Article

The Impact of Total Laryngectomy: The Patient's Perspective

Brendan Noonan

Josephine Hegarty

head and neck cancer, head/neck malignancies
ONF 2010, 37(3), 293-301. DOI: 10.1188/10.ONF.293-301

Purpose/Objectives: To describe the experiences of patients who had total laryngectomy from their perspective.

Research Approach: Descriptive, qualitative study.

Setting: Participants' homes or investigator's hospital office.

Participants: 10 patients after total laryngectomy.

Methodologic Approach: Data were collected by semistructured, open-ended interviews during a period of six months, with an interview topic guide built on the framework of the literature review. Data were analyzed with descriptive content analysis. Trustworthiness of the study was enhanced through the use of verbatim quotations, audible data analysis trail, and a reflexive approach.

Main Research Variables: Patients' experiences of undergoing total laryngectomy.

Findings: Patients who have undergone a total laryngectomy report difficulties and concerns that are largely functional and psychological. The functional difficulties reported included descriptions of altered swallow, excess phlegm, speech difficulties, weak neck muscles, and altered energy levels. The psychological concerns reported included descriptions of depression, regrets, and personal resolve.

Conclusions: As a group, patients experience a broad range of problems well after completion of treatment, reinforcing the need for rehabilitation management for prolonged periods after surgery.

Interpretation: Nurses are suitably positioned to support this group of patients across the disease management trajectory, from the initial preoperative period to the postoperative period and through to the rehabilitative period and beyond.

