Larynx cancer: quality of life and voice after treatment / Câncer de laringe: qualidade de vida e voz pós-tratamento

INTRODUCTION: Treatment for patients with larynx cancer often results in a negative impact on their physical, social and psychological functions. OBJECTIVE: To evaluate quality of life and voice in patients treated for advanced laryngeal cancer as a consequence of surgery or exclusive chemoradiation. METHODS: Retrospective cohort study with 30 patients free of disease: 10 total laryngectomy patients without production of esophageal speech (EVS); 10 Total laryngectomy patients with tracheoesophageal voice (TEV) and 10 patients with laryngeal voice. Quality of life was measured by SF-36; Voice-Related Quality of Life (V-RQOL) and Voice Handicap Index (VHI) protocols, applied on the same day. RESULTS: The SF-36 demonstrated that patients who received chemoradiotherapy exclusively enjoyed a feature better quality of life than the group of TEV and EVS. In V-RQOL it was observed that the quality of life related to voice is lower than in the EVS. In the VHI group EVS presented higher scores for overall VHI, emotional, functional and organic. DISCUSSION: Quality of life and voice in patients treated with chemoradiotherapy was better than in patients treated surgically. CONCLUSION: The type of medical treatment selected in patients with laryngeal cancer can influence changes in quality of life and voice. .

INTRODUÇÃO: Tratamentos para pacientes com câncer de laringe podem ter grande impacto negativo na função física, social e psicológica. OBJETIVO: Avaliar qualidade de vida e voz de pacientes tratados de câncer avançado de laringe por meio cirúrgico ou quimioradioterapia exclusiva. MÉTODOS: Estudo coorte retrospectivo com 30 pacientes livres da doença: sendo 10 laringectomizados totais sem produção de voz esofágica (SVE); 10 laringectomizados totais com voz traqueoesofágica (VTE) e 10 com voz laríngea. A qualidade de vida foi mensurada pelos protocolos SF-36; Qualidade de Vida em Voz (QVV) e Índice de Desvantagem Vocal (IDV), aplicados no mesmo dia. RESULTADOS: No SF-36, observou-se que pacientes que receberam quimioradioterapia exclusiva apresentaram melhor qualidade de vida do que o grupo de VTE e SVE. No QVV observou-se que a qualidade de vida relacionada à voz é menor no grupo SVE. No IDV grupo, SVE apresentou escore maior para IDV total, emocional, funcional e orgânica. DISCUSSÃO: Qualidade de vida e voz dos pacientes tratados com quimioradioterapia e melhor do que os pacientes tratados cirurgicamente. CONCLUSÃO: O tipo de tratamento médico utilizado em pacientes com câncer de laringe pode trazer alterações na qualidade de vida e voz. .

Implicações Orgânicas e Psicossociais Decorrentes do Câncer de Laringe / Organic and Psychosocial Implications Involved in Larynx Cancer

Sendo o câncer de laringe um dos mais frequentesno que se refere às neoplasias de cabeça e pescoço, estetrabalho teve como objetivo traçar considerações teóricas arespeito das implicações orgânicas e psicossociaisdecorrentes desta doença. Discussão: O tabagismo e oetilismo estão fortemente associados ao câncer de laringe,podendo surgir, em consequência destes, distúrbios da voz(disfonia), da deglutição (disfagia e odinofagia) e dispnéia. Areabilitação do paciente com câncer laríngeo deve iniciar-sepelo abandono dos hábitos viciosos, o que muitas vezes édifícil, além de que este poderá deparar-se com a perda totalda voz e o uso do traqueostoma de forma permanente,influenciando significativamente a qualidade de suaconvivência social. Conclusão: As alterações vocais e dedeglutição decorrentes do câncer de laringe poderão serminimizadas através da atuação de uma equipe multidisciplinare, em especial, do fonoaudiólogo, que terá como objetivo deintervenção terapêutica desenvolver, se possível, a técnicada voz esofágica, promover um padrão de deglutiçãoadequado e orientar este paciente acerca de como secomportar diante das suas limitações, no intuito de otimizar asua qualidade de vida...

