Itzhak Brook MD was awarded the Distinguished Service Award by The Head and Neck Cancer Alliance at their Survivorship Symposium in Philadelphia on October 5, 2024.
My Voice: Laryngectomy and Head and Neck Cancer Information
Created by Itzhak Brook MD a physician and a laryngectomee. It contains information about head and neck cancer, life after laryngectomy, and manuscripts and videos about Dr. Brook's personal experiences as a patient with throat cancer. It has information about side effects of radiation and chemotherapy; methods of speaking; airway, mucus, stoma, voice prosthesis; eating and swallowing; medical, dental and psychological issues; respiration; anesthesia; travelling; and COVID-19.
"My Voice"
To obtain suggestions for laryngectomees how to cope with COVID-19 pandemic click the Laryngectomee Newsletter link.
Friday, October 11, 2024
Itzhak Brook MD was given the Distinguished Service Award by The Head and Neck Cancer Alliance
Thursday, August 8, 2024
Social isolation and loneliness in laryngectomees
Laryngectomees, face many psychological,
social and personal challenges . Laryngectomees also experience social
isolation and loneliness (SIL) because of their difficulties in communication
and their post-surgical deformities. A study by Itzhak Brook MD from Georgetown University, published in European
Annals of Otorhinolaryngology, Head and Neck diseases; shed light on this issue
by evaluating the frequency of SIL in laryngectomees.
Members of Facebook laryngectomee support
groups were asked if they experience social SIL. Statistical analysis used:
'N-1' Chi squared test. A total of 379
individuals responded (208 males, 171 females). A total of 237 (62.6%) reported
SIL (117 males, 120 females). SIL was present in 117 males ( 56.2% of
males) and 120 of females ( 70.2 %
of females). Ninety four individuals (
61 males and 33 females) reported their method of speaking. SIL was reported in
voice prosthesis users in 17 (47%) males, and 12 (66%) females). It was
reported in electrolaryx users in 6 (24%) males, and 7 (43%) females. The
difference between males and females was not significant in either group.
However, the presence of SIL was significantly higher in all voice prosthesis
users compared to all electrolarynx users.) The higher frequency of SIL in
females compared to males may be due to their awareness of their anatomical
changes following laryngectomy.
SIL is common in cancer survivors,
contributing to poor outcomes and is associated with increased risk of
cardiovascular disease, hypertension, stress, decreased quality of life, poor
physical and mental health, and higher mortality. Loneliness was present in a
quarter of HNC patients.(5) Patients who
were younger, lived in deprived circumstances, had advanced disease and had been
treated with chemotherapy or radiotherapy reported greater levels of
loneliness. Loneliness was associated with a worse overall quality of life, and
worse physical and social-emotional function.
Despite the limitations of our analysis,
due to the use of a Facebook group that included various groups of
laryngectomees, and the lack of a validated standard test to analyze
loneliness, our data highlight the high frequency of SIL in laryngectomees. It
is hopeful that these findings would inspire further research and encourage
clinicians to recognize and treat SIL in laryngectomees. Early recognition and
interventions to relieve SIL are urgently needed.
link to the manuscript https://drive.google.com/file/d/1Vqqy1BBMYQa35a_J5bD7IT4Sx3r5JZ06/view?usp=sharing
Friday, August 2, 2024
Instructions for inpatient care of laryngectomees.
It is advisable that laryngectomees provide the Instructions below to the medical staff who cares for them:
INSTRUCTIONS: INPATIENT CARE OF LARYNGECTOMEE
GENERAL
- 100% neck breather. Breathe through neck stoma.
- Air, oxygen, suction and respiration resuscitation is through my stoma.
- Keep my trachea moist by inserting saline bullets every 3-4 hours.
- I do not have radial artery pulse on my left/right arm (in case you had a free flap)
.
RESPIRATORY SUPPORT:
- To deliver respiratory support, or if I am unconscious, remove HME (heat moisture exchanger filter) if you wear one).
- Oxygen given to me should be humidified.
- Oxygen mask should be “child-mask” size over stoma.
