Long-Term Quality of Life and Functional Outcomes in Patients with Total Laryngectomy

Abstract

Background: Laryngeal cancer affects quality of life (QoL), speech, and swallowing. Total laryngectomy (TL) causes severe impairments, while partial laryngectomy (PL) and chemoradiotherapy (CRT) preserve the organ but yield variable outcomes. This study assesses QoL, speech rehabilitation, swallowing, and social reintegration across these treatments.

Methods: This prospective observational cohort study was conducted at the ENT Clinic, Victor Babeș University of Medicine and Pharmacy, Timișoara; recruitment was conducted between October 2019 and January 2024. Seventy-five patients diagnosed with laryngeal squamous cell carcinoma (LSCC) were initially enrolled but only 15 patients (20%) completed the 12-month follow-up, with an attrition rate of 80%. Tumor stages ranged from T1 to T4a, with TL patients having a higher proportion of advanced-stage disease (Stage III-IV: 76%) compared to PL (45%) and CRT (50%). Validated instruments, including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Head and Neck Cancer (EORTC QLQ-H&N35), the Voice Handicap Index-30 (VHI-30), the Hospital Anxiety and Depression Scale (HADS), and the Dysphagia Outcome and Severity Scale (DOSS), were used to assess QoL, voice function, swallowing function, and psychological impact.

Results: At 12 months, the global QoL score from the EORTC QLQ-H&N35 was lowest in TL patients (49.8 ± 10.9), significantly lower than both PL (61.2 ± 9.6, p = 0.002) and CRT (64.1 ± 7.8, p < 0.001). Post hoc Bonferroni analysis confirmed significant pairwise differences between TL vs. PL (p = 0.002) and TL vs. CRT (p < 0.001), while the difference between PL and CRT was non-significant (p = 0.14). TL patients had higher speech-related disability (VHI: 88.3 ± 12.6) and dysphagia prevalence (DOSS: 4.0 ± 1.2), with 16% remaining enteral feeding-dependent. Anxiety (HADS-A: 7.5 ± 2.9) and depression (HADS-D: 9.0 ± 3.2) were highest in TL patients, with 36% meeting clinical depression criteria at 12 months. Multivariable regression identified TL (OR = 3.92, 95% CI: 2.14-5.79, p < 0.001) and advanced tumor stage (OR = 2.85, 95% CI: 1.79-4.21, p = 0.002) as strong predictors of poor QoL. Kaplan-Meier analysis showed no significant OS differences (p = 0.12), but CRT patients had lower DFS (78%) compared to TL (82%) and PL (85%) (p = 0.048).

Conclusions: TL patients experience the most significant impairments in QoL, speech, and social reintegration despite rehabilitation. CRT patients show higher recurrence rates but better QoL, while PL offers the best balance of function and survival. These findings highlight the need for long-term survivorship support tailored to treatment type.

Keywords: cancer survivorship; functional outcomes; head and neck oncology; laryngeal cancer; quality of life; social reintegration; speech rehabilitation; swallowing function; voice handicap.

Figure 1

Quality of life (EORTC QLQ-H&N35) over time. Quality of life (QoL) scores over time measured by the EORTC QLQ-H&N35. QoL improved across all groups from baseline to 12 months, with CRT and PL groups achieving the highest scores. TL patients showed slower improvements, reflecting ongoing challenges related to speech and swallowing rehabilitation. Error bars represent standard deviations (SD) to reflect data variability.

Figure 2

Dysphagia severity (DOSS scores) and enteral feeding dependence over time. TL patients had the highest dysphagia burden, with 28% requiring enteral feeding at 6 months, decreasing to 16% at 12 months. In contrast, PL and CRT patients showed better swallowing function, with significant reductions in enteral feeding dependence over time. Error bars represent standard deviations (SD) to reflect data variability.

Figure 3

Trends in HADS-A (anxiety) and HADS-D (depression) scores over time. Anxiety and depression levels declined progressively from baseline (0M) to 12 months, with the most significant improvements observed in the partial laryngectomy (PL) and chemoradiotherapy (CRT) groups. Total laryngectomy (TL) patients had the highest anxiety and depression scores at all time points, reflecting persistent psychological distress despite rehabilitation efforts. Error bars represent standard deviations (SD) to reflect data variability.

Figure 4

Percentage of patients reporting social reintegration difficulties over time. TL patients faced the greatest social reintegration challenges, with 40% experiencing difficulty at 6 months, improving to 30% at 12 months. In contrast, PL and CRT patients reintegrated more successfully, with 15–20% reporting persistent difficulties at 12 months. Error bars represent standard deviations (SD) to reflect data variability.