Eberhard F. Meister

VALIDATION OF THE EORTC QLQ-C30 AND EORTC QLQ-H&N35 IN PATIENTS WITH LARYNGEAL CANCER AFTER SURGERY

The aim of this study was to test the validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core Module (QLQ‐C30) and Head and Neck Module (QLQ‐H&N35) for patients who have undergone surgery due to laryngeal cancer.

Sexual Problems After Total or Partial Laryngectomy

Objectives: To investigate sexual problems that can occur after laryngeal and hypopharyngeal cancer surgery and to specify possible influencing factors.

Quality of life before and after total laryngectomy: Results of a multicenter prospective cohort study

The purpose of this study was to determine what quality of life (QOL) areas improve and deteriorate during the first year after total laryngectomy and to identify predictors of these changes.

Mental disorders and psychosocial support during the first year after total laryngectomy: A prospective cohort study

To assess the frequency of mental disorders and the use of psychosocial services in laryngectomised patients during the first year after surgery.

Clinical relevance of quality-of-life data in laryngectomized patients.

Statistically significant differences in health‐related quality of life (HRQL) are not always clinically relevant. It is also plausible that patients perceive other changes to be relevant than health professionals do. The objective of this study was to find thresholds for HRQL that laryngectomees consider to be clinically relevant 1 year after surgery, (i.e., the level of HRQL that patients rate as satisfactory). A second aim was to investigate how many laryngectomized patients reached those targets.

Psychische Morbidität bei Partnern kehlkopfloser Karzinompatienten: Womit hängt die Auftrittswahrscheinlichkeit zusammen?

In a multicenter cross-sectional study of 106 spouses of laryngectomized patients differences between spouses with a mental disorder and spouses without were analyzed. The probability of occurrence was mainly related to relationship factors: Spouses, who reported a better quality of their relationship with the patient (OR=0.77; 95% CI: 0.631-0.939; p=0.010), whose sexual desire was not diminished in response to their partners disease (OR=0.077; 95% CI: 0.011-0.527; p=0.009) and who had no problems in dealing with the tracheostomy (OR=0.062; 95% CI: 0.006-0.619; p=0.018) presented a mental disorder less frequently. The cross-sectional nature of this study does not allow conclusions regarding causality. The results should be reappraised in a longitudinal study. However, the findings suggest that patients with laryngectomy and their families should be also offered couple interventions besides individual counseling.

Die Rolle des Geschlechts bei stimmlicher Rehabilitation und emotionalem Befinden nach Laryngektomie

BACKGROUND Data on psychosocial factors of laryngectomized women is rare. All means of alaryngeal voice production sound male due to low fundamental frequency and roughness, which makes postlaryngectomy voice rehabilitation especially challenging to women. Aim of this study was to investigate whether women use alaryngeal speech more seldomly and therefore are more emotionally distressed. MATERIAL AND METHODS In a cross-sectional multi-centred study 12 female and 138 male laryngectomees were interviewed. To identify risc factors on seldom use of alaryngeal speech and emotional functioning, logistic regression was used and odds ratios were adjusted to age, time since laryngectomy, physical functioning, social activity and feelings of stigmatization. RESULTS Esophageal speech was used by 83% of the female and 57% of the male patients, prosthetic speech was used by 17% of the female and 20% of the male patients and electrolaryngeal speech was used by 17% of the female and 29% of the male patients. There was a higher risk for laryngectomees to be more emotionally distressed when feeling physically bad (OR=2,48; p=0,02) or having feelings of stigmatization (OR=3,94; p≤0,00). Besides more women tended to be socially active than men (83% vs. 54%; p=0,05). CONCLUSIONS There was no influence of sex neither on use of alaryngeal speech nor on emotional functioning. Since there is evidence for a different psychosocial adjustment in laryngectomized men and women, more investigation including bigger sample sizes will be needed on this special issue.

Quality of life during the first year after partial laryngectomy: Longitudinal study

This prospective study was conducted to assess changes in quality of life (QOL) of patients who undergo a partial laryngectomy.

Berufliche Rehabilitation nach Laryngektomie

BACKGROUND Aim of this study was to find out how many patients after a total laryngectomy (TLE) return to work successfully and what factors support vocational rehabilitation. PATIENTS AND METHODS Laryngectomees (n=231) aged up to 60 years completed questionnaires and structured interviews before TLE (t1), before rehabilitation (t2), at the end of rehabilitation (t3), 1 year after TLE (t4), 2 years after TLE (t5), and 3 years after TLE (t6). RESULTS Prior to TLE, 38% of all respondents were employed, 34% were unemployed, 23% received disability-related and 3% age-related pension retirement. One year after TLE, 13% were employed, 15% 2 years and 14% 3 years after TLE. Unemployed were 10% (t4), 5% (t5), and 7% (t6) of the patients. For 59% of all respondents it was very important to have a job. Predictors of successful vocational rehabilitation were employment prior to TLE, age <50 years, being self-employed or clerical employee, good physical functioning, good speech intelligibility, high motivation to go back to work, and support from colleagues. CONCLUSION Only few laryngectomees return to work. However, even before TLE only a third of the patients was employed, another third was unemployed. Most of the patients receive pension retirement after TLE. As return to work is important for many patients, patient consultations should consider possibilities to support vocational rehabilitation before offering to apply for retirement.

Progredienzangst (PA) nach Kehlkopfteilresektion (KTR)

BACKGROUND Fear of recurrence (FoR) is a common problem in cancer patients. However, it is quite unknown in which extent patients who underwent a PL have FoR. This pilot study examines the extent of FoR and coping strategies in cancer patients after PL as well as associations between FoR and medical, treatment-related, psychosocial and demographic parameters. MATERIAL AND METHODS In a multicentre cross-sectional study, data was taken from 154 cancer patients after PL. Data was collected in personal interviews and with standardised questionnaires (e. g., PA-F; HADS; EORTC H&N-C35). RESULTS The study participants had a low level of FoR (MW=6.67; SD=2.43) and a high level of coping strategies (MW=3.24; SD=0.83). FoR was higher in young patients (r=-0.265; p=0.002) and in users of medical rehabilitation programs (U=1 480; p=0.025). Patients who thought smoking (r=0.197; p=0.029) or/and inner conflicts (r=0.177; p=0.050) was/were the reason(s) for their cancer and who reported more swallowing problems, had a significantly higher level of FoR (r=0.496; p<0.001). There was a negative correlation between the extent of FoR and time passing by since the last surgery of the larynx (r=- 0.322; p<0.001). CONCLUSIONS Frequently occurring swallowing problems as well as internal causal attributions for the development of cancer as smoking increase the level of FoR. Since internal causal attributions may cause feelings of guilt, psycho-oncological treatment can be indicated for patients with higher levels of FoR. Furthermore, younger individuals and patients with more swallowing problems need more attention by physicians and therapists.