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
18th most common cancer in the UK

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. Functional Oral Intake Scale (FOIS) Crary et al 2005
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
Fois validated 7 item scale - describes patients actual daily intake of food and liquid

8. Results - Demographics
n 50 82% male, 18% female Median age - 66 years (range ) Median time since surgery years (range 4 mths - 29 years)
50 subjects, 82% of sample were male, 18% were female. Median age 66 years (range 43-85). Median time since surgery 6.9 years (range 4 mths-29 years).

9. Results - FOIS 7 Oral intake with no restrictions 11 (22%)
FOIS diet level n 1
No oral intake 2
Tube dependent with minimal inconsistent oral intake 3
Tube supplements with consistent oral intake 4
Single consistency oral intake
1 (2%) 5
Multiple consistency oral intake with special preparation
18 (36%) 6
Oral intake avoiding specific food or liquid items
20 (40%) 7
Oral intake with no restrictions
11 (22%)
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. Social emotional composite score
Results – UOW QOL v4
Composite score
Physical composite score
Social emotional composite score
Median score (min-max)
82.5 ( )
78.91 ( )
68.8 ( )
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
Median composite score higher than that in Robertson et al 2011 (larger study)
Domains reflect those of Robertson et al 2011
Differ to older sti=udies Villasea et al 2005 and Kazi et al 2007 (Speech, appearance and activity)
Social
I wouldn’t go to a concert, afraid of coughing

12. QOL issues not addressed
Physical
I get teased about not swimming
Stoma
Issues with mucous not covered
Social I wouldn’t go to a concert, so afraid of coughing
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
Emotional score
Functional score
Physical score
Global score
Total score
Median score
(min-max)
73.3 ( )
76 (28-100)
68.8 (30-100)
80 (20-100)
71( )
Consistent with Robertson et al 2011, global score higher in this study
Lower scores than Kazi et al 2006
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