Quality of life after conservative laryngeal surgery: a multidimensional method of evaluation

Abstract

Assessment of quality of life (QoL) and satisfaction with care are particularly important in the field of oncology. The definition of QoL and the requirements for its measurement are still a matter of debate, but it is generally accepted that QoL is a multidimensional concept involving three different domains: physical, psychological and social. The aim of this study was to test a simple, inexpensive, multidimensional method of QoL measurement, based both on patients’ perception of clinical outcome and the quantitatively evaluated clinical outcome, equally weighted, in patients who underwent three different types of conservative laryngeal surgery: horizontal laryngectomy (HG), supraglottic laryngectomy (SL) and subtotal reconstructive laryngectomy (SRL). The following were carried out for each patient: subjective-objective evaluation of speech [computerized spectrographic analysis of fundamental frequency (F0), percentage of noise and intensity and logopedic evaluation of speech], evaluation of deglutition (videofluoroscopic parameters, and qualitative assessment) and evaluation of physical, social, emotional and functional well-being (Functional Assessment of Cancer Therapy, FACT-G, and modified University of Washington Quality of life Scale, UWQoL). Each assessment was given a score rating from one to three points. The overall evaluation of the qualitative and quantitative score for each field and for each type of laryngeal surgery shows that SL results in the best post-operative QoL. Although HG is less damaging and involves swifter functional recovery times, its slightly lower score is due to the poorer quality of speech. The analysis of the results obtained confirm the need to set up an evaluation protocol combining both the subjective perceptions of the patient, as well as the more objective evaluation of the functions that are impaired following surgery. The protocol described above, although limited by the low number of cases, was easy to carry out, inexpensive and applicable in relation to the various types of surgery that may compromise phonation and deglutition.