Being the larynx cancer one of the most frequentamong head and neck cancers, this work aimed to pointtheoretical considerations about organic and psychosocialimplications arising from that illness. Discussion: Thetobaccoism and alcoholism are strongly associated to larynxcancer that can cause voice disorders, deglutition disordersand dyspnoea. The patients’ rehabilitation must be initiatedby the addictions abandonment, which is very difficult forthose people. Additionally, they might totally lose their voicesand require a permanent tracheostomy, influencing theirquality of living in the social life. Conclusion: The voice anddeglutition disorders caused by larynx cancer may bedecreased through a multidisciplinary team’s performanceand, in special, a phonoaudiologist’s, who aims to developthe esophageal voice technique, to promote an adequatedeglutition standard and to guide such patients on how tobehave before their limitations, intending to improve qualityof life...

Comportamiento de laringectomía total: Provincia Holguín 2004-2009 / Behavior of the total laryngectomy: Holguin Province: 2004-2009

Realizamos un estudio retrospectivo longitudinal, sobre el comportamiento de la laringectomía total y sus principales complicaciones en nuestro hospital durante 6 años. Existió un predominio del sexo masculino con 85,2% y en la década de 60-70 años, el 91,3% de los pacientes refirieron algún hábito tóxico, siendo los síntomas clínicos predominantes la Disfonía y Disnea con un 46,9%, el tiempo de evolución de los síntomas en la primera consulta fue de 7-9 meses para el 31,1%, el 60,5% de lospacientes tenían nódulos linfáticos cervicales en el momento del diagnóstico. La más temida de las complicaciones del paciente laringectomizado los faringostomas sólo se presentaron en un 3,7%, lo que representa un verdadero logro de la cirugía laríngea de nuestro trabajo.

We conducted a retrospective longitudinal study on the behavior of the total laryngectomy and its major complications in our hospital for 6 years. There was a predominance of males with 85.2% and in the decade from 60-70 years, 91.3% of the patients reported any toxic habits, being predominantclinical symptoms of dysphonia and dyspnea 46.9%, the time evolution of symptoms at the first visit of 7-9 months was 31.1%, 60.5% of patients had cervical lymph nodes at diagnosis. The most feared complications of the laryngectomized patient pharyngostoma only occurred in 3.7%, which representsa real achievement for laryngeal surgery in our work.

Surgical voice restoration after total laryngectomy: An overview.

Total laryngectomy is potentially a debilitative surgery resulting in compromise of some of the most basic functions of life including speech and swallowing. This may have a profound adverse effect on the patient's physical, functional, and emotional health, and may result in a decreased quality of life (QOL). Until the 1980s, total laryngectomy was regarded as a dreadful, but often, life-saving procedure for which there was little alternative, and was used as a last resort. At that time survival at any cost in terms of QOL was paramount and many laryngectomies were forced into an isolated life as a mute and dysphasic recluse. Most attempts at voice restoration produced inconsistent results and often techniques were laborious, expensive, and ineffective, particularly when carried out as a salvage procedure after failed radiotherapy. Progress in voice rehabilitation, following total laryngectomy, over the last 30 years, has made an enormous difference in the whole concept of the management of laryngeal cancers. Currently there are several options available for these patients, namely, esophageal speech, artificial larynx, and tracheoesophageal speech. The choice of speech rehabilitation varies from patient to patient, but tracheoesophageal voice has become the preferred method. This article provides a brief account of surgical voice restoration after total laryngectomy. Special emphasis has been given to the surgical technique, special considerations, complications, and the prevention / treatment of tracheoesophageal voice restoration.

O significado do tabagismo no contexto do câncer de laringe / The meaning of smoking within the context of larynx cancer

Este estudo qualitativo objetivou compreender crenças e valores estabelecidos na relação entre câncer de laringe e tabagismo utilizando a estratégia do Discurso do Sujeito Coletivo. Participaram três pacientes, três profissionais de saúde e três familiares. Os dados foram coletados por meio de entrevistas semi-estruturadas. A análise identificou as categorias: história do tabagismo; busca por ajuda para sua doença; saúde, câncer de laringe e tabaco; cuidado familiar e cuidado profissional. O estudo demonstrou a necessidade de ampliar o foco de atuação dos profissionais acrescentando na formação desses trabalhadores paradigmas das ciências humanas visando contribuir para mudanças comportamentais no que diz respeito às orientações de saúde sobre os hábitos e/ou estilos de vida dos usuários dos serviços de saúde e seus familiares.

