Laryngectomy rehabilitation in the United Kingdom

Abstract

Organ preservation treatment paradigms have led to profound changes in the management of locally advanced laryngeal cancer. Whereas there has been a reduction in primary total laryngectomies, the proportion of patients needing laryngectomy after failed chemoradiation has increased. These changes have affected the rehabilitation service requirements and outcomes following rehabilitation in this group of patients. It is particularly important to understand the current issues as UK service commissioning and funding arrangements are undergoing significant changes at this time. There is evidence of change to functional outcomes and rehabilitation of communication and swallowing in relation to current treatment protocols for laryngeal cancer. Other factors such as an ageing population in the UK are also affecting outcomes and service delivery. Centralized delivery of head and neck cancer services and speech and language therapy-led practice has resulted in implications on service delivery and training. Surgical voice restoration continues to be the most common method of communication rehabilitation in the UK for laryngectomees. Laryngectomy rehabilitation has become increasingly complex. Whilst there are some well established guidelines for treatment, these may be out of date and further work is required to evaluate the outcomes and needs of this complex and vulnerable group of patients.