Generic health-related quality of life amongst patients employing different voice restoration methods following total laryngectomy

Abstract

Three methods of voice restoration—tracheosophageal speech (TEP), oesophageal speech, electrolarynx—are available following total laryngectomy. TEP produces better voice quality compared with other methods and is assumed to result in better quality of life. Little evidence exists to support the relationship between voice quality and quality of life, however. Advertising this study through several leading laryngectomy charities resulted in the completion of 226 questionnaires (TEP = 147; oesophageal speech = 42; electrolarynx = 37) comprising the Short Form 36 (SF-36) quality of life measure and questions examining perceived voice intelligibility. Additionally, 89 questionnaires comprising only the SF-36 were completed by participants who reported having no serious medical problems, to form a healthy control group. Results indicate that improved voice quality does not result in widespread benefits to quality of life. On only a few dimensions were there differences between voice restoration method: electrolarynx and TEP better than oesophageal speech with respect to pain, TEP better than oesophageal speech with respect to role limitation: physical problems. Additionally whilst widespread differences between voice restoration methods did not occur, all three groups had a worse quality of life compared with the healthy control group. Implications of the results for the selection of voice restoration method to maximize quality of life are discussed.

Keywords:

• Quality of life
• voice restoration
• voice intelligibility
• total laryngectomy

Acknowledgements

We are grateful to Macmillan Cancer Relief for funding this project. Many thanks are due to the National Association of Laryngectomy Clubs, The Cancer Laryngectomy Trust and laryngectomylife.com for their support in advertising the study, Dr Annemieke Ackerstaff for permitting use of questions examining perceived voice quality from a questionnaire specifically devised to examine quality of life in laryngectomized patients developed by the Netherlands Cancer Institute and Professor Michael Hyland and Reviewer B for making many helpful suggestions on versions of the paper. Finally we are indebted to the Speech and Language Therapists and Head and Neck Cancer Nurses for their encouragement throughout the research.