Dysphagia related quality of life (QoL) following total laryngectomy (TL)

Abstract

Purpose: This cross-sectional study evaluated the relationship between dysphagia post-total laryngectomy (TL) and quality of life (QoL) of people who reside in Greece. This is the first such report to be undertaken on the topic. Methods: Speech and language therapists typically use patient judgement to identify difficulties with swallowing. The Greek adaptations of the M.D. Anderson Dysphagia Inventory (MDADI) and the Eating Assessment Tool (EAT-10) were completed by members of the Hellenic Association of Laryngectomees (HAL). More than 400 questionnaires were sent, but only 23 were returned (18 males and 5 females). Results: The results revealed that dysphagia has a negative impact on the QoL of people who have undergone TL for treatment of laryngeal cancer. Conclusion: It appears that not only treatment (i.e. TL) of the primary disease, but also secondary problems as a result of the treatment, such as dysphagia, have a significant impact on the QoL of patients and must be taken into consideration when therapeutic decisions for laryngeal cancer are made. The qualitative measures used here provide a starting point to objectively describe QoL as perceived by TL patients. This is particularly pertinent in Greece where access to delivery and quality of health services has been challenging because of recent fiscal constraints.

Diagnosis and treatment of oropharyngeal dysphagia after total laryngectomy with or without pharyngoesophageal reconstruction: Systematic review

“…None of the studies was rated level A. Thirty-two studies were rated level B and 12 studies level C, according to Siwek et al 10 Level B studies comprised one low-quality randomized controlled trial, 13 ten prospective cohorts, [14][15][16][17][18][19][20][21][22][23] ten retrospective cohorts, [24][25][26][27][28][29][30][31][32][33] two case-control studies, 34,35 and nine crosssectional studies. [36][37][38][39][40][41][42][43][44] All case series were classified as level C evidence. [45][46][47][48][49][50][51][52][53][54][55][56] None of the 44 articles met all critical appraisal criteria (Table 3).…”

“…Thirty studies applied statistical analytic methods. 13,[15][16][17][18][19][20][21][22][23][25][26][27][28][29][30][31][32][33][35][36][37][38][40][41][42][43][44]46,47 6 | DIAGNOSIS OF OD AFTER TLE…”

“…37 Only four studies compared preoperative to postoperative data from the questionnaires. 20,27,29,36,37,43 The prevalence of OD after TLE ranged from 35% to 89% 21,22,32,39,42,43 and the incidence of OD after TLE was 58%. (Chemo)radiotherapy performed either preoperatively or postoperatively adversely affected swallowing.…”

“…28 The main OD symptoms reported in the studies were the following: prolonged mealtime, need for fluids to wash down a bolus, multiple swallows, avoidance of certain food consistencies, pain, coughing while eating, food "sticking" in the throat, regurgitation, and gastroesophageal reflux. 17,18,21,28,31,[38][39][40]43,50 OD had a negative impact on all MDADI domains, 43 on the SWAL-QoL domains "feeding duration," "communication," "fear," "mental health," and "general burden," 17,50 and on the TOM subscales "handicap," "well-being and distress," and "disability." 39,42,48 Ten studies reported a negative impact of OD on the patients' QoL.…”

“…14,16,17,19,20,[23][24][25][26][27]29,[32][33][34][35][36][37]41,43,45,49,54,55 The most frequently reported functional and/or structural complications of the neopharynx causing OD were pharyngeal weakness, increased resistance to bolus passage, strictures, and pseudodiverticulum formation. It may be due to radiotherapy, pharyngeal closure technique, the extent of additional pharyngeal mucosa resection, and postoperative complications.…”