Jump to a section

    References

    Central Statistics Office Ireland. (2009). Principal statistics. Retrieved from http://www.cso.ie
    Donnelly, D. W., Gavin, A. T., & Comber, H. (2009). Cancer in Ireland 1994-2004: A summary report. Cork, Ireland: National Cancer Registry, Ireland.
    American Cancer Society. (2008). Overview: All about laryngeal and hypopharyngeal cancer. Retrieved from http://www.cancer.org/docroot/CRI/CRI_2x.asp?sitearea=&dt=23
    Ampil, F. L., Nathan, C. O., Caldito, G., Lian, T. F., Aarstad, R. F., & Krishnamsetty, R. M. (2004). Total laryngectomy and postoperative radiotherapy for T4 laryngeal cancer: A 14-year review. American Journal of Otolaryngology, 25, 88-93. doi: 10.1016/j.amjoto.2003.11.004
    Berg, A., & Welander Hansson, U. (2000). Dementia care nurses' experiences of systematic clinical group supervision and supervised planned nursing care. Journal of Nursing Management, 8, 357-368. doi: 10.1046/j.1365-2834.2000.00191.x
    Bjordal, K., & Kaasa, S. (1995). Psychological distress in head and neck cancer patients 7-11 years after curative treatment. British Journal of Cancer, 71, 592-597.
    Byrne, A., Walsh, M., Farrelly, M., & O'Driscoll, K. (1993). Depression following laryngectomy. A pilot study. British Journal of Psychiatry, 163, 173-176.
    Campbell, B. H., Marbella, A., & Layde, P. M. (2000). Quality of life and recurrence concern in survivors of head and neck cancer. Laryngoscope, 110, 895-906. doi: 10.1097/00005537-200006000-00003
    Coyne, I. T. (1997). Sampling in qualitative research. Purposeful and theoretical sampling: Merging or clear boundaries? Journal of Advanced Nursing, 26, 623-630.
    Craig, Y. J. (1996). Patient decision-making: Medical ethics and mediation. Journal of Medical Ethics, 22, 164-167.
    Davis, R. H. L., & Roberts, D. (1999). Nursing care of the patient with head and neck cancer. Oncology Nurses Today, 4(1), 9-15.
    De Boer, M. F., McCormick, L. K., Pruyn, J. F., Ryckman, R. M., & van den Borne, B. W. (1999). Physical and psychosocial correlates of head and neck cancer: A review of the literature. Otolaryngology—Head and Neck Surgery, 120, 427-436.
    de Graeff, A., de Leeuw, J. R., Ros, W. J., Hordijk, G. J., Blijham, G. H., & Winnubst, J. A. (2000a). Long-term quality of life of patients with head and neck cancer. Laryngoscope, 110, 98-105. doi: 10.1097/00005537-200001000-00018
    de Graeff, A., de Leeuw, J. R., Ros, W. J., Hordijk, G. J., Blijham, G. H., & Winnubst, J. A. (2000b). Pretreatment factors predicting quality of life after treatment for head and neck cancer. Head and Neck, 22, 398-407. doi: 10.1002/1097-0347(200007)22:4<398::AID-HED14>3.0.CO;2-V
    DeSanto, L. W., Olsen, K. D., Perry, W. C., Rohe, D. E., & Keith, R. L. (1995). Quality of life after surgical treatment of cancer of the larynx. Annals of Otology, Rhinology, and Laryngology, 104(10, Pt. 1), 763-769.
    Devins, G. M., Stam, H. J., & Koopmans, J. P. (1994). Psychosocial impact of laryngectomy mediated by perceived stigma and illness intrusiveness. Canadian Journal of Psychiatry, 39, 608-616.
    Donnelly, D. W., Gavin, A. T., & Comber, H. (2009). Cancer in Ireland 1994-2004: A summary report. Cork, Ireland: National Cancer Registry, Ireland.
    Dropkin, M. J. (2001). Anxiety, coping strategies, and coping behaviors in patients undergoing head and neck cancer surgery. Cancer Nursing, 24, 143-148.
    Eadie, T. L., & Doyle, P. C. (2005). Quality of life in male tracheoesophageal (TE) speakers. Journal of Rehabilitation Research and Development, 42, 115-124.
    Farrand, P., & Duncan, F. (2007). Generic health-related quality of life amongst patients employing different voice restoration methods following total laryngectomy. Psychology, Health and Medicine, 12, 255-265. doi: 10.1080/13548500600665542
    Feber, T. (1996). Promoting self-esteem after laryngectomy. Nursing Times, 92(30), 37-39.
    Fritz, D. (2001). Life experiences of head and neck cancer survivors: A pilot study. ORL—Head and Neck Nursing, 19(4), 9-13.
    Gamba, A., Romano, M., Grosso, I. M., Tamburini, M., Cantu, G., Molinari, R., & Ventafridda, V. (1992). Psychosocial adjustment of patients surgically treated for head and neck cancer. Head and Neck, 14, 218-223.
    Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105-112. doi: 10.1016/j.nedt.2003.10.001
    Gritz, E. R., Carmack, C. L., de Moor, C., Coscarelli, A., Schacherer, C. W., Meyers, E. G., & Abemayor, E. (1999). First year after head and neck cancer: Quality of life. Journal of Clinical Oncology, 17, 352-360. Retrieved from http://jco.ascopubs.org/cgi/content/full/17/1/352 http://jco.ascopubs.org/cgi/content/full/17/1/352
    Hall, F. T., O'Brien, C. J., Clifford, A. R., McNeil, E. B., Bron, L., & Jackson, M. A. (2003). Clinical outcome following total laryngectomy for cancer. ANZ Journal of Surgery, 73, 300-305. doi: 10.1046/j.1445-2197.2003.02562.x
