FUNCTIONAL OUTCOMES FOLLOWING TREATMENT FOR ADVANCED LARYNGEAL-CANCER- PART I - VOICE PRESERVATION IN ADVANCED LARYNGEAL-CANCER - PART II - LARYNGECTOMY REHABILITATION - THE STATE-OF-THE-ART IN THE VA SYSTEM

This two-part investigation assessed functional outcomes related to co mmunication (including amount of speech therapy), swallowing and eatin g, and employment status for patients who received one of the two trea tment modalities for advanced laryngeal cancer (stage III or IV laryng eal squamous cell carcinoma) in Veterans Administration Cooperative St udy #268. One hundred sixty-six patients were randomized to primary su rgery (laryngectomy) and radiotherapy (RT), and 166 to induction chemo therapy (CT) and RT. The first investigation dealt with examining and comparing functional outcomes for patients in the two treatment arms o f the main study. Results showed clearly that patients with advanced l aryngeal cancer are better off from the standpoint of speech communica tion if they can be treated for this disease without removal of the la rynx. In contrast, there were few significant differences between pati ent groups for other non-speech-related measures. The second investiga tion focused on communication-related outcomes associated with the reh abilitation of total laryngectomy patients. Results revealed that only relatively small percentages of total laryngectomy patients (6%) deve loped usable esophageal speech or remained nonvocal (8%), and that a m ajority of patients ended up as users of artificial electrolarynx (55% ) or tracheoesophageal (31%) speech. The results from both investigati ons are discussed with respect to factors that can influence the rehab ilitation process and long-term outcome status of patients who are tre ated for advanced laryngeal cancer with these two strategies.