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Methods: Subjects were 43 patients who underwent laryngectomy in three university hospitals in Fukuoka Prefecture which agreed to cooperate in our research. Self-administered questionnaires were handed directly to or mailed to patients before discharge from hospital and mailed to them three, six, and twelve months after discharge from hospital. We checked subjects' age, sex, employment status, family structure, communication methods (esophageal speech, electrolarynx, shunt speech, written message, and gesture), conversation time, and admission to a patients' association. We collected descriptive statistics of their basic attributes and communication methods. We then classified communication methods into two groups – speech (esophageal speech, electrolarynx, and shunt speech) or no speech (written message and gesture) and analyzed their changes of communication methods after discharge from hospital by the Cochran-Mantel-Haenszel test. The admission to and the participation in a patients association was tested by a chi-square test. This study was approved by Institutional Review Boards (IRBs) in each hospital. We explained to subjects that we protect their privacy both verbally and in written forms. We asked those who agreed to participate in this research to sign the letter of consent before conducting survey.
Results: The number of subjects reduced from 43 to 38, 34, 33 three, six, and twelve months after discharge from hospital, respectively, due to a variety of reasons such as rehospitalization, poor health, and the loss of life. Their average age and sex were 67.3±8.9 (ranging from 46-82 years) and 56 males (87.5%) and 8 females (12.5%). Eight subjects (12.5%) lived alone and 56 subjects (87.5%) were lived with other family members. At the time of discharge from hospital 30 subjects (46.9%) had jobs, 28 subjects (43.8%) did not have jobs, and there were 6 “no answers” (9.3%). On the means of communication those who used esophageal speech were 3 (7%) before discharge from hospital and 5 (15.2%) twelve months after it. Those who used electrolarynx were 3 (7%), 12 (31.6%), 18 (52.9%), 16 (48.5%) before, three months after, six months after, and twelve months after discharge from hospital, respectively. Those who used shunt speech were 0 before discharge from hospital and became 2 (5.3 to 6.1%) after that. Those who used written messages were 38 (88.4%) before discharge from hospital, decreasing to 11 (44.1%) three months after that and increasing to 17 (51.5%) twelve months after that. Those who used gesture were 19 (44.2%) before discharge from hospital, hovering around 11 to 13 (32.4% to 39.4%) after that.
Many respondents answered that they used both speech and no speech as the means of communication. Those who used speech increased gradually from 5 (11.6%) before discharge from hospital to 22 (71.0%) twelve months after it. Those who used no speech gradually decreased from 38 (88.4%) before discharge from hospital to (29.0%). This trend of increase and decrease was statistically significant on all periods (p< 0.0001). The number of those who do not make a conversation was two (4.7%), eleven (25.6%), and nine (20.9%) in pre-discharge from hospital, 30-to-60 minutes, and 60-to-180 minutes, respectively. Average conversation time for 13 patients (38.2%) three months after discharge from hospital was 60-to-180 minutes, followed by 30-to-60 minutes by seven patients (20.6%) and 180-to-360 minutes by seven patients (20.6%). Eleven patients (45.8%) answered that their average conversation time was 60-to-180 minutes six months after discharge from hospital while four patients (2.9%) did not make a conversation. Those who made conversation for 30-to-60 minutes were 11 (33.3%) eleven months after discharge from hospital, followed by 10 patients (30.3%) who spoke for 60-to-180 minutes.
The number of those who were admitted to a patients' association was 13 (32.5%) before discharge from hospital, 14 (42.4%) three months after it, 17 (51.5%) six months after it, and 12 (38.7%) twelve months after it. More specifically, the number of those who were admitted to a patients' association in the group of speech and the group of no speech was 0 (0%) and 13 (100%) before discharge from hospital, 10 (71.4%) and 4 (28.6%) three months after it, 15 (88.2%) and 2 (11.8%) six months after it, and 11 (91.7%) and 1 (8.3%) twelve months after it, respectively. The analysis of patients three months after discharge from hospital revealed that those who were admitted to a patients' association were more likely to rely on speech than those who were not (p=0.02) but there were no association with the means of communication at a statistically significant level.
Conclusion: The means of communication for laryngectomy patients were esophageal speech, electrolarynx, shunt speech, written message, and gesture. More than fifty percent of laryngectomy patients used no speech such as written message and gesture before discharge from hospital but many of them gradually acquired the speech skills after discharge from hospital. Yet, there was no one who relies only on the means of speech. Esophageal speech is based on the technique in which patients draw air into the esophagus and regurgitate it, producing a vibration in the pharyngoesophageal segment. The training of esophageal speech involves a heavy physical and mental burden on patients, so that only five patients used it twelve months after discharge from hospital. It is expected that there are few patients who want to master it. Yet, most laryngectomy patients tried to be accustomed to social life by using both speech and no speech because they expected to face some difficulties on their daily life if they rely only on no speech.
It also clarified that conversation time gradually increased after discharge from hospital. It is considered that this is because those who had jobs returned to work and some patients participated in a patients' association. The increase of those who do not have a conversation six months after discharge from hospital implies that they might be cut off from their social connections by living alone, leaving a job, or failing to participate in a patients' association. It has been considered that it is necessary to join a patients' association and conduct training by regularly attending its events in order to acquire the means of communication by speech. Yet, there was no association between the means of communication and the participation in a patients' association although there was a significant association between the means of communication and the admission to a patients' association three months after discharge from hospital. Those who were admitted to a patients' association were more likely to acquire the means of communication by speech as time passed but its pace declined eleven months after discharge from hospital.
Previous studies reported that patients failed to participate in a patients' association due to their own problems such as their physical problems and the unavailability of transportation to the place of a meeting. In other words, it is suggested that some patients who participated in a patients' association for acquiring the means of communication by speech gave it up because they did not feel well and did not want to talk to others, and the place of a meeting was not conveniently located. Yet, laryngectomy patients could acquire necessary information such as the means of communication by sound such as electrolarynx by joining a patients' association, showing that it becomes the support for the reconstruction of communication. This study revealed that laryngectomy patients' acquisition of the means of communication is affected by their decision to join a patients' association, suggesting that it is important for them to understand the necessity to join it.