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The purpose of this study is to clarify the association between the quality of life (QOL) and medical treatment by comparing the QOL of patients who underwent total laryngectomy with that of patients who underwent both total laryngectomy and radiation therapy from the period of time before discharge from a hospital to 12 months after it.
Methods:
Subjects were 58 patients who underwent total laryngectomy in three hospitals located in Prefecture A, Japan, agreed to participate in the research, and returned questionnaires before discharge from hospitals and 3, 6, 12 months after discharge from hospitals. Main study subjects were age, sex, and the QOL, and the data of diagnosis, staging, and medical treatment were collected from medical records. SF-36v2 and mail survey were used in the analysis of the QOL data. SF-36v2 is a comprehensive QOL scale composed of 8 domains: physical function (PF), role physical (RP), body pain (BP), general health perception (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH). As an analytical method we calculated descriptive statistics of basic attributes and QOL scale scores. Norm-based scoring (NBS) was used in the calculation of the latter.
We confirmed that there is no statistical difference on QOL scale scores in age and staging. Then subjects were classified into two groups: patients who underwent only total laryngectomy and patients who underwent both total laryngectomy and radiation therapy for conducting t-tests to examine their associations with the QOL (p < 0.05). This study was approved by ethical review committees of an affiliated university and medical facilities.
Results:
Subjects' basic attributes were as follows:
average age: 67.4 years old (ranging from 48 to 83) at the time of total laryngectomy
sex: 52 males (89.7%) and 6 females (10.3%)
diagnosis: cancers of larynx 19 (32.8%), of hypopharynx 29 (50.0%), of oropharynx 1 (1.7%), of thyroid 1 (1.7%), of tongue 1 (1.7%) and of cervical esophagus 7 (12.3%).
staging: stage I – 2 (3.5%), stage II – 6 (10.3%), stage III – 13 (22.4%), and stage IV – 37 (63.8%).
treatment: only total laryngectomy 23 (39.6%), and both total laryngectomy and radiation therapy 35 (60.4%).
The basic attributes of patients who underwent only total laryngectomy were as follows:
average age: 68.8 years old (ranging from 49 to 83)
sex: 22 males (95.7%) and 1 females (4.3%)
diagnosis: larynx cancer 9 (39.1%), hypopharynx cancer 9 (39.1%), and other types of cancers such as neck cancer and esophagus cancer 5 (21.8%).
staging: stage II – 5 (21.7%), stage III – 8 (34.8%), and stage IV – 10 (43.5%).
The basic attributes of patients who underwent both total laryngectomy and radiation therapy were as follows:
average age: 66.3 years old (ranging from 48 to 82)
sex: 30 males (85.7%) and 5 females (14.3%)
diagnosis: larynx cancer 10 (28.6%), hypopharynx cancer 20 (57.1%), other types of cancers such as neck cancer and esophagus cancer 5 (14.3%).
staging: stage I – 2 (5.7%), stage II – 1 (2.9%), stage III – 5 (14.3%), and stage IV – 27 (77.1%).
types of radiotherapy: preoperative 18 (31.0%), postoperative 11 (19.0%), and preoperative and postoperative 6 (10.3%).
There were 43 responses from those who took treatment before discharge from hospital. Among them PF_N of those who underwent only total laryngectomy was 25.0±3.8 (mean and standard deviation) and PF_N of those who underwent both total laryngectomy and radiation therapy was 39.5 ± 3.6, showing that there was statistical difference between them (p=.009). Yet, there was no statistical difference between them on BP_N, GH_N, VT_N, and MH_N. (There was no investigation on RP_N, SF_N, and RE_N). There were 38 responses from those who took treatment 3 month after discharge from hospital. GH_N of patients who underwent only total laryngectomy and of patients who underwent both total laryngectomy and radiation therapy were 38.2 ± 2.3 and 45.6 ± 2.3, respectively, showing statistical difference between them (p = .03). Yet, there was no statistical difference between them on PF_N, RP_N, BP_N, VT_N, SF_N, RE_N, and MH_N. There were 34 responses from those who took treatment 6 month after discharge from hospital. Yet, there was no statistical difference in every item. There were 33 responses from those who took treatment 12 month after discharge from hospital. PF_N of patients who underwent only total laryngectomy and of patients who underwent both total laryngectomy and radiation therapy were 35.0 ± 3.4 and 44.5 ± 3.1, respectively, showing statistical difference between them (p =.047). Yet, there was no statistical difference between them on PF_N, RP_N, BP_N, VT_N, SF_N, RE_N, and MH_N.
Conclusion:
Laryngectomy is done for advanced cancers of the head and neck and of cervical esophageal. Radiation therapy is also used as adjuvant therapy before and after surgery. Total laryngectomy causes several physical problems such as a loss of voice functions, the change of breathing route, the increase of cough and phlegm, and the change of swallowing function and appearance (Armstrong et al., 2001). These physical problems bring about socio-economic problems such as a loss of jobs and fall in income (Kotake, et al. 2005) and other problems such as the loss of human relationship and of social contribution and negative effects on family members. There is also a research which shows that the disruption of social life brings about social trauma and other mental disorders (Bussian et al. 2010). Such physical, psychological, and social problems impair the QOL of laryngectomees severely. This research also revealed that the QOL of patients who underwent total laryngectomy was consistently below the national standard value. Previous studies gained the results that the QOL of patients who underwent only total laryngectomy had no significant difference with the QOL of patients who underwent only chemoradiation therapy (Hanna et al., 2004). Yet, there is no study which compares between the QOL of patients who underwent only total laryngectomy and the QOL of patients who underwent both total laryngectomy and radiation therapy. This research showed that the QOL of patients who underwent total laryngectomy 12 month after discharge from a hospital was lower than the QOL of patients who underwent both total laryngectomy and radiation therapy. This shows that the latter improved their physical functions, compared with the former. PF_N of those who underwent only total laryngectomy was 25.0±3.8 before discharge from a hospital and 35.0 ± 3.4 twelve month after discharge from a hospital. PF_N of those who underwent both total laryngectomy and radiation therapy was 39.5 ± 3.6 before discharge from a hospital and 44.5 ± 3.1 twelve month after discharge from a hospital. These results show that in both treatment patients' physical functions improved with time. In this study we examined patients who underwent preoperative, postoperative, and preoperative and postoperative radiotherapy but we could not examine irradiation period due to the size of sample number. This is a future subject. We also need to examine the reasons why physical functions of patients who underwent only total laryngectomy are more likely to improve than those of patients who underwent both total laryngectomy and radiation therapy by focusing on patients' awareness of functional disorder.