform, with quite some differences in approach and infrastructure between various countries. In, for example, the Netherlands, Switzerland, Scandinavia, and more recently also in the UK, head and neck cancer (HNC) treatment and rehabilitation shows a high level of centralization in dedicated HNC centres. In other European countries, the level of centralization is lower, with more patients treated in low-volume hospitals. This article focusses on the situation in the Netherlands and, where applicable, will discuss the regional variations in Europe. RECENT FINDINGS: Prosthetic surgical voice restoration (PSVR) presently is the method of choice in Europe, and use of oesophageal and electrolarynx voice has moved to the background. In most European countries (except the UK and Ireland), PSVR is physician driven, with an indispensable role for speech-language pathologists and increasingly for oncology nurses. Indwelling voice prostheses are mostly preferred, also because these devices can be implanted at the time of trachea-oesophageal puncture. Pulmonary rehabilitation is achieved with heat and moisture exchangers, which, based on extensive clinical and basic physiology research, are considered an obligatory therapy measure. In addition to PSVR, also issues such as smoking cessation, dysphagia/swallowing rehabilitation, and olfaction/taste rehabilitation are discussed. Especially, the latter has shown great progress over the last decade and is another example of increasing implementation of evidence-based practice in TLR. SUMMARY: TLR has shown considerable progress over the last decades, and through the intensified collaboration between all clinicians involved, significantly has improved vocal, pulmonary, and olfactory rehabilitation after total laryngectomy.Current opinion in otolaryngology & head and neck surgery 04/2013; 21(3). DOI:10.1097/MOO.0b013e3283610060 · 1.39 Impact Factor
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ABSTRACT: The purpose of this study is to compare health-related quality of life (HRQoL) and emotional distress among diverse cancer survivors who had completed all treatment within the previous year. A convenience sample of 353 cancers survivors (lung, head and neck, breast and prostate cancers) were recruited to complete a survey, which consisted of (i) Hospital Anxiety and Depression Scales; (ii) Chinese version of the Functional Assessment of Cancer Therapy-General version; and (iii) demographic and clinical data. The HRQoL scores were similar among the four types of survivors. Mild anxiety and depression levels were reported, but no significant difference was noted. Younger females with financial burdens and uncertain prognosis were particularly associated with HRQoL and emotional distress. Further studies are essential to identify specific problems that cancer patients experience after cancer diagnosis that might lead to the early detection of those most at risk of ongoing problems.International Journal of Nursing Practice 06/2013; 19(3):306-17. DOI:10.1111/ijn.12074 · 0.54 Impact Factor