    Hammerlid, E., Ahlner-Elmqvist, M., Bjordal, K., Biorklund, A., Evenson, J., Boysen, M., … Westin, T. (1999). A prospective multicentre study in Sweden and Norway of mental distress and psychiatric morbidity in head and neck cancer patients. British Journal of Cancer, 80, 766-774. doi: 10.1038/sj.bjc.6690420
    Hammerlid, E., Bjordal, K., Ahlner-Elmqvist, M., Jannert, M., Kaasa, S., Sullivan, M., & Westin, T. (1997). Prospective, longitudinal quality-of-life study of patients with head and cancer: A feasibility study including the EORTC QLQ-C30. Otolaryngology—Head and Neck Surgery, 116(6, Pt. 1), 666-672. doi: 10.1016/S0194-5998(97)70246-8
    Hammerlid, E., Mercke, C., Sullivan, M., & Westin, T. (1998). A prospective quality of life study of patients with laryngeal carcinoma by tumor stage and different radiation therapy schedules. Laryngoscope, 108, 747-759. doi: 10.1097/00005537-199805000-00023
    Herranz, J., & Gavilan, J. (1999). Psychological adjustment after laryngeal cancer surgery. Annals of Otology, Rhinology, and Laryngology, 108, 990-997.
    Hutton, J. M., & Williams, M. (2001). An investigation of psychological distress in patients who have been treated for head and neck cancer. British Journal of Oral and Maxillofacial Surgery, 39, 333-339. doi: 10.1054/bjom.2001.0645
    Langius, A., Bjorvell, H., & Lind, M. G. (1993). Oral- and pharyngealcancer patients perceived symptoms and health. Cancer Nursing, 16, 214-221.
    List, M. A., Ritter-Sterr, C. A., Baker, T. M., Colangelo, L. A., Matz, G., Pauloski, B. R., & Logemann, J. A. (1996). Longitudinal assessment of quality of life in laryngeal cancer patients. Head and Neck, 18, 1-10. doi: 10.1002/(SICI)1097-0347(199601/02)18:1<1::AID-HED1>3.0.CO;2-7
    Llatas, M. C., Ramirez, M. J., Ferriol, E. E., Domenech, F. G., Suarez-Varela, M. M., & Martinez, R. L. (2003). Psychosocial adaptation in surgically treated patients for laryngeal cancer. International Congress Series, 1240, 813-817. doi: 10.1016/S0531-5131(03)01045-8
    Op de Coul, B. M. R., Ackerstaff, A. H., van As, C. J., van den Hoogan, F. J. A., Meeuwis, C. A., Manni, J. J., & Hilgers, F. J. (2005). Quality of life assessment in laryngectomised individuals: Do we need additions to standard questionnaires in specific clinical research projects? Clinical Otolaryngology, 30(2), 169-175. doi: 10.1111/j.1365-2273 .2004.00932.x
    Patton, M. (1990). Qualitative evaluation and research methods (2nd ed.). Newbury Park, CA: Sage.
    Rapoport, Y., Kreitler, S., Chaitchik, S., Algor, R., & Weissler, K. (1993). Psychosocial problems in head-and-neck cancer patients and their change with time since diagnosis. Annals of Oncology, 4, 69-73.
    Rogers, S. N., Hannah, L., Lowe, D., & Magennis, P. (1999). Quality of life 5-10 years after primary surgery for oral and oro-pharyngeal cancer. Journal of Cranio-Maxillofacial Surgery, 27, 187-191.
    Sandelowski, M. (1995). Sample size in qualitative research. Research in Nursing and Health, 18, 179-183.
    Sandelowski, M. (1996). Focus on qualitative methods: Using qualitative methods in intervention studies. Research in Nursing and Health, 19, 359-364.
    Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing and Health, 23, 334-340.
    Savage, J., & Birchall, M. (2001). Distribution of head and neck cancer in the UK. Lancet, 357, 1982.
    Servaes, P., Gielissen, M. F. M., Verhagen, S., & Bleijenberg, G. (2007). The course of severe fatigue in disease-free breast cancer patients: A longitudinal study. Psycho-Oncology, 16, 787-795. doi: 10.1002/pon.1120
    Sollner, W., DeVries, A., Steixner, E., Lukas, P., Sprinzl, G., Rumpold, G., & Maislinger, S. (2001). How successful are oncologists in identifying patient distress, perceived social support, and need for psychosocial counselling? British Journal of Cancer, 84, 179-185. doi: 10.1054/bjoc.2000.1545
    Stewart, M. G., Chen, A. Y., & Stach, C. B. (1998). Outcomes analysis of voice and quality of life in patients with laryngeal cancer. Archives of Otolaryngology Head and Neck Surgery, 124, 143-148. Retrieved from http://archotol.ama-assn.org/cgi/content/full/124/2/143 http://archotol.ama-assn.org/cgi/content/full/124/2/143
    Terrell, J. E., Fisher, S. G., & Wolf, G. T. (1998). Long-term quality of life after treatment of laryngeal cancer. The Veterans Affairs Laryngeal Cancer Study Group. Archives of Otolaryngology Head and Neck Surgery, 124, 964-971. Retrieved from http://archotol.ama-assn.org/cgi/content/full/124/9/964 http://archotol.ama-assn.org/cgi/content/full/124/9/964
    Thorne, S. E., Bultz, B. D., & Baile, W. F. (2005). Is there a cost to poor communication in cancer care? A critical review of the literature. Psycho-Oncology, 14, 875-884. doi: 10.1002/pon.947
    Whale, Z., Lyne, P. A., & Papanikolaou, P. (2001). Pain experience following radical treatment for head and neck cancer. European Journal of Oncology Nursing, 5, 112-120. doi: 10.1054/ejon.2000.0113
    Ziegler, L., Newell, R., Stafford, N., & Lewin, R. (2004). A literature review of head and neck cancer patients' information needs, experiences and views regarding decision-making. European Journal of Cancer Care, 13, 119-126. doi: 10.1111/j.1365-2354.2004.00449.x