- If I am not able to cough, I need to be frequently suctioned through the stoma.
COMMUNICATION:
- I am unable to speak without HME (if you wear one over my stoma.
- Without HME, I can communicate via lip reading or writing on a board or paper.
- I have a round 10 mm plastic voice prosthesis inside my trachea, visible through the stoma.
- Don’t remove, even if I need to be intubated.
NEED ASSISTANCE?
Contact a speech pathologist for supplies & help.
Click to get the link to obtain the Instructions
Saturday, June 22, 2024
The sixth edition of the Expanded Laryngectomee Guide is available
I am happy to announce the publication of the 6 th edition
of the Expanded Laryngectomee Guide, now spanning 379 pages. This updated and
revised edition offers valuable information to assist laryngectomees and their
caregivers with a wide range of concerns, including medical, dental, and
psychological issues.
The guide includes comprehensive details on head and neck
cancer and its surgical treatments, side effects of radiation and chemotherapy,
various speaking methods, and care for the airway, stoma, and voice prosthesis.
It also addresses eating and swallowing challenges, and provides guidance on
respiration, preventive medicine, urgent care, anesthesia, and traveling.
Additionally, the guide offers helpful resources specifically for
laryngectomees and head and neck cancer patients.
The E Book is free for download https://bit.ly/3xvA49f
Paperback and Kindle are available at https://www.amazon.com/dp/B0D7SHQN48
Saturday, May 11, 2024
Oral HPV infection before and after treatment for HPV16-positive and negative head and neck squamous cell carcinoma
Oral HPV infection can persist in the oro-pharynx after treatment for head and neck squamous cell carcinoma (HNSCC), with different patterns observed for HPV16-positive and HPV-negative tumors:
For HPV16-positive HNSCC:
- Most patients have detectable oral HPV16 prior to treatment.
- After treatment with radiation or chemoradiation, many patients clear the oral HPV16
- However, a significant proportion (around 25%) continue to have detectable oral HPV16 infection after treatment completion.
For HPV-negative HNSCC:
- Oral HPV is less common prior to treatment compared to HPV16-positive cases.
- Oral HPV rates tend to remain low after treatment completion.
In summary, oral HPV16 infection is more likely
to persist after treatment in patients with HPV16-positive HNSCC compared to
those with HPV-negative tumors.
This means that patients with this type of cancer are still carrying the HPV16 in their body and can potentially spread it to others. However, since this virus is very prevalent in individuals ( can be found in almost half of adults ) the significance of this information is unclear.
A systematic review and random effects
meta-analysis of 60 studies reported increased cancers in the population with
previous HPV-associated cancer when compared to controls. The clinical implications of persistent oral
HPV infection after treatment are still being investigated, but it may increase the risk of recurrence or second primary tumors.
Monday, May 6, 2024
Navigating Uncertainty: Coping Strategies for Cancer Patients Facing an Uncertain Future
Cancer diagnosis brings with it a whirlwind of
emotions, and perhaps one of the most daunting is uncertainty about the future.
From treatment outcomes to long-term prognosis, cancer patients often grapple
with a sense of unpredictability that can be overwhelming. In this article, we
explore the challenges of uncertainty in cancer patients and offer strategies
for coping and finding hope in the face of the unknown.
Uncertainty in cancer patients stems from various sources, including the unpredictable nature of the disease itself, the efficacy of treatments, and the impact on daily life. The fear of recurrence, side effects of treatment, financial concerns, and changes in relationships can all contribute to feelings of uncertainty. Moreover, the unpredictable trajectory of the disease can make planning for the future seem like an impossible task.
Coping Strategies include:
1. Open Communication: Honest and open communication with healthcare providers is crucial for addressing concerns and understanding treatment options. Patients should feel empowered to ask questions and seek clarification about their prognosis and the potential outcomes of treatment.
2. Support Systems: Building a strong support network of family, friends, and fellow cancer survivors can provide emotional support and practical assistance during challenging times. Support groups offer a safe space for sharing experiences and coping strategies, reducing feelings of isolation and loneliness.
