MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH
HANOI MEDICAL UNIVERSITY

BÙI THẾ ANH

HEALTH-RELATED QUALITY OF LIFE OF
LARYNGEAL CANCER PATIENTS
PRE- AND POST- SURGICAL TREATMENT
Major: Otorhinolaryngology
Code: 62.72.01.55

SUMMARY OF THESIS FOR DOCTOR OF MEDICINE

HANOI - 2019


THESIS COMPLETED IN:
HANOI MEDICAL UNIVERSITY

Supervisor: Assoc Prof. Pham Tuan Canh, MD, PhD

Reviewer 1:
Reviewer 2:
Reviewer 3:

Thesis will be defended at University level Doctoral thesis
assessment committee at .........Hanoi Medical University.

Thesis can be found in:
National library of Vietnam
Hanoi Medical University library

habitude, reduction of olfactory and gustatory ability, dyspnea,
cough, limited social integration, loss of work, increasing risk of
stress and depression). Based on these essential quality of life
informations, healthcare professionals can provide good


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recommendation for patients pre-treatment; plan post-treatment
psychological consult and adaptive rehabilitation for every single
patient. Up to now, there are few published researches in Vietnam
mentioned health-related quality of life of laryngeal cancer pre- and
post- surgical treatment. The study "Quality of life of laryngeal
cancer pre- and post- surgical treatment" was carried out with 3
aims:
1.Evaluate pre-operative health-related quality of life of
laryngeal cancer.
2. Evaluate post-operative health-related quality of life of
laryngeal cancer.
3.Compare pre-operative and post-operative health-related
quality of life to improve patient consultation.
NEW CONTRIBUTIONS OF THESIS
 For the fisrt time, health-related quality of life assessment
using modern tool (EORTC-C30 and EORTC-H&N35
questionnaires) was successfully applied on Vietnamese laryngeal
cancer patients pre-operation and post-operation.
 Provide a thorough database about health-related quality of
life of Vietnamese laryngeal cancer patient treated with different
surgical techniques (Transoral Laser Microsurgery, Open Partial
Laryngectomy and Total Laryngectomy) in 5 occasions: preoperation, 1 month, 3 months, 6 months and 12 months postoperation. Post-operative QOL in three patient groups were worse

defecation and also serves to stabilize the thorax during heavy
lifting by the arms.
1.5.Treatment of laryngeal cancer.
Treament of laryngeal cancer includes surgery, radiotherapy or
chemotherapy (single- or multi-modal treatment). Surgery is still
the most common method of treatment in Vietnam. Early stage
disease (S1 - S2) is treated by conservative surgery (transoral laser
microsurgery; laryngofissure or open partial laryngectomy). When
the disease is on locally advanced stage but resectable: indication
of total laryngectomy plus neck dissection and adjuvant


4

radiotherapy. With advanced stage and unresectable disease:
indication of concurrent chemoradiotherapy or palliative treatment.
1.5.1.Surgery.
Common surgical techniques for laryngeal cancer in Vietnam are:
transoral laser microsurgery, laryngofissure, partial laryngectomy
with crico-epiglotto-hyoidoplasty or total laryngectomy.
* Transoral laser microsurgery (TLM): tumor mass is resected
together with partial or total cordectomy (other structures may also
be included in the resection: impaired vocal process, anterior
commissure, ventricular fold, subglottic mucosa). Anatomy of
glottis and vocal cords is modified after TLM, therefore glottis can
not close properly in phonation and voice is disturbed (hoarseness,
breathy voice, increased effort required to talk). Sometimes glottic
scar (possible sequelae of TLM) can cause glottic stenosis and
laryngeal dyspnea.
*Laryngofissure: thyroid cartilage is cut vertically in the midline

disability or disorder. Characteristics of HRQOL include: selfreported, subjective, multi-dimensional and changes over time.
HRQOL may be measured globally or componently with different
domains: physical activity, psychological state, social interaction
and somatic sensation / symptoms. HRQOL research plays more
and more important role in general medicine. In oncology, HRQOL
is considered an index in assessing treatment outcomes (similar to
other classic indexes such as overall survival, 5-year specific
survival…). HRQOL research provides multi-dimensional
information about patient's health status as well as adverse effects
during or after treatment. Based on these data, healthcare
professionals can plan to treat those adverse effects and apply
better rehabilitation for patients. In clinical practice, HRQOL data
give patients more concrete information about the disease process
and prognosis. This information contributes in patient's decisionmaking before treatment. HRQOL research also helps to compare
different treatment modalities and to assess novel therapeutic
treatment.
1.7.Tools to measure HRQOL of laryngeal cancer patients.


