Klaske van Sluis

Life after total laryngectomy 143 ment for laryngeal cancer in both male and female patients [11]. Singer et al. (2008) showed that having reduced physical strength (“not enough stamina”) rather than the changes in appearance and/or the sputum are considered as most problematic for having sexual intercourse [11]. By contrast, our study suggests that the issues women experience herein involve both their altered appearance and functioning, i.e. physical disabilities. Thus, our respondents worried that the noises their stoma produces and their coughing fits might be unattractive to their partner or interfere with the intercourse. Similarly, a Of- ferman et al.’s (2015) study on the impact of total laryngectomy on the spousal relationship showed that female laryngectomees experience more deterioration in their sexual relationship and more sexual problems when compared to their male counterparts [8]. Further research should explore the role of appearance, functionality and physical strength in reduced sexuality in male as well as fe- male patients. The women in our study who were of working age could not return to their former job after surgery. After a period of recuperation and adaption, most wanted to re-integrate into work activities nevertheless. In the end, two respondents started a business, and three turned to volunteer work (one com- bined the two). In a study conducted by Graham and Palmer (2002), the female laryngectomy participants included were younger at time of surgery [10]. As a consequence, more females compared to males were working or on disability leave after surgery [10]. This highlights the importance of returning to work- related activities for women following total laryngectomy. Well’s et al.’s (2013) systematic review of qualitative studies exploring return to work after can- cer demonstrates that successfully returning to work depends on shifts and adjustments in each aspect of what is already a complex set of factors at the individual, organizational and societal level [24]. Successful return to work after total laryngectomy might be influenced by former work activities, functional outcomes and adjustment, and age at total laryngectomy. As our results sug- gest, it also depends on gender. Our respondents—and women generally—are still predominantly employed in areas such as teaching, administration, or care, which involve communication and service-orientation. All eight respondents in this study have (had) contact with peers. Peer support is highly satisfying for people with cancer [25, 26]. Peer support pro- vided by a laryngectomized patient visitor can play an important role in both information giving and counselling before surgery [1, 27, 28]. Indeed, all eight participants of this study remembered the pre-operative meeting with a la- ryngectomized patient visitor vividly. Although the female participants of our study did not explicitly indicate that they would have liked to meet a female patient, we suggest such a match might aid prospective women laryngectomees form realistic expectations concerning voice quality, appearance, and other out- comes that may affect women differently than men. Similarly, one respondent who received her surgery at age 29 indicated she could not relate to elderly peers. Earlier research, too, shows that younger female laryngectomees prefer contact with younger peers [12].