3. Mindfulness and Acceptance: Practicing mindfulness techniques, such as meditation and deep breathing exercises, can help cancer patients cultivate acceptance of uncertainty and live in the present moment. Mindfulness encourages patients to acknowledge their emotions without judgment and find peace amidst the chaos.
4. Education and Advocacy: Knowledge is empowering, and staying informed about one's diagnosis, treatment options, and potential side effects can help alleviate anxiety and uncertainty. Patients are encouraged to become advocates for their own health, actively participating in decision-making processes and seeking second opinions when necessary.
5. Setting Realistic Expectations: While hope is essential for maintaining resilience, it's important for cancer patients to set realistic expectations and embrace uncertainty as part of the journey. Setting achievable goals and focusing on small victories can provide a sense of control and accomplishment.
6. Seeking Professional Support: Professional
counseling or therapy can offer additional support for cancer patients
struggling with uncertainty and anxiety. Therapists trained in oncology can
provide coping strategies, emotional support, and practical guidance for
navigating the challenges of cancer survivorship.
Despite the uncertainty that accompanies a cancer diagnosis, it's essential for patients to hold onto hope and find meaning in their journey. Each day brings opportunities for connection, growth, and resilience. By embracing uncertainty as a natural part of life and focusing on the present moment, cancer patients can cultivate a sense of peace and optimism in the face of an uncertain future.
Uncertainty is an inevitable aspect of the cancer journey, but it doesn't have to overshadow hope and resilience. By implementing coping strategies, building strong support networks, and embracing mindfulness practices, cancer patients can navigate the uncertainties of the future with courage and grace. Remember, you are not alone in this journey, and there is always hope for a brighter tomorrow.
Saturday, May 4, 2024
The power of a hug in caring for head and neck cancer patients
The power of a hug in caring for head and neck cancer
patients can be immense. Cancer treatments, especially those targeting the head
and neck area, can be physically and emotionally taxing. Patients often
experience pain, discomfort, and emotional distress throughout their journey.
A hug can offer several benefits:
Emotional Support: Cancer treatment can evoke
feelings of fear, anxiety, and depression. A hug provides emotional
reassurance, comfort, and a sense of connection, reminding patients that they're
not alone in their struggle.
Pain Relief: Hugs trigger the release of oxytocin,
often referred to as the "love hormone" or "bonding
hormone." Oxytocin has analgesic effects, reducing pain and promoting
relaxation, which can be particularly helpful for patients dealing with
physical discomfort.
Stress Reduction: Hugs can lower levels of stress
hormones like cortisol, promoting a sense of calm and well-being. Managing
stress is crucial for cancer patients as it can impact immune function and
overall health.
Improved Mood: The physical touch of a hug stimulates
the release of dopamine and serotonin, neurotransmitters associated with
happiness and pleasure. This can uplift the mood of patients, offering a moment
of joy amidst the challenges they face.
Enhanced Social Support: Cancer treatment often leads
to social isolation as patients may feel alienated or misunderstood. A hug
signifies empathy and solidarity, strengthening the patient's support network
and fostering a sense of belonging.
Communication Without Words: Sometimes, words fail to
convey the depth of care and compassion we feel for someone going through a
difficult time. A hug serves as a powerful non-verbal expression of empathy,
love, and support.
It's important to note that not everyone may feel comfortable
with physical touch, so it's essential to respect individual preferences and
boundaries. However, for those who are receptive, a simple hug can have
profound effects on their well-being and healing journey.
I experienced the “power of a hug” as a patient with throat
cancer. Read my article about this ib the Los Angeles Times https://www.latimes.com/health/la-he-my-turn-hugs-20110523-story.html
and my interview about it at https://www.youtube.com/watch?v=LG6AFlPQtM8
Thursday, May 2, 2024
The Transformative Power of a Smile in Laryngectomees
After undergoing a laryngectomy, I received invaluable advice from a seasoned laryngectomee: before engaging in conversation, always start with a smile. He emphasized that this simple gesture has been instrumental in fostering a positive and approachable demeanor, particularly given the challenges of being understood with his altered voice. This was an invaluable advice that I learned to appreciate time and again.
