Human life consists of two important parts, the quantity of survival and the quality of survival, which are an inseparable organic whole, and there is a complex relationship between the two rather than a simple positive correlation. In the past, people generally pay attention to the quantity of survival, but with the progress of society and the development of medicine, improving the quality of survival nowadays has been widely concerned. With the change of the concept of health, the evaluation of survival quality has become one of the important indicators of clinical trial efficacy assessment. Modern research on quality of survival not only emphasizes the integrity of somatic functions, but also focuses on social functions (social adaptation, social support, etc.) and harmony with the environment.
①The quality of survival is subjective and comes from the patient’s feelings;
②Survival quality is multidimensional and covers many aspects of the patient’s life;
③Survival quality is dynamic and changes with time and environment. People in different cultures have different subjective evaluations of survival quality, so survival quality is culturally dependent. Sun Yan, Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Qingdao University
The Cancer Control Research Society of the American Southwest Oncology Organization recommended in 1989 that quality of survival measures are appropriate for patients with the following cancers.
①Cancer with poor prognosis ;
②Cancer treatment problems involving comparison of different protocols;
③Effectiveness evaluation of adjuvant therapeutic measures for recurrence in patients with breast, melanoma and colorectal cancers;
④The problem of comparing the intensity and duration of different treatments;
⑤ Comparison of various treatment regimens with similar survival time but different quality of survival. Different strategies exist for the treatment of laryngeal and laryngopharyngeal cancers, and the impact of surgical modalities on survival quality is of great concern as they may have the same or similar oncological effects among different surgical modalities in surgical treatment, but have different effects on survival quality. In recent years, domestic scholars have conducted many studies on the relationship between the preservation of laryngeal function and the survival quality of patients with laryngeal cancer and laryngopharyngeal carcinoma using different survival quality scales as tools, and these results are reviewed here.
1.University of Washington Quality of Survival Scale
The University of Washington -quality of life scale (UW-QOL) includes 9 aspects of pain, appearance, mobility, recreation/leisure, occupation, chewing, swallowing, speech communication, shoulder dysfunction, etc. affected by head and neck cancer treatment, and is a self-assessment scale for patients. scale, with lower scores associated with poorer function.
To investigate the effect of total laryngectomy and partial laryngectomy on patients’ survival quality, Wang et al. used the UW-QOL scale to compare 81 patients after partial laryngectomy and 37 patients after total laryngectomy more than six months after surgery; the results showed that the total score of patients after partial laryngectomy was higher than that of patients after total laryngectomy, suggesting that the survival quality of patients after partial laryngectomy was better than that of patients after total laryngectomy; in the comparison of different In the comparison of different aspects, the difference between the two groups was the most significant in speech communication, and it was the aspect with the lowest score in total laryngectomy patients, which was also the most important aspect constituting the postoperative survival quality of patients.
Wang et al. observed that 45.9% of post-total laryngectomy patients used esophageal articulation, artificial larynx, and articulation reconstruction, but their scores in speech communication were still very low, indicating that their results were still unsatisfactory; Wang et al. also observed that 62.3% of post-total laryngectomy patients thought that their speech communication could only be understood by family and friends, or even could not be understood, and many post-total laryngectomy patients Many post-total laryngectomy patients reported that they were in a bad mood and easily irritable, especially when the other person could not understand their intentions correctly.
Wang et al. showed that in terms of appearance, partial laryngectomy patients were better than post-total laryngectomy patients, and the fistula of total laryngectomy became a sign of disfigurement and disability, affecting patients’ confidence in interacting with others and enjoyment of activities in public places; in addition, it was also observed that total laryngectomy patients were better than partial laryngectomy patients in terms of pain, presumably due to the fact that total laryngectomy cut off more skin and It was also observed that total laryngectomy patients had better pain than partial laryngectomy patients.
Shang Qingjuan et al [6] used the UW-QOL scale to observe the quality of survival in 18 post-partial laryngectomy patients and 12 post-total laryngectomy patients, and the results showed that the quality of survival of post-partial laryngectomy patients was better than that of post-total laryngectomy patients in terms of speech communication and recreation/leisure.
2. Functional assessment scale for head and neck tumor treatment
The functional assessment of head and neck cancer therapy (FAS) is a scale for the assessment of the function of head and neck cancer therapy.
The Functional Assessment of Cancer Therapy -head and neck (FACT-HN) has two components: (i) the common module of the scale, FACT-G, is a comprehensive questionnaire consisting of four aspects: physical status, social and family status, emotional status and functional status; (ii) additional The additional concern is the specific concern area of head and neck tumor. A total of 38 questions were asked, and higher scores obtained indicated better quality of survival.
