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LitAlert #45

Communicative participation after total laryngectomy and COVID-19 impact

Dahl KL, Bolognone RK, Childes JM, Pryor RL, Graville DJ, Palmer AD. Characteristics associated with communicative participation after total laryngectomy. J Commun Disord. 2022;96:106184.

Individuals who undergo total laryngectomy (TL) are at risk of reducing interpersonal interactions, also called ‘communicative participation’ affecting their quality of life (QoL). After TL, most individuals use different communication competences to make themselves understood across various social settings, including supplementing spoken communication with writing, gesture, or other repair strategies. The Communicative Participation Item Bank (CPIB) is a validated tool to measure communicative participation. This study assessed which demographics, medical, social and communication characteristics are associated with communicative participation after TL using the CPIB tool. Additionally, it examined the impact of social distancing during the COVID-19 pandemic. The study showed that reduced CPIB scores were associated with younger age, less time since TL, a history of reconstructive surgery, poorer self-rated health, more depressive symptoms, worse quality of life and a weaker social network of friends. Furthermore, increased CPIB scores were associated with fewer non-spoken communication methods, higher levels of satisfaction with speech and communication, and better communicative effectiveness. Finally, there were non-significant differences in CPIB scores measured before and during the COVID-19 pandemic. The authors concluded that these findings could help clinicians identify patients at greater risk of reduced communicative participation and design interventions targeting this outcome.

Speech and swallowing outcomes following pharyngolaryngectomy and total laryngectomy

Layton T, Thomas R, Harris C, Holmes S, Fraser L, Silva P, et al. Functional Outcomes Following Total Laryngectomy and Pharyngolaryngectomy: A 20-Year Single Center Study. The Annals of otology, rhinology, and laryngology. 2022:34894211072987.

Pharyngolaryngectomy (PL) and total laryngectomy (TL) are central surgical techniques in treating advanced laryngeal cancer. However, they are associated with impaired speech and swallowing, thus impacting patient quality of life (QoL). This study systematically analyzed functional speech and swallowing outcomes in salvage and primary resections of the pharynx across 20 years to understand which factors influence functional outcomes. The analysis of 155 patients showed poorer speech and swallowing outcomes with more radical pharyngeal resections since lower proportion of patients used surgical voice rehabilitation (SVR) undergoing Total PL (TPL) as compared Partial PL (PPL) and TL. Increased chronic swallowing difficulties in patients undergoing TLP since a lower proportion managed a normal diet compared with PPL and TL. A higher use of SVR use was observed in primary procedures and an increase in the proportion of patients managing a normal diet compared with salvage procedures. Regarding reconstructive methods, free tissue transfer increased successful use of SVR in patients undergoing PPL and TPL compared with regional flaps. Moreover, free tissue transfer improved swallowing function in TLP since a higher rate of obtaining a normal diet in TPL and PPL was observed compared to regional flaps. The authors concluded that radical pharyngeal resection and prior radiotherapy carries a substantial risk of incurring impaired speech and swallowing in patients.

Cost-effectiveness of Provox ActiValve  

Mayo-Yanez M, Chiesa-Estomba C, Lechien JR, Calvo-Henriquez C, Vaira LA, Cabo-Varela I. Long-term outcomes and cost-effectiveness of a magnet-based valve voice prosthesis for endoprosthesis leakage treatment. Eur Arch Otorhinolaryngol. 2022.

Tracheoesophageal speech is considered the gold standard for rehabilitation following total laryngectomy. Central leakage is the main reason for voice prosthesis (VP) failure. Provox® ActiValve® incorporates a magnet-based valve flap system that prevents the valve flap from opening inadvertently when breathing or swallowing to reduce central leakage. This study compared Provox® Vega™ and Provox ActiValve device life in 5 patients with a replacement rate increase due to central leakage and analyzed the costs of using this type of VP over a mean period of 5.42 years. The prospective cross-over study found that Provox ActiValve had a significantly longer mean device-life (317 days) compared to Provox Vega (45 days), as well as significantly lower annual replacement rates (1.15 compared to 8.16, respectively). According to the effectiveness analysis that considers the number of annual VP replacements predicted in the literature and the outcome of this study, Provox ActiValve presents an increased effectiveness of 7.01 and a reduction in overall costs. Therefore, for every replacement not made thanks to the Provox ActiValve there was a saving of 133.97€. The study concludes that Provox ActiValve is a more cost-effective intervention for patients with increased prosthesis replacements due to central leakage.

“My life’s not my own” - expectations of HNC carers

Weaver R, O’Connor M, Golding RM, Gibson C, White R, Jackson M, et al. “My life’s not my own”: A qualitative study into the expectations of head and neck cancer carers. Support Care Cancer. 2022.

Head and neck cancer (HNC) patients experience significant physical and psychological changes because of the disease and treatment. Informal carers (family members, friends or neighbors) are essential for HNC patients’ support during and after active treatment. The extent of care required by the patient places a substantial disruption on the carers’ quality of life. This study used a qualitative research design through co-construct meaning by interpreting the participants’ experience to understand being an HNC carer and their perceived expectations of the role. During the interviews, three overarching themes were identified: 1. From the carer’s perspective, taking responsibility for the patient’s health was expected and directly related to the patient’s food intake or nutrition. 2. The carer’s relationship with the patient became strained as they navigated a new and different relationship from what they previously had with the patient. 3. The difficulty of being a carer was likely exacerbated by the feeling that they had no life outside the patient, compassion fatigue and feelings such as their role was unsustainable. The authors concluded that it should be a priority for HCPs to prepare and support HNC carers and that additional support interventions for HNC carers are needed to reduce their burden.

Interested in further reading?

Check out these newly published literature reviews!


Meta-analysis on the safety and efficacy of early oral feeding after total laryngectomy

Yi X, Hu C, Peng Y, Wen Z, Li X, Ye L, et al. Meta-analysis on the safety and efficacy of early oral feeding after total laryngectomy. J BUON. 2021;26(5):2019-25.

A systematic review and meta-analysis of the safety and efficacy of early oral feeding (≤ 3 days) and delayed oral feeding (≥ 7 days) following total laryngectomy.

Trismus therapy devices: a systematic review

Charters E, Dunn M, Cheng K, et al. Trismus therapy devices: A systematic review. Oral Oncol. 2022.

A systematic review comparing the efficacy (maximal inter-incisal opening and patient reported outcome results) of trismus therapy devices.




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