The human smile is a universal language, transcending barriers of culture, language, and circumstance. Its power lies not only in its ability to convey happiness but also in its capacity to heal, comfort, and connect. For laryngectomees, individuals who have undergone surgery to remove their voice box due to cancer or other medical conditions, the simple act of smiling takes on profound significance, serving as a beacon of hope and resilience in the face of adversity.
Laryngectomy is a life-altering procedure that not only robs individuals of their voice but also challenges their sense of identity and communication. The loss of speech can lead to feelings of isolation, frustration, and diminished self-esteem. However, amidst the silence, the smile emerges as a powerful tool for communication and emotional expression.
A smile is more than just the movement of facial muscles; it is a reflection of the inner strength and resilience of the human spirit. For laryngectomees, whose voices may be silenced, the smile becomes their voice, speaking volumes without uttering a single word. It conveys warmth, kindness, and positivity, transcending the limitations imposed by their condition.
Moreover, the act of smiling has been scientifically proven to have numerous physical and psychological benefits. When we smile, our brains release endorphins, neurotransmitters that promote feelings of happiness and reduce stress. This natural mood booster not only uplifts the spirits of laryngectomees but also enhances their overall well-being.
Furthermore, a smile is contagious, capable of brightening the darkest of days and fostering connections with others. For laryngectomees navigating a world where communication may be challenging, a genuine smile can break down barriers, fostering empathy, understanding, and acceptance in their interactions with others.
Beyond its individual impact, the smile of a laryngectomee serves as a beacon of hope for others facing similar challenges. It embodies resilience, courage, and optimism in the face of adversity, inspiring others to find strength in their own struggles.
In addition to its emotional and social significance, the smile plays a practical role in the rehabilitation process for laryngectomees. Speech therapists often incorporate smile exercises into therapy sessions to help improve facial muscle control and articulation, facilitating the development of alternative methods of communication such as esophageal speech or the use of assistive devices.
The power of a smile
in the lives of laryngectomees cannot be overstated. Beyond its role as a
symbol of joy and positivity, the smile serves as a lifeline, connecting
individuals to their inner resilience and to the world around them. In a
journey marked by challenges and obstacles, the simple act of smiling emerges
as a beacon of hope, lighting the path towards healing, acceptance, and
connection.
Saturday, April 27, 2024
Anxiety, depression and quality of life following laryngectomy. A long-term prospective evaluation.
Mukoyama and colleagues from Nagoya
University Graduate School of Medicine, Nagoya, Japan; assessed anxiety,
depression and quality of life in 150 patients with head and neck cancer
undergoing laryngectomy.
The surgical procedures were total
laryngectomy, pharyngo-laryngectomy and pharyngo-laryngo-oesophagectomy in 97
(65%), 41 (27%) and 12 (8%) patients, respectively. All quality of life items were
significantly worse than those of the normal population at baseline and at 3
months after surgery. However, general health, vitality, mental health and
bodily pain improved to normal levels within 1 year after surgery and were
maintained for 5 years. In this study, 35% of patients were categorized as potential
cases of depression, and 35% were potential cases of anxiety. During the
follow-up period, the proportion of patients with anxiety gradually decreased
after surgery.
The authors concluded that anxiety,
depression and quality of life in laryngectomized patients improved at one year after surgery
and were maintained throughout the 5 years of the study..
Friday, April 12, 2024
Dr Itzhak Brook Keynote address. “ Back to Life” 2nd Annual Head and Neck Cancer Patient & Caregiver Symposium at Keck Medicine University of California. April 6, 2024.
Dr. Itzhak Brook Keynote address. “Back to Life” after laryngectomy 2nd Annual Head and Neck Cancer Patient & Caregiver Symposium at Keck Medicine University of California. April 6, 2024
Tuesday, April 9, 2024
How wearing a hearing aid can improve speech
Hearing loss may make individuals perceive that their voice is weaker than it actually is. It may contribute to social isolation and make laryngectomees try to speak louder. In those who use tracheoesophageal speech and are trying to speak louder by generating greater expiratory effort a separation of the HME base plate from the skin can occur. This is especially true in those who use a hands free HME. Wearing a hearing aid enables a laryngectomee to hear their actual voice.