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It is common to use subjective methods to measure HRQOL:
those methods are patient-reported questionnaires. Two
questionnaires were selected (EORTC-C30 and EORTC-H&N35,
developed by European Organization of Research and Treatment of
Cancer) to use as measuring tool to assess HRQOL of laryngeal
cancer in this study.
1.8.Post-operative QOL of laryngeal cancer patients.
Treatment of head and neck cancer (including laryngeal
cancer) can cause many sequelae: voice disorder, swallowing

1.Study subjects.
Sample patients were selected among laryngeal cancer patients
underwent curative surgery in Department of Oncology - Head and
Neck Surgery (National ENT Hospital of Vietnam - 78 Giai Phong
Road, Dong Da - Hanoi).
Sample selection criteria.
Patient with definitive diagnosis of primary laryngeal cancer
(confirmed by histological result of squamous cell carcinoma)
without any previous treatment; All medical records were
available; curative surgery indicated; Agreed to participate into this
study; Had at least 12 months of follow-up; completely all
questionnaires at all 5 timepoints: pre-operation; 1 month, 3
months, 6 months and 12 months post-operation. Sample patients
Patients were categorized into three groups based on surgical
treatment of the primary tumor. These groups were: Group 1-TLM,
Group 2-Open Partial Laryngectomy (OPL), and Group 3-Total
Laryngectomy (TL).
Exclusion criteria.
Exclusion criteria included: previous treatment of cancer,
distant metastases or second primary tumor (confirmed before
treatment or during first-year follow-up period), palliative surgical


8

treatment, cognitive impairment or lack of proficiency in
Vietnamese, or loss to follow-up at any time-point.
2.2.Methods of study.
This was a longitudinal prospective study with convinience
sampling. There was no control group in the study.

status (numbered 28 in table 2.3) indicates a lower QOL. A higher
score for a symptom scale item (numbered from 6 to 27 in table
2.3) also represents a greater severity of symptoms or problems.


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Table 2.3: QOL scales and items in EORTC-C30 and H&N35
Number

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.

Dry mouth
Sticky saliva
Senses problems
Trouble with social eating
Speech problems
Coughing
Trouble with social contact
Global HRQOL

Group

General functional
scales

11 scales / symptoms
caused by cancer and /
or its treatment

11 specific scales /
symptoms for head
and neck cancer


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Chapter 3
RESULTS
3.1.Socio-demographic characteristics of sample patients.
125 patients were divided into 3 groups: Group 1-TLM had
38 patients; Group 2-OPL had 60 patients; and Group 3-TL had

Item / scale

Preop

1 month
𝑋̅

3 month
𝑋̅

6 month
𝑋̅

12 month
𝑋̅

Appetite loss
8.8
16.7*
30.7**
20.2*
16.7*
Sticky saliva
4.4
17.5**
30.7**
22.8**
18.4**
Senses problems
6.1

11.4
23.1**
12.9**
11.5
Speech problem
40.9
52.3*
65.5**
48.8
43.9
Financial difficulty
14.9
32.5**
26.3*
17.5
13.2
Pain
8.8
9.7
16.2*
7.9
6.1
Pain in mouth
5.3
11.4
22.6**
7.9
7.0
Teeth
24.6

14.9
20.2
14.9
23.7*
Feeling ill
8.8
16.7
28.9**
14.9
10.5
Nausea-vomiting
3.9
6.1
6.1
2.2
1.3
Diarrhea
0
2.6
2.4
1.8
1.5
Less sexuality
35.9
33.5
47.4
41.7
39.0
(*): p < 0.05; (**): p < 0.01 (in comparison with pre-operation)
Values > 20 were in bold font (can have impact to QOL)


