Impact of education on quality of life of laryngectomized patients before and after vocal rehabilitation

Abstract

Introduction. Larynx carcinoma is one of the most common malignant tumors of the upper aerodigestive tract that causes the change in normal anatomical relationships in the neck, which leads to communication and social interaction disorders. The aim of the paper is to examine the impact of education on the quality of life of laryngectomized patients. Methods.The study included 50 laryngectomized patients, aged 51 to 83 years. The subjective voice assessment was carried out using the Voice Handicap Index (VHI) and the University of Michigan Head & Neck Quality of Life Instrument (HNQOL). The patients filled in the questionnaires before and after vocal rehabilitation. Results. The comparison of average scores of all examined laryngectomized patients before and after vocal rehabilitiation showed a statistically significant difference in the total score on VHI scale (107.20 ± 8.46 vs. 21.32 ± 13.29; p lt 0.001), HNQO scale (52.50 ± 17.71 vs. 93.57 ± 6.36; p lt 0.001), as well as on all subscales. Prior to vocal rehabilitation, there was no statistically significant difference between the scores on these two scales in patients with different level of education. After vocal rehabilitation, there was a statistically significant difference between the patients with secondary education and the ones with tertiary education in the scores on all VHI subscales, and total VHI score (23.60 ± 13.54 vs. 18.83 ± 11.59; p = 0.012), as well as in the scores for individual domains and the total score of HNQOL instrument (88.90 ± 6.58 vs. 99.80 ± 4.25; p = 0.048). Conclusion. Vocal rehabilitation after total laryngectomy had a positive effect on patients' quality of life, and patients with higher education showed a tendency towards better quality of life compared to the ones with lower education.

Uvod. Karcinom larinksa je jedan od najčešćih malignih tumora gornjeg aerodigestivnog trakta, koji dovodi do promene normalnih anatomskih odnosa u vratu, što izaziva poremećaj komunikacije i socijalne interakcije. Cilj rada je ispitati uticaj obrazovanja na kvalitet života laringektomisanih bolesnika. Metode. Istraživanje je obuhvatilo 50 bolesnika kojima je urađena totalna laringektomija, starosne dobi od 51 do 83 godine. Sprovedena je subjektivna procena glasa instrumentima Indeks glasovnog oštećenja (Voice Handicap Index - VHI) i Kvalitet života pacijenata sa karcinomom glave i vrata Univerziteta u Michigan-u (University of Michigan Head & Neck Quality of Life instrument-HNQOL). Pacijenti su upitnike popunjavali pre i posle vokalne rehabilitacije. Rezultati. Poređenje prosečnih vrednosti skorova svih ispitivanih laringektomisanih bolesnika pre i posle vokalne rehabilitacije pokazalo je značajnu razliku u ukupnom skoru na VHI skali (107,20 ± 8,46 vs. 21,32 ± 13,29; p lt 0,001) i na HNQO skali (52,50 ± 17,71 vs. 93,57 ± 6,36; p lt 0,001) kao i na svim subskalama. Između skorova dobijenih pomoću obe skale kod bolesnika sa različitim stepenom obrazovanja nije bilo razlike pre vokalne rehabilitacije. Posle vokalne rehabilatacije dokazana je statistički značajna razlika između bolesnika sa srednjim u odnosu na one sa višim/visokim obrazovanjem kako u skrovim svih VHI subskala i ukupnom VHI skoru (23,60 ± 13,54 vs. 18,83 ± 11,59; p = 0,012), tako i u skorovima pojedinih domena i ukupnom skoru HNQOL instrumenta (88,90 ± 6,58 vs. 99,80 ± 4,25; p= 0,048). Zaključak. Vokalna rehabilitacija nakon totalne laringektomije pozitivno je uticala na kvalitet života bolesnika, a bolesnici sa višim obrazovanjem imali su tendenciju ka boljem kvalitetu života u odnosu na one sa nižim obrazovanjem.