Klaske van Sluis

156 9.3. Future research perspectives the lives of the respondents. After the surgery, they made efforts to reintegrate into the social communities they belonged to before their surgery and return to former everyday activities. All respondents found various ways to participate in daily life again. Nevertheless, participants remain persistently vulnerable after total laryngectomy, because of the effort required by taking care and managing functional, social and health-related issues. The interviews showed that women-specific issues are present in returning to work, the performance of informal care-work, the spousal relationship, intimacy, and social interaction. In social interaction the presented issues were mostly stigmatization due to voice and appearance. For some respondents it was very helpful to engage in peer-support activities. Peer-support can play an important role in counselling and rehabilitation since it offers an opportunity to relate to the experiences of others and help form realistic expectations regarding outcomes. 9.3 Future research perspectives The prospective study still leaves unanswered questions regarding the predic- tion of individual speech outcomes. Despite all the advances in speech reha- bilitation, we are still not able to predict individual voice outcomes. Previ- ous research has shown that individual factors, such as social status and cop- ing strategy, in addition to treatment factors, such as type of surgery and post-operative radiotherapy, are related to vocal functioning. However, in the prospective study (chapter 3) we did not find an effect of these oncological treatment variables, which might be influenced by sample size and variability of our cohort. If, however, correlations between certain factors and voice out- comes exist, those factors might be used to develop a predictive model. With individualized and patient-centered medicine in mind, there is a demand for methods that can present probable speech outcomes to a patient during the planning phase of cancer treatment. This would allow appropriate predictions of voice and speech quality as well as an audio rendering of the probable speech sound after total laryngectomy. Subsequently, insight in factors which improve voice outcomes would contribute to clinicians’ decision making. Future work can further build on this systematic evaluation of voice outcomes, to create a larger dataset and work towards personalized predictions. There is a need for validated instruments to evaluate functional issues in- cluding voice outcomes and participation issues after total laryngectomy. Val- idation of the AVQI for tracheoesophageal speech specifically contributes to objective outcomes with acoustic analysis. Further development of perceptual scales to assess voice quality and intelligibility are needed, as well as the de- velopment of patient-reported outcome measures and/or validating existing instruments which assess functional and participation issues following total la- ryngectomy. Pulmonary rehabilitation after total laryngectomy remains an important