Klaske van Sluis

Voice outcomes following total laryngectomy 59 could be interpreted as a response shift with a change of internal standards, values, and meaning of QoL [41]. The response shift could be explained by the ability of human beings to adapt to life events. Investigating this response shift specific for the head and neck cancer group is an important issue for further research. To develop a full picture of what speech related QoL means for in- dividuals before and after a total laryngectomy we suggest to perform studies with a combination of acoustic, patient rated, and clinician rated methods, to explore how speech related QoL is related to these measures. 3.5 Conclusion Outcomes show that voice-related outcomes are already impaired before surgery, all worsen after surgery with a gradual improvement from six up to twelve months post-surgery. A response shift is seen in VHI-10, were acoustic mea- sured voice quality worsen, reported voice handicap indicates acceptance of the condition and sufficient coping in the long term. The study leads to recommendations for clinical practice; before total laryn- gectomy, patients should be counselled on the expected course of voice prob- lems after surgery, with a focus on the long-term acceptable outcomes which are reached in TE-speakers. The discrepancy between reported voice hand- icap and objective acoustic rated voice quality, clearly demonstrates that a patient’s adjustment to post-laryngectomy dysphonia does not solely rely on their acoustically measured voice quality. As such, clinicians should utilise a range of measures – both acoustic (instrumental) and patient or clinician re- ported, to comprehensively analyse a patient’s vocal ability. Lastly, patients should be prepared for the possibility that they might not accomplish accept- able tracheoesophageal speech during their post-treatment phase, especially when medical complications occur, or oncologic treatment fails. This may be more common in the salvage procedures. The findings of this study have implications for future research. A specific AVQI cut-off value for tracheoesophageal speech should be determined, as well as assessing the discriminative power of this instrument in this type of speech. Validation of the VHI-10 specifically for use after total laryngectomy is needed. We demonstrate a change in response of patient-reported outcomes after total laryngectomy in the relation to acoustic outcomes. Patient reported outcome measures reflect the way patients accept their condition and cope with their permanent altered speech. This is likely to vary depending on their access to support (medical, nursing and allied health, funding and equipment, support of family and friends). Future research in vocal functioning after total laryngec- tomy should expand beyond vocal impairment, evaluating psychosocial conse- quences and participation restrictions. Simultaneously, investigating the effect of medical history, including oncologic treatment factors on voice outcome, can ultimately lead to personalized pre-surgery counselling.