Tracheoesophageal Prosthesis Use Results in Durable Improvements in Vocalization and Overall Quality of Life

Abstract

Objectives: (1) Determine whether tracheoesophageal prosthesis (TEP) use is associated with improved quality of life. (2) Identify factors which negatively correlate with quality of life in patients utilizing TEP. Methods: Cross-sectional analysis of total laryngectomy patients with and without TEP treated at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC). Demographic, tumor, and treatment characteristics were reviewed. Functional status and quality of life were measured using the Voice Handicap Index (VHI), MD Anderson Dysphagia Index (MDADI), and University of Washington Quality of life Index (UW-QOL). Results: Sixty-one patients were identified, including 27 patients using TEP communication and 34 using either nonverbal communication or electrolarynx. TEP use at time of evaluation was associated with significantly higher VHI (TEP vs no TEP, global: P = .00, functional: P = .01, and emotional: P = .00), MDADI (TEP vs no TEP global: P = .01, functional: P = .03) and UW-QOL scores (TEP vs no TEP P = .00) compared with other forms of communication. The effect of TEP on VHI, MDADI, and UW-QOL persisted even when we limited the analysis to patients with a follow-up greater than 5 years. Total laryngectomy for recurrent cancer did not significantly impact VHI or UW-QOL but was associated with worse MDADI scores for patients using TEP. A history of irradiation was not significantly associated with worse functional outcomes. Conclusions: TEP use is associated with durable improvements in quality of life and functional outcomes for veterans undergoing total laryngectomy. TEP placement should be considered in all total laryngectomy patients when technically feasible.