Xiao Hongjun et al [7] used the FACT-HN scale to compare the survival quality of 38 patients with total laryngectomy and 21 patients with partial laryngectomy, 2 to 196 months after surgery (mean 46 months); the results showed that the scores of physical status, social and family status, emotional status, functional status and additional concerns were higher in patients with partial laryngectomy than in patients with total laryngectomy. The results showed that the scores of physical status, social family status, emotional status, functional status and additional concerns were higher in partial laryngectomy patients than in total laryngectomy patients, indicating that the quality of life was better in partial laryngectomy patients than in total laryngectomy patients; partial laryngectomy patients were better than total laryngectomy patients in vocalization, appearance, communication with others, eating and annoyance by side effects, and the differences between total laryngectomy and partial laryngectomy patients in pain and work were not significant; multiple linear regression analysis suggested that the factors affecting the quality of survival in descending order were radiotherapy, complications, surgical modality and disease stage.
Li Yujun [8] used the FACT-HN scale to compare the survival quality of 76 patients undergoing different types of partial laryngectomy, and the results showed that the four different procedures of laryngectomy for split tumor, vertical partial laryngectomy, horizontal partial laryngectomy, and subtotal laryngectomy (supracricoid cartilage laryngectomy-cricohyoid anastomosis with cricohyoid epiglottic anastomosis) had different survival quality in There were differences in the scores of survival quality and head and neck cancer specificity scale; the scores in the additional areas of concern were: laryngectomy for split tumor, vertical partial laryngectomy, horizontal partial laryngectomy, and subtotal laryngectomy (including superior laryngectomy for cricohyoid cartilage – cricohyoid anastomosis and cricohyoid anastomosis) in descending order, suggesting that the effects of partial laryngectomy on vocalization, feeding, and other functions after the different procedures The effects of partial laryngectomy on vocalization and feeding are different.
It is generally believed that standard vertical partial laryngectomy has a greater impact on vocal function, and standard horizontal partial laryngectomy has a significant impact on feeding function. Li Yujun
In terms of vocalization, laryngectomy with split vocal cords had the highest score, followed by horizontal partial laryngectomy, and secondary total laryngectomy had the lowest score; in terms of feeding, both laryngectomy with split vocal cords and vertical partial laryngectomy were better than horizontal laryngectomy and secondary total laryngectomy. In terms of the overall survival quality score, the scores of the various procedures were different, from the highest to the lowest, including laryngectomy, vertical partial laryngectomy, horizontal partial laryngectomy and subtotal laryngectomy, among which laryngectomy was significantly better than horizontal partial laryngectomy, and laryngectomy, vertical partial laryngectomy and horizontal partial laryngectomy were better than subtotal laryngectomy. In partial laryngectomy, the quality of survival tended to decrease with the expansion of the operation.
In addition, Li Yujun et al. [The physical, emotional, and functional status of laryngeal cancer patients who did not undergo neck clearance were better than those who underwent neck clearance in terms of survival quality; the survival quality of laryngeal cancer patients who were more than 1 year postoperative was better than those who were within 1 year postoperative.
The quality of survival of 10 total laryngectomy and 17 partial laryngectomy patients was observed by using the FACT-HN scale, which showed that the quality of survival of partial laryngectomy patients was higher than that of total laryngectomy patients at 6 months after surgery, and it was concluded that tumor-preserving surgery was essential to improve the quality of survival of laryngeal cancer patients.
3. University of Michigan Quality of Survival Scale for Head and Neck Cancer Patients
The University of Michigan Head and Neck Quality of Life Scale (UMCQLS) is a measure of the quality of life of patients with head and neck cancer.
Head and neck quality of life (HNQOL) is a 21-item self-assessment questionnaire, which is a multidimensional, concise, reliable and validated scale, and is a comprehensive disease-specific scale for measuring the quality of survival of head and neck cancer patients with high reliability.
Zhou ZN et al [10] used a modified HNQOL to study 90 cases of stage III and IV laryngeal cancer treated by different surgical methods, including 64 cases of supraglottic, 20 cases of glottic, and 6 cases of subglottic cancer with local lesions of T3 and T4 grade; the conditions for inclusion in the study were.
①those who had not removed the tracheal tube after laryngeal subtotal resection (excluding those who had removed the tube to close the fistula);
(ii) those who underwent tracheoesophageal fistula articulation reconstruction after total laryngectomy;
The results showed that the patients in the subtotal laryngectomy group had better speech function (including conversation ability, voice volume, voice clarity), psychological function (including disease reasons, economic reasons, social interaction, recreation and work) and physical function (including eating, pain, smell, sputum) than those in the subtotal laryngectomy group without articulation reconstruction, while the patients in the subtotal laryngectomy group had better speech function than those in the subtotal laryngectomy group without articulation reconstruction. There was no significant difference in the quality of survival between the group with subtotal laryngectomy and the group with tracheoesophageal fistula reconstruction after total laryngectomy.
Zhou Zining et al [10] concluded that although postoperative patients with total laryngectomy without articulation reconstruction could obtain certain speech communication ability through electronic laryngeal and esophageal sounds or by using lip sounds plus gestures, they were easily irritable when the other party failed to understand their meanings, leading to depression, autistic tendency, and poor