An investigation of the effect of laryngectomy on swallowing and QOL

1. An investigation of the effect of laryngectomy on swallowing and QOL • NWL Research symposium – Sept 21st 2016 Dr Margaret Coffey Mr Neil Tolley Professor Mary Hickson Mr David Howard

2. Laryngeal cancer • 2,315 new cases diagnosed in UK • 4 in 10 receive major surgical resection • 62% survive for 10 years or more • Causes: Smoking, alcohol, occupational exposure • Cancer Research UK 2013

3. Breathing after laryngectomy?

4. Voicing after laryngectomy

5. Swallowing after laryngectomy

6. Aim • To investigate the effect of laryngectomy on oral intake, self reported dysphagia and quality of life

7. Methods • Oral intake • Functional Oral Intake Scale (FOIS) Crary et al 2005 • Self report dysphagia • Any change in ability to swallow? Maclean et al 2009 • QOL • UOW QOL v4 – HNC general QOL Rogers et al 2002 • MDADI – HNC specific to swallow Chen et al 2001

8. Results - Demographics • n 50 • 82% male, 18% female • Median age - 66 years (range 43 - 85 ) • Median time since surgery - 6.0 years • (range 4 mths - 29 years)

9. Results - FOIS No patient dependent on enteral feeding 78% experienced some restriction to oral intake

10. Results – self report of dysphagia • 78% (n - 39) experienced swallowing difficulty after surgery “Takes a hell of a long time to eat, I’m always hungry” “I’m too embarrassed to eat with others, my food has to be mushy and it looks like baby food” • “We have no social life and I feel bad eating when he has so much trouble”

11. Results – UOW QOL v4 • 3 most important domains over the past 7 days • Speech, swallow and activity • Thematic analysis of issues not addressed – • 6 categories • Social • Physical • Stoma • Communication • Swallowing • Other Social I wouldn’t go to a concert, afraid of coughing

12. QOL issues not addressed Physical I get teased about not swimming Social I wouldn’t go to a concert, so afraid of coughing Stoma Issues with mucous not covered Physical I get teased about not swimming

13. QOL issues not addressed Communication It bothers me when people turn around to look at me Swallowing Family worry in case I’m choking Other Laughing sounds strange Other I feel suicidal when my prosthesis leaks Other Laughing sounds strange Swallowing Family worry in case I’m choking

14. Results - MDADI 53% took longer to swallow Commented that they were unlikely to cough on liquids unless voice prosthesis was leaking

15. Conclusions • Swallowing difficulty is an issue for patients after laryngectomy • Frequently used HNC QOL scales fail to address impairments in functioning specific to laryngectomy • Need for a QOL scale specific to laryngectomy

16. Acknowledgements Laryngectomy patients Supervisors Dr Mary Hickson, Professor of Dietetics, Plymouth University Mr Neil Tolley, Consultant Otolaryngologist, ICHT Professor David Howard, Consultant Head and Neck Surgeon Professor Gary Frost, Imperial College London Collaborators Professor Susan Langmore, Boston University Medical Centre Professor Stephen Leder, Yale University Medical Centre