Tuesday, February 20, 2024
Decisional Conflict in Patients with Advanced Laryngeal Carcinoma
Heirman and colleagues from the Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, studied the decision conflict in patients with a locally advanced laryngeal carcinoma (T3 and T4). The decision is challenging due to the treatment choice between organ preservation and laryngectomy, both with different and high impact on function and quality of life (QoL). The complexity of these treatment decisions and their possible consequences might lead to decisional conflict (DC). This study aimed to explore the level of DC in locally advanced laryngeal carcinoma patients facing curative decision-making, and to identify possible associated factors.
Participants completed questionnaires on
DC, level of shared decision-making (SDM), and a knowledge test directly after
counseling and 6 months after treatment.
Directly after counseling by their
medical providers, almost all participants (44/45; 98%) experienced clinically significant
DC score (CSDC >25, scale 0-100). On average, patients scored 47% (SD 20%)
correct on the knowledge test. Questions related to radiotherapy were answered
best (SD 69%), whilst only 35% (SD 29%) of the questions related to
laryngectomy were answered correctly. Patients' perceived level of SDM (scale
0-100) was 70, and for physicians this was 70 .
The authors concluded that most patients
with advanced larynx cancer experience high levels of DC. Low knowledge levels
regarding treatment aspects indicate a need for better patient counseling.
Saturday, January 27, 2024
A poem by Anne Pitkin about life challenges of Laryngectomee published in JAMA in the Healing and Poetry Section January 23, 2024
You can do everything you did before except swim.
Sunday, January 7, 2024
Artificial Intelligence helping laryngectomees to speak again
The developments in artificial intelligence led to developments that can help laryngectomees use new ways by which they can speak again. Most of these methods are in the developmental stages. However, some, such as Google Duplex is available today.
Google Duplex is an artificial
intelligence (AI) technology that mimics a human voice and makes phone calls on
a person's behalf. It enables users to perform a variety of tasks -- including
make reservations, schedule appointments and perform other functions -- without
having to speak to someone.
Whispp’s language independent AI
technology and calling app converts whispered speech and vocal cord impaired
speech into a clear and natural voice of one’s choice, without any delay. By
providing recordings, one’s Whispp voice can sound like the person’s own
healthy voice.
Other methods of generating speech
are under development. Tank and his colleagues from the University of Texas at
Austin, have developed a non-invasive language decoder that can reconstruct
speech from functional MRI data. This technology can one day help people who
have lost their ability to speak called a semantic decoder.
The Australian start-up Laronix is developing a bionic device that uses AI-based voice-cloning technology to restore the voices of laryngectomees.
Friday, December 29, 2023
Dysautonomia in oral and head and neck cancer patients
Dysautonomia is an umbrella term referring to a group of several medical conditions that cause a malfunction of the Autonomic Nervous System (ANS). This is the part of the nervous system that controls automatic processes or the things that one’s body does without having to think about them, such as heart rate, blood pressure, digestion, dilation, and constriction of the pupils of the eye, kidney function, and temperature control. Dysautonomia can be acute and reversible or non-reversable, chronic and progressive.
Dysautonomias in adults often are associated with, and may
be secondary to, another disease process or a drug. Common secondary causes
include medications, chemotherapy, radiation treatments, spinal cord or head
injury, or diabetes .
Oral, head and neck cancer patients that receive radiation
as part of their treatments, can have varying degrees of scatter radiation to
these structures, and years after treatment develop some of the manifestations
of dysautonomia. When the ANS doesn’t work as it should, it can cause heart and
blood pressure problems, trouble breathing, and loss of bladder control among
other symptoms.
People living with various forms of dysautonomia have
trouble regulating some of the ANS systems, which can result in
lightheadedness, fainting, unstable blood pressure, abnormal heart rates, and malnutrition.
