Patient Reflections on Decision Making for Laryngeal Cancer Treatment

Abstract

Objective To describe the reflections of patients treated for laryngeal cancer with regard to treatment-related decision making. Study Design Cross-sectional survey-based pilot study. Setting Single-institution tertiary care cancer center. Subjects/Methods Adults with laryngeal carcinoma were eligible to participate (N = 57; 46% treated surgically, 54% non-surgically). Validated surveys measuring decisional conflict and regret explored patients’ reflections on their preferences and priorities regarding treatment-related decision making for laryngeal cancer and how patient-reported functional outcomes, professional referral patterns, and desired provider input influenced these reflections. Results When considering the level of involvement of surgeons, radiation oncologists, and medical oncologists in their care, patients were more likely to believe that the specialist whom they saw first was the most important factor in deciding how to treat their cancer (Fisher’s exact, ~χ2 = 16.2, df = 6, P = .02). Patients who were treated for laryngeal cancer who reported worse voice-related quality of life recalled more decisional conflict (P = .01) and experienced more decisional regret (P <.001). Of the patients for whom speech was a top priority prior to treatment, better voice-related quality of life overall scores were correlated with less decision regret about treatment decisions (P <.02). Of the patients for whom eating and drinking were top priorities prior to treatment, better MD Anderson Dysphagia Inventory global scores were correlated with less decision regret about treatment decisions (P <.002). Conclusion Patient priorities and attitudes, coupled with functional outcomes and professional referral patterns, influence how patients reflect on their choices regarding management of laryngeal cancer. Better understanding of these variables may assist in ensuring that patients’ voices are integrated into individualized laryngeal cancer treatment planning.

Patient perspectives and treatment regret after de‐escalated chemoradiation for human papillomavirus‐positive oropharyngeal cancer: Findings from a phase II trial

“…Although there have been limited studies evaluating treatment regret in head and neck cancer, our findings are similar to the low level of treatment regret noted in patients treated with standard of care therapy, suggesting that patients treated with de‐escalated approach reflect similarly in their treatment decision making . Instructively, various negative factors have been found to predict for treatment regret in the setting of others cancers including the development of severe long‐term treatment toxicities, a passive role in treatment decision‐making, baseline patient expectations regarding treatment outcomes that may be artificially inflated, poor global posttreatment quality of life, and functional impairments in patients with head and neck cancers with swallowing function particularly associated with regret in patients with oropharyngeal carcinoma . Further research evaluating treatment regret in patients with head and neck cancer of higher risk and in patients facing poorer functional outcomes are warranted.…”

Factors associated with gastrostomy tube dependence following salvage total laryngectomy with microvascular free tissue transfer

“…While much has been published regarding the effect of microvascular‐free tissue transfer (MFTT) on the rate of PCF, its impact on long‐term swallowing outcomes and rates of gastrostomy tube (G‐tube) dependence remains largely unknown . After cure from cancer, the ability to swallow consistently ranks as a top priority for head and neck cancer patients . Although aspiration is not a concern for total laryngectomy (TL) patients, they remain at risk for dysphagia as a result of the pharyngeal weakness and pharyngoesophageal restriction …”

“…6,7 After cure from cancer, the ability to swallow consistently ranks as a top priority for head and neck cancer patients. 8,9 Although aspiration is not a concern for total laryngectomy (TL) patients, they remain at risk for dysphagia as a result of the pharyngeal weakness and pharyngoesophageal restriction. 10 As patients and providers choose between surgical and nonsurgical paradigms for management of locally advanced larynx cancer, understanding treatment implications for longterm swallowing function is critical.…”

Use of a Multidisciplinary Design Optimization Approach to Model Treatment Decisions in Oropharyngeal Cancer

“…The vector space of actions is state-specific and determined by appropriate clinical practice. As noted before, these can be limited by patient preference, financial considerations, and available diagnostic technologies (Shuman et al 2017). Because practice and infrastructure vary widely between and within countries, the selection of actions to include must be part of the domain analysis and, if extensive travel or other burdens are imposed on the patient in order to deliver care, these may cause psychosocial effects that will likewise need to be included in the model.…”