Integrated medical program of therapy and support of laryngectomized patients: evaluation of their quality-of-life

Objectives Surgical procedures and in particular laryngectomy can become a life-saving treatment for patients with laryngeal or hypopharyngeal cancer, but can result in permanent damage. Clinical observation suggests that patients vary considerably in their ways to deal with this new situation and their ability to cope. The goal of this study is to evaluate the quality of life in patients with head and neck cancer who have been subjected to laryngectomy and assess how they perceive their illness from an emotional and physical viewpoint, as well as to propose to them an integrated medical management (logopedic, otolaryngological, and psychiatric) matching their health status. This study has been conducted at the Medical University "Federico II" in Naples, Italy. Methods The sample was composed of 24 women (mean age 59 years), 16 of whom were subjected to total and 8 to partial laryngectomy. In 14 cases, lymph nodes were removed bilaterally and in two cases unilaterally. Postoperatively, six patients were treated with radiotherapy, one of whom received also chemotherapy (Fig. 1). To assess physical and psychological aspects of the patient's postoperative life we used the Statisfaction Profile of the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (Eortic Olg-C-30) 1, and the Illness Perception Questionnaire; analyzed were functional-physical components, oral communication, and aspects of family, social, psychological, and professional life. The EORTC QLQ-C30, is an a cancerspecific multidimensional questionnaire incorporating five functional scales (physical, role, cognitive, emotional and social), three symptom scales (fatigue, pain, nausea and vomiting), a global health status/QL scale, five questions assessing additional symptoms (dyspnoea, loss of appetite, insomnia, constipation and diarrhoea), and the perceived financial impact of disease. Illness perceptions were derived from the Illness Perception Questionnaire. The Identity scale is composed of symptom items that the patient rates for frequency on a four-point scale ranging from "all the time" to "never". The Revised Illness Perception Questionnaire was used to assess patient's beliefs and understanding of their illness and has proven validity and reliability across a range of illness groups. Results The most frequent complaints of the patients were increased bronchial discharge and reduced olfactory function. Problems with communicating with others were mentioned by 25%, using the telephone by 80%. With regard to psychological status, 50% were ashamed of their voice, 50% were ashamed of their appearance, 50% stated they were depressed; 37.5% had sleep difficulties; 25% did not participate in social meetings outside their house (Tables I, II). Conclusion Interviews indicated the effectiveness of integrated logopedic and psychological support. Such approach aims to regain functional physical ability and to alleviate the psycho-behavioural changes following laryngectomy. An integrated medical treatment could be important to support patients before surgery and increase their insight unto illness and its functional-physical and psychological consequences.