● Balance Problems
● Fatigue
● Nausea, Vomiting, GI Trouble
● Irregular Heart Rate and Blood
Pressure
● Fainting/ Loss of Consciousness
● Lightheadedness, Dizziness,
Vertigo
● Brain Fog/ Forgetfulness
● Exercise intolerance
Patients with autonomic disorders
usually require a multi-disciplinary team, as autonomic disorders can impact
almost every organ and system of the body. While each specialist will have his
or her own areas of expertise, it is still important for each member of the
patient’s team to be familiar with the most up-to-date information on the
patient’s autonomic disorder.
There is no cure for
dysautonomia. Secondary forms of dysautonomia may improve with treatment of the
underlying disease. The best that can be done is to deal with the various
manifestations of it and their individual symptoms. Treating symptomology is not
the same as treating the disease and is a coping mechanism not a cure.
Lifestyle changes will be necessary for many of the symptoms to be reduced or
mitigated.
Read more about dysautonomia at https://thedysautonomiaproject.org/dysautonomia/
Saturday, December 16, 2023
Patients requiring multiple dilations are at increased risk of persistent dysphagia long-term.
Following total laryngectomy (TL) or laryngopharyngectomy
(TLP), patients may develop strictures that Head Neck require multiple
dilations to treat. However, the risk factors associated with dysphagia
refractory to a single dilation are unknown.
The authors concluded that shorter time interval to
stricture formation is a prognostic indicator of the need for multiple
dilations following TL/TLP. Patients requiring multiple dilations are at
increased risk of persistent dysphagia long-term.
Endoscopic dilation balloon
Monday, November 6, 2023
Quality of Life, Dysphagia, Voice Problems, Depression, and Anxiety after Laryngectomy
Wulff and colleagues from Zealand University Hospital, Køge, Denmark.; determine health-related quality of life (HRQoL), including voice problems, dysphagia, depression, and anxiety after total laryngectomy, and investigate the associations between HRQoL and the late effects.
The 172 participants scored worse than normative reference
populations on all scales/itemss, except one, and almost half of the
scales/items showed a clinically relevant difference. Moderate/severe dysphagia
was present in 46%, moderate/severe voice problems in 57%, depression in 16%,
and anxiety in 20%. Younger age, increasing numbers of comorbidities,
increasing voice problems, increasing dysphagia, and increasing depression
symptoms, were associated with a lowered EORTC QLQ-C30 summary score.
The study illustrated that a substantial proportion of
participants experienced clinically significant late effects and increasing
levels of these were associated with a lowered HRQoL.
Thursday, November 2, 2023
Loneliness and quality of life in head and neck cancer patients
Patients with head and neck cancer (HNC) are at risk of loneliness
because of the effects of the disease and its treatment on important social
interactive functions such as appearance, speech, facial expression, and
eating. Dahill and colleagues from Aintree University Hospital, Liverpool, UK,
evaluated the association between loneliness and the quality of life, mental
illness, physical health, and premature mortality.
The investigators survived 140 patients treated for primary
squamous cell HNC between 2015 and 2016. Tumor sites were oropharyngeal (42%),
oral (35%), laryngeal (14%), and elsewhere (9%).
In response to the question "How often do you feel
lonely?" three-quarters said "hardly ever" and only
6% "often". Similar responses were obtained for the other
three indicator questions. It is encouraging that a relatively small proportion
had serious issues with loneliness. Similarly, one-quarter had feelings of
loneliness and a minority had serious problems. Patients who were younger, who
lived in more deprived circumstances, who had advanced disease and had been
treated with chemotherapy or radiotherapy reported greater levels of
loneliness.
The study showed that loneliness was associated with a worse
overall quality of life, and worse physical and social-emotional function. Dahill
and colleagues recommended that lonely patients need to be identified as early
as possible so that support and interventions can be implemented and outcomes
improved.
Information about support and interventions to help individuals with HNC click this link.
