Clinical Publications of Interest 2025-06
Tracheoesophageal puncture and quality of life after total laryngectomy: A systematic review and meta-analysis
Common voice restoration methods after total laryngectomy (TL) include the insertion of a prosthesis through a tracheoesophageal puncture (TEP). The article reviews the effects of TEP on the Quality of Life (QOL) of patients post-TL. A literature review was conducted to identify articles within the last decade that addressed QoL after TEP. The initial 71 hits were filtered, totaling 6 final articles with a collective sample size of 253 patients. Across these articles, six different indices that quantify and describe life quality were used to measure QOL outcomes: short form 36-item health survey (SF-36), World Health Organization QOL scale (WHOQOL), voice-related QOL questionnaire (V-RQOL), MD Anderson dysphagia index (MDADI), University of Washington QOL index (UW-QOL) and voice handicap index (VHI). The latter two were subjected to meta-analysis due to their inclusion in more than one study. The meta-analysis and systematic review were assigned an Oxford Level of Evidence, which categorizes studies based on their quality and type, as grade 2a, indicative of a systematic review (with homogeneity) of cohort studies with low risk of bias. The authors noted that the depth of meta-analysis was limited due to the use of different indices. Results using WHOQOL, SF-36, MDADI and V-RQOL indices showed improved QOL in TL patients with TEP. UW-QOL meta-analysis showed a significant difference in QOL between TL patients with and without TEP (p < 0.001). The VHI index’s 3 subsections (functional, physical and emotional) did not show significant improvement of QOL in TL patients with and without TEP (p = 0.13, p = 0.14 and p = 0.09, respectively). The variety in selected indices and results demonstrates the inconsistency of assessing QOL. The review concludes that QOL improves after TEP in all studies regardless of the index used. The authors recommend healthcare professionals to adopt a patient-centric approach and to inform patients of the benefits of TEP on their QOL after TL.
Laryngeal cancer relative survival trends from 1972 to 2021 in the Nordic countries
Laryngeal cancer has seen varying survival trends over the past decades. This observational study examines the relative survival trends of laryngeal cancer patients in the Nordic countries from 1972 to 2021 and discusses the potential impact of factors such as changes in treatment protocols. Using data from the NORDCAN database, the study analyzed five-year relative survival rates for 33,692 laryngeal cancer cases. The results showed that Denmark and Norway experienced an increasing trend in five-year relative survival, while Finland and Sweden remained static. Specifically, from 1992–1996 to 2017–2021, survival improved by 9 percentage points in Denmark (from 57% to 66%), 4 percentage points in Finland (from 59% to 63%), 13 percentage points in Norway (from 61% to 74%), and 2 percentage points in Sweden (from 69% to 71%). Among women in Sweden, a linear negative trend was observed, with a 16 percentage-point decline in five-year relative survival (from 71% to 55%). The authors highlight significant breakthroughs in diagnostics and treatment, such as improved imaging techniques and advancements in radiotherapy, which have impacted survival trends. However, the authors emphasize the complexity of interpreting survival trends due to various factors, including differences in treatment protocols, changes in incidence rates, tumor characteristics, advances in diagnostics and treatment, comorbidities, and methodological differences. They suggest that while organ-preserving methods may improve quality of life, their impact on survival is unclear. Future research should focus on multicenter cohort studies to better assess the effects of treatment changes on disease-specific survival.
Laryngeal Cancer in Women: Unveiling Gender-Specific Risk Factors, Treatment Challenges, and Survival Disparities
Laryngeal cancer has been predominantly studied in men, leaving a gap in understanding its impact on women. This review article aims to address this gap by examining the differences in incidence, risk factors, hormonal influences, survival rates, and therapeutic approaches between men and women. The main results indicate that while smoking and alcohol are primary risk factors for both sexes, women have a higher relative risk from smoking (odds ratio OR = 435.7) and a significant risk from heavy alcohol consumption (OR = 4.3). Hormonal factors, such as estrogen, also play a crucial role in women's susceptibility to laryngeal cancer, potentially accelerating tumor growth and complicating treatment. Additionally, women tend to receive less intensive treatment compared to men, with only 34% receiving combinations of the chemotherapy cisplatin and radiotherapy versus 44% of men. Despite these challenges, women often have a better prognosis than men, with a 5-year disease-specific survival (DSS) rate of 65% for women compared to 59% for men, and an overall survival (OS) rate of 50% for women compared to 44% for men. Notably, the incidence of laryngeal cancer in women shows significant geographical variability, with higher rates in countries like Cuba and Hungary, and lower rates in regions such as Benin and Guadeloupe. In conclusion, the increasing incidence of laryngeal cancer in women necessitates further research to fully understand the underlying biological mechanisms and to develop more personalized treatment strategies. Addressing these gender-specific differences is essential for optimizing clinical outcomes and improving the quality of care for women with laryngeal cancer.