The objective of this qualitative study was to understand beliefs and values established as to the relation between larynx cancer and smoking by using the Collective Subject's Speech strategy. Three patients, three healthcare providers and three family members participated in the study. Data were collected in semi-structured interviews. The data analysis identified the following categories: smoking background; looking for help for the disease; health, larynx cancer and tobacco; family care and professional care. The study showed the need of broadening the focus of healthcare providers' performance when qualifying these workers by adding paradigms of human sciences in order to enable behavioral changes as to health guidance on habits and/or life styles of users of healthcare services and their family members.

El objetivo de este estudio cualitativo fue comprender las creencias y valores establecidos sobre la relación entre el cáncer de laringe y el tabaquismo utilizándose la estrategia del Discurso del Sujeto Colectivo. En el estudio participaron tres pacientes, tres profesionales de la salud y tres familiares. Los datos fueron colectados por medio de entrevistas semi-estructuradas. El análisis de los datos identificó las siguientes categorías: historia de tabaquismo; la busca por ayuda para la enfermedad; salud, cáncer de laringe y tabaco; cuidado familiar y cuidado profesional. El estudio demostró la necesidad de ampliar el foco de la actuación de los profesionales acrecentándose a la formación de estos trabajadores los paradigmas de las ciencias humanas con el objetivo de contribuir para mudanzas de comportamiento relacionadas a las orientaciones de salud sobre los hábitos y/o estilos de vida de los usuarios de los servicios de salud y de sus familiares.

O adoecimento pelo cancer de laringe / The illness narrative for larynx cancer

Com a finalidade de aprimorar a assistência ao laringectomizado, este estudo teve o objetivo de compreender o adoecimento pelo câncer de laringe na visão do paciente e sua família. Participaram do estudo 14 pacientes laringectomizados e familiares, em diferentes períodos pós-operatórios. Na análise das narrativas identificamos categorias que foram interpretadas sob a visão antropológica da cultura. Na interpretação dos participantes, o processo é permeado pelo sofrimento, pela busca de estratégias de enfrentamento, pela valorização de sobreviver à cirurgia, ou seja, pressupostos culturais que diferem do modelo biomédico dos profissionais e que devem ser considerados na sua reabilitação.

With the purpose of improving the care of laryngectomized patients, the aim is to understand the illness experience of patients and families of having larynx cancer. The participants were 14 laryngectomized patients and their families, in different post-surgical periods. The narrative analysis searched for categories which were understood on the basis of an anthropological focusing the culture. The understanding that the participants had of the illness experience of having a larynx cancer shows us that this process is one of suffering, of searching of strategies of coping, of evaluating the survival to the surgical treatment, which were based on the cultural system, which is different from the biomedical model of the health professionals and they must be considered in the approach for the rehabilitation.

Laryngectomy: a quality of life assessment.

Cosmetic disfigurement and loss of voice following a total laryngectomy can cause major psychosocial problems. Fifty patients who had undergone a total laryngectomy and completed more than six months following surgery, were randomly selected during a routine follow-up, and asked to answer a questionnaire, to asses their degree of disability and extent of rehabilitation. The questionnaire have five main components viz. general information, functional evaluation, vocal rehabilitation, social assessment and economic sequelae. Results revealed that these patients suffered from a significant decrease in social acceptance (70%), social activity (82%), sexual activity (62%), ability to communicate vocally (58%), and severe financial repercussions (78%). A large number of patients (40%) were dissatisfied with the present level of rehabilitation offered. Inspite of these problems the majority (80%) were willing to accept a total laryngectomy as treatment of their cancer. This emphasizes the need for greater interaction between the treating surgeon, speech therapist, occupational therapist, and psychotherapist to rehabilitate these patients adequately.