Saturday, October 28, 2023
Tobacco Cessation Following Laryngeal Cancer Diagnosis Predicts Response to Treatment and Laryngectomy-Free Survival
Krutz and colleagues from the University of Oklahoma Health Sciences Center studied the effect of tobacco cessation following laryngealcancer diagnosis on response to first-line therapy, laryngectomy-free survival, and overall survival in patients who were current smokers at the time of diagnosis.
The authors evaluated 140 patients diagnosed with laryngeal
squamous cell carcinoma, who were smokers at the time of diagnosis, and were
treated with first-line definitive radiation or chemo/radiation with the intent
to cure.
Of the 140 current smokers, 61 patients (45%) quit smoking
prior to treatment initiation. Smoking, quitters had 3.7 times higher odds of
achieving a complete response to first-line therapy than active smokers (odds
ratio: 3.694 [1.575-8.661]; P = .003). Quitters
were 54% less likely to require salvage laryngectomy within 7 years of
diagnosis than active smokers (hazard ratio: 0.456 [0.246-0.848]; P = .013).
Quitters had a statistically significant increase in 7-year overall survival
compared to active smokers (P = .02).
This is the first study to show that in newly diagnosed
laryngeal cancer patients who are current smokers at the time of diagnosis,
tobacco cessation significantly increases therapy response, laryngectomy-free
survival, and overall survival. These data stress the importance of
systematically incorporating tobacco cessation programs into laryngeal cancer
treatment plans.
Saturday, September 30, 2023
Who is the best surgeon and what is the best place to have laryngectomy?
Saraswathula from
Johns Hopkins University in Baltimore, and colleagues evaluated therelationship between surgeon volume and operative morbidity and mortality for
laryngectomy.
The Nationwide Inpatient Sample was used to identify 45,156
patients who underwent laryngectomy procedures for laryngeal or hypopharyngeal
cancer between 2001 and 2011.
The authors found that higher-volume surgeons were more
likely to operate at large, teaching, nonprofit hospitals and were more likely
to treat patients who were white, had private insurance, hypopharyngeal cancer,
low comorbidity, admitted electively, and to perform partial laryngectomy,
concurrent neck dissection, and flap reconstruction. Surgeons treating more
than 5 cases per year were associated with lower odds of medical and surgical
complications, with a greater reduction in the odds of complications with
increasing surgical volume. Surgeons in the top volume quintile (>9
cases/year) were associated with a decreased odds of in-hospital mortality (OR
= 0.09 [0.01-0.74]), postoperative surgical complications (OR = 0.58
[0.45-0.74]), and acute medical complications (OR = 0.49 [0.37-0.64]). Surgeon
volume accounted for 95% of the effect of hospital volume on mortality and
16%-47% of the effect of hospital volume on postoperative morbidity.
The authors concluded that there is a strong volume-outcome
relationship for laryngectomy, with reduced mortality and morbidity associated
with higher surgeon and higher hospital volumes. Observed associations between
hospital volume and operative morbidity and mortality are mediated by surgeon
volume, suggesting that surgeon volume is an important component of the
favorable outcomes of high-volume hospital care.
Wednesday, August 16, 2023
Fatal Tracheoesophageal Puncture Leakage Associated With Lenvatinib.
Fatal tracheoesophageal puncture leakage associated with Lenvatinib treatment was reported by Salvatori S. and Tanvetyanon T. from Moffitt Cancer Center and Research Institute, Tampa, FL. The report was published in Cureus [15(8): e43490].
Tracheoesophageal puncture (TEP) is a voice restorative is often
used in laryngectomees. Though generally safe, TEP may develop leakage.
Lenvatinib is a tyrosine kinase inhibitor (TKI) with anti-tumoral activity
against head and neck malignancies. TKIs, including lenvatinib, have been
associated with organ perforation or fistula formation. The authors described a
patient with adenoid cystic carcinoma of the larynx who had a TEP for several
years. After approximately two weeks of treatment with lenvatinib, the patient
developed a leakage of TEP. Despite several interventions, the patient died
three months afterward due to a retropharyngeal abscess secondary to Fusobacterium
nucleatum infection.