Prevalence and Risk Factors of Oropharyngeal Dysphagia in Newly Diagnosed Head-and-Neck Cancer Patients
Early identification of oropharyngeal dysphagia (OD), a common complication in head-and-neck cancer (HNC) patients, is crucial for better preparing them for their cancer treatment trajectory and improving their quality of life. The objective of the study was to assess the prevalence of OD in newly diagnosed HNC patients within three weeks before the start of cancer treatment and to investigate demographic and oncological characteristics that may be associated with the risk of OD at baseline. The study involved 225 patients who completed the Eating Assessment Tool-10 (EAT-10) and Short Nutritional Assessment Questionnaire (SNAQ). The results indicated that 21.3% of the patients were at risk for OD, with advanced-stage cancer and malnutrition identified as significant risk factors. Specifically, 33.3% of patients with advanced-stage cancer (stages 3-4) were at risk for OD, compared to 13.0% of those with early-stage cancer (stages 0-2). Additionally, 41.0% of patients at risk of malnutrition were also at risk for OD, compared to 13.7% of those not at risk of malnutrition. Logistic regression analysis showed a significant association between advanced-stage cancer and the risk of OD, even after correcting for malnutrition risk. The study also found that patients with higher tobacco use, and more advanced regional disease, were less likely to engage in OD screening. In conclusion, approximately one-fifth of newly diagnosed HNC patients are at risk of OD before cancer treatment, with advanced-stage cancer and malnutrition being significant risk factors, underscoring the need for effective screening and management to improve outcomes and quality of life.
Anxiety, Depression and Cancer-Related Post-Traumatic Stress in Patients Undergoing Total Laryngectomy
Head and neck cancer (HNC) diagnoses often lead to significant psychosocial distress due to concerns about eating, drinking, swallowing, appearance, and social interactions. Patients preparing for laryngectomy frequently experience emotional shock and psychological distress, yet there is limited knowledge about the prevalence of cancer-related post-traumatic stress (PTS) and its impact on other psychiatric disorders during the follow-up period. Therefore, the objective of this prospective longitudinal study was to assess the incidence of cancer-related PTS, anxiety, and depression in patients undergoing total laryngectomy (TL), both before and one year after the surgery. The study involved 97 patients who completed self-reported questionnaires to measure these psychological conditions. Results indicated that prior to surgery, 32 patients (33%) exhibited cancer-related PTS. Among these patients, 56% had anxiety and 76% had depression, compared to 8% and 20% respectively in those without PTS (p<0.001 for both). One-year post-surgery, patients with PTS continued to show significantly higher depression scores (44% vs. 37%, p=0.03), although anxiety levels did not differ significantly between the two groups (22% vs. 14%, p=0.15). The study highlighted the importance of early identification and intervention for depressive disorders in these patients. The level of evidence for this study is 4, which means it is based on case series and cohort studies without control groups. This level indicates moderate quality evidence, suggesting that while the findings are valuable, they should be interpreted with caution and ideally confirmed by higher-level studies. In conclusion, preoperative assessment and active psychiatric interventions are crucial for managing psychological distress in TL patients.
Retrospective Exploration of Botulinum Toxin Injection for Pharyngoesophageal Segment Dysfunction Post-laryngectomy
Total laryngectomy (TL) has long-lasting consequences on speech and swallowing. Pharyngoesophageal (PE) dysfunction may complicate the success of tracheoesophageal voice prostheses used in voice rehabilitation, as well as contribute to dysphagia complications. Botulinum toxin A offers a safe, minimally invasive and durable treatment option for resolving PE dysfunction, though previous studies investigating this have had small sample sizes. This retrospective cohort study investigates the effects of botulinum toxin A on the speech and swallowing of 43 patients who had undergone TL. Botulinum toxin A was administered using varied modalities of injection, including videofluoroscopy-guided injection, electromyography-guided injection, US-guided injection, TNE-guided injection or performed in the operating room, based on the training and comfort of the surgeon. Outcomes were determined in pre- and post-injection subjective surveys by the patient, surgeon and speech-language pathologist. Overall, 38% (n=16) of patients showed improvement in both speech and swallowing, 29% (n=12) experienced improvement only in swallowing and 19% (n=8) reported improvement in only their voice, with an overall 86% (n=37) subjective symptom improvement. Further, 12% (n=5) experienced no effect from the treatment, while 2% (n=1) reported worsening of voice and swallowing. It was found that 19% (n=8) of patients experienced improvement of their symptoms after one injection, while 60% (n=25) showed improvement after two. The average duration of response was 8.1 months. No difference between injection techniques was noted, although the authors suggest that this observation is under-powered for concrete conclusions. Despite the use of subjective evaluations over objective data, the study demonstrates botulinum toxin A’s potential for treating PE dysfunction and improving voice and swallowing post-laryngectomy.
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