6 month
𝑋̅

12 month
𝑋̅

62.2*
90.2*
86.4*
78.5*
89.5
79.4**

60.1**
79.7**
62.3**
70.4**
75.9**
66.7**

70.0
84.0**
70.2**
88.2
85.5*
78.5**

74.3
85.9**

65.8**

70.3**

75.3

Physical functioning

94.7

77.9**

86.5**

91.5*

93.9

Role functioning

98.7

53.0**

65.7**

72.7**

77.0**


72.1**

75.3**

79.9**

(*): p < 0.05; (**): p < 0.01 (in comparison with pre-operation)
Values < 80 were in bold font (can have impact to QOL)


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Table 3.19: QOL scores (symptom scales) in group OPL preand post-operation
Post-operation
Item / scale

Preop

1 month
𝑋̅

3 month 6 month
𝑋̅
𝑋̅

12 month
𝑋̅

Speech problem
31.8 68.9** 55.1** 48.9** 47.3**

22.0** 8.7*
3.7
4.1
Pain in mouth
4.0 27.0** 11.2**
6.8
4.5
Dyspnea
14.1 39.3** 28.0*
18.7
15.3
Insomnia
30.1 54.7** 40.0*
35.3
28.0
Feeling ill
4.7 37.3** 15.3**
9.3
4.7
Opening mouth
3.3 15.3**
8.2
5.3
4.7
Nausea - vomiting
3.7
17.3**
5.0
2.1
1.3

Table 3.20: QOL scores (symptom scales) in group TL pre- and
post-operation
Post-operation
Item / scale

Preop

1 month
𝑋̅

3 month
𝑋̅

6 month
𝑋̅

12 month
𝑋̅

Speech problems
36.6 92.5** 87.4** 82.3** 79.9**
Social contact
1.9 53.2** 42.2** 34.9** 22.9**
Coughing
9.0 72.9** 45.9** 34.2** 44.1**
Opening mouth
0.9
9.9**
7.2*
7.3*

11.7
3.6*
11.7
5.4
25.2**
Diarrhea
0
0
10.8** 16.2**
0.9
Pain
3.2
31.9** 12.6**
3.2
0.9
Pain in mouth
4.1 40.8** 17.8**
5.2
2.7
Swallowing
8.1 42.8** 19.6** 14.9
11.9
Nausea-vomiting
4.9
30.6**
8.1
2.3
1.8
Teeth
17.1


Global QOL

77.9

38.7** 50.7** 59.6**

Physical functioning

94.6

69.9** 85.2**

Role functioning

98.2

44.1** 54.1** 61.3**

Emotional functioning

73.9

68.5

Cognitive functioning

98.2

82.9**


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operation). That bad mood expresses in "insomnia" symptom as
well as negative "emotional functioning". All these impaction was
reflected in the deterioration of "global QOL".
4.3. Pre-operative QOL of laryngeal cancer patients.
4.3.1.Group TLM.
There was a moderate, clinically significant worsening in
global health QOL status at 1 month post-surgery (p
scores at 1 month. At 12 months, “physical functioning” scores
essentially returned to baseline (p
dysgeusia in 11.4%, of patients. Almost 21% of patients were
bothered by an impaired gustatory ability and 50.5% of patients
were affected by their loss of olfaction. Patients who reported a
deterioration of olfaction and gustation tended to experience


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negative consequences such as the inability to smell smoke, leaking
gas, or agreeable odors. About "less sexuality": our result was
accordance with data from Ozturk, Yilmaz and Singer (with the
rate of patient admitted a worse sex life 47.4, 51 and 53%
consequently).
*Global QOL and functional scales.
There was a moderate, clinically significant worsening in
global health QOL status at 1 month after surgery (p
"speech problems", "insomnia" and "less sexuality". "Global QOL"
was slightly affected.
* Post-operative QOL of laryngeal cancer patients.
a) Group TLM: Quality of life deteriorated at 1 month, became
worst at 3 month then recovered at 6 month post-operation. At 12
month post-operation: QOL was affected in two scales: "role
functioning" and "social functioning" (73.3 and 79.4 points).