To the authors’ knowledge, this is the first report of fatal
lenvatinib-associated TEP leakage. They urge clinicians to be cognizant of the potentially rapid development of this complication when prescribing TKI for
patients with TEP.
Wednesday, July 12, 2023
Quality of sexual life after total laryngectomy for cancer.
Babin and colleagues from the Department of Otolaryngology of the University of Caen France, reviewed 24 studies that evaluated sexual life after total laryngectomy (TL) for cancer. The main endpoint was the impact of impairment of quality of sexual life after TL. The secondary endpoints were the type of sexual impairment, associated variables and their treatment.
The study population
consisted of 1511 TL patients aged 21 to 90 years, with a male/female sex ratio
of 7.5/1. Impaired quality of sexual life was reported by 47% of patients on
average. Erectile and ejaculatory function and ejaculatory behavior of male
patients decreased after TL. Other impairments comprised decreases in libido,
frequency of sexual intercourse and satisfaction. Tracheostomy, advanced
disease stage, young age and associated depression were factors for impairment.
In all, 23% of patients reported lack of postoperative support in this area.
The authors concluded that laryngectomy impacted both
patients and partners, negative effects being reported in more than 30% of
cases. The physical transformation has aesthetic and emotional impact,
inhibiting sexuality. the quality of sexual life is severely impacted by TL for
cancer. There is patient demand for improved management of sexuality.
Monday, June 12, 2023
RESOURCES FOR LARYNGECTOMEES By Itzhak Brook MD , M Sc,
• The
Laryngectomee Guide. Paperback and Kindle at http://goo.gl/z8RxEt Free download at https://www.entnet.org/laryngectomee-guide/ (helpful for new patients)
The Laryngectomee Guide is available (Free eBooks) in 24
languages. https://dribrook.blogspot.com/2018/08/the-laryngectomee-guide-is-available-in.html
• The
Laryngectomee Guide Expanded Edition, 5TH
edition., Paperback and Kindle at https://www.amazon.com/dp/B0BBJPY5P2 Free download at https://bit.ly/3QGTqNa
(Recommended for seasoned patients)
• The
“Laryngectomee Guide for COVID-19 Pandemic” provides information for
laryngectomee and neck breathers how to cope with the pandemic. The E books are
free. Available at https://amzn.to/3i5XncR
as paperback, and at https://bit.ly/3hZHynb
as eBook (free).
• “My Voice:
A Physician’s Personal Experience with Throat Cancer.” Paperback and Kindle at http://goo.gl/j3r51V Free download at https://dribrook.blogspot.com/p/my-voice-physicians-personal-experience.html
• Rescue
breathing of neck breathers including laryngectomees
Video: https://www.youtube.com/watch?v=YE-n8cgl77Q
Manual: https://bit.ly/3k1iRO5
Friday, May 5, 2023
Pravastatin antifibrotic efficacy in reversing radiation-induced fibrosis after radiation therapy for head and neck cancer
A prospective study done by Celine Bourgier and colleagues from Université de Montpellier, France; .showed that pravastatin (a statin) is an efficient antifibrotic agent in patients with established cutaneous and subcutaneous radiation-induced fibrosis (RIF) after radiation therapy for head and neck cancer.
The primary endpoint was reduction of RIF thickness by more than 30% at 12 months, as measured by cutaneous high-frequency ultrasonography. Secondary endpoints included RIF severity reduction, pravastatin tolerance, and quality of life.
Sixty patients were enrolled from February 2011 to
April 2016. The mean interval between RIF diagnosis and pravastatin initiation
was 17.1 months. Pravastatin was stopped before 11 months of treatment in 18
patients (because of grade ≥2 adverse events related to pravastatin in 8
patients [13%]). In the 40 patients in whom pravastatin efficacy was assessed
by high-frequency ultrasonography at baseline and at 12 months of treatment, a
reduction of RIF thickness ≥30% was observed in 15 of 42 patients (35.7%). At the 12-month clinical evaluation, RIF
severity was decreased in 50% of patients (n = 21), and the patients' self-perception, mood state, and social
functioning were significantly improved. Pravastatin was well tolerated.