CN80 - Why do some patients undergoing laryngectomy for head and neck cancer opt to not reacquire their voice?

Background

Voice loss is a serious problem following surgery for head and neck cancer. Several voice substitutes are available for patients who have undergone laryngectomy; however, none can completely reproduce the original voice and vocal behaviour. Opting in or out for a substitute voice is a decision the patient makes. This study aimed to determine differences in vocal preference and communicative adaptation with and without a substitute voice.

Methods

This prospective observational study used 156 patients who underwent laryngectomy at a cancer hospital in Aichi Prefecture between April 2013 and September 2021. Based on responses from a questionnaire, voice preference and communication adaptation status were assessed, and differences in scores between the substitute voice group and the written communication-only group were analysed. The survey period was from December 2022 to January 2023.

Results

Fifty-seven (62.6%) patients were in the substitute voice group, and 34 (37.4%) were in the written communication-only group. Among the substitute voice group, 28 (49.1%) mainly used an electric larynx. The social life score of the communication adaptation status subscale was significantly (p<.001) higher for the substitute voice group (mean±standard deviation [SD] 15.71±6.49) compared to the written communication-only group (10.23±5.52). In addition, communication confidence scores trended higher (p=.066) in the substitute voice group (10.45±5.67) compared to the written communication-only group (8.03±4.53). In contrast, the preference for vocal actions, a subscale of voice preference, trended higher (p=.055) in the written communication-only group (20.7±2.95) compared to the substitute voice group (18.68±5.10).

Conclusions

In Japan, approximately one-third of patients with head and neck cancer who have undergone laryngectomy live without a voice. Patients who communicated through written means tended to dislike voice substitutions due to desiring a more natural vocalisation. However, written communicators were less adapted to communication than those with voice substitutes. Multidisciplinary support is important for these patients to regain their voice.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

M. Iwai.

Funding

SGH Foundation.

Disclosure

All authors have declared no conflicts of interest.