A Comparison of Older and Younger Individuals Living after the Surgical Treatment of Laryngeal Cancer

Journal of Rehabilitation,  Oct, 1995  by Gordon W. Blood,  Ingrid M. Blood,  Susan Kauffman,  Susan C. Raimondi,  Mary Dineen

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Introduction

Cancer of the larynx often necessitates the surgical removal of the larynx, resulting in communication and psychosocial problems for the individual surviving cancer. The median age of diagnosis for cancer of the larynx is between 50 and 60 years of age. An estimated 13,000 new cases of laryngeal cancer were diagnosed in 1990, and approximately 9,000 persons will survive (American Cancer Society, 1991). Early detection and high survival rates suggest that laryngeal cancer is becoming one of a growing number of "chronic, curable diseases" in the elderly. One of the primary aims of rehabilitation programs for individuals with laryngectomies (IWL) is functional communication.

Some studies have examined the psychosocial qualities of IWL and found post-surgery depression, sense of loss, problems in adjustment to the permanent hole in their neck, irritability, isolationism, and anxiety are present in some IWL (Blood & Blood, 1982; Manuel et al., 1987; Richardson & Bourque, 1985; West, 1977). Recently, Blood, et al. (1992) reported on the coping and adjustment of IWL. Results from 41 face-to-face interviews revealed that over 70% of the sample showed good adjustment to the cancer experience. The good copers used predominantly problem-focused and seeking-social support strategies to deal with their cancer. They perceived themselves to have positive self-esteem and higher scores on general well-being than poor copers.

Kane (1991) in describing psychological and social issues for older people with cancer suggests the major issues revolve around: multiple losses, reactions of others, arranging for care, learned helplessness, and loss of control. She indicated that learned helplessness in older people may result in depression, failure to recognize their control of events, and failure to exercise influence in their lives.

No studies have examined adjustment, communication traits, and activities in daily living of IWL using standardized scales. In fact, only a few studies have examined the issue of aging in laryngeal cancer survivors. It would seem important for counseling, as well as developing effective rehabilitation interventions in speech language pathology to determine if older laryngeal cancer survivors' adjustment styles, communication attributes, or functional capabilities in daily living activities differ from younger laryngeal cancer survivors' attributes. The present study is part of an ongoing series of investigations examining life after a laryngectomy. The specific aims were to 1) determine if differences exist between two age cohorts (IWL between 46 - 65 years and IWL 66 - 82 years of age) using standardized measures of adjustment, communication skills, and activities of daily living, and 2) determine if relationships exist between the variables of adjustment, communication, and activities of daily living for IWL.

Methods

Subjects

A questionnaire was mailed to 200 IWL who had volunteered to participate. The questionnaire contained items about communication, adjustment, voice restoration, and activities of daily living. Also included with the questionnaire were an explanation of the study, assurances of confidentiality and informed consent forms. A follow-up post card reminder was sent two weeks after the initial mailing to increase the response rate. One hundred and fifty-seven respondents (79% return rate) completed the questionnaire. Thirty-three subjects' data could not be used because of incomplete responses, failure to follow the directions, or incomplete demographic data. Therefore, the total number of subjects for this investigation was 124.

The 124 European American males with laryngectomies ranged in age from 46-82 years, with a mean age of 63 years. Subjects were divided into two age cohorts. Sixty-two subjects were placed in Group 1 (Younger Adult Group), and ranged in age from 46 - 65 years of age, with a mean of 52 years. Eighty-one percent (n=50) were married and six percent were widowed (n=4) and thirteen percent were divorced (n=8). Education level ranged from 7th grade to graduate school, with a mean of 12.8 years. Seventy-three percent of Group 1 were employed full time (n=45), sixteen percent (n=10) were employed part time, and eleven percent (n=7) were retired. Although all subjects had undergone total laryngectomies, surgical variations included flap procedures and radical neck dissections. Forty-eight percent (n=30) of the subjects were esophageal speakers, thirty-five percent (n=22) were tracheoesophageal speakers and sixteen percent (n=10) were artificial larynx speakers. Time from surgery to participation in the study ranged from 6 to 58 months, with a mean of 40 months.

Sixty-two subjects were included in Group 2 (Older Adult Group), and ranged in age from 66 - 82 years of age, with a mean of 73 years. Fifty-five percent (n=34) were married and thirty-eight percent were widowed (n=23) and eight percent were divorced (n=5). Education level ranged from 7th grade to graduate school, with a mean of 10.1 years. Sixteen percent of Group 2 were employed full time (n=10), nineteen percent (n=12) were employed part time, and sixty-five percent (n=40) were retired. Although all subjects had undergone total laryngectomies, surgical variations included flap procedures and radical neck dissections. Sixty-three percent (n=39) of the subjects were esophageal speakers, twenty-six percent (n=16) were tracheoesophageal speakers and eleven percent (n=7) were artificial larynx speakers. Time from surgery to participation in the study ranged from 9 to 64 months, with a mean of 48 months. The demographic variables were analyzed to determine similarities between the two groups. Significant differences were found between the two age groups for marital status and employment. A significantly greater number of subjects in the older group were widowed compared to the younger group (X2 (121) = 7.4, p [is less than] .01). No other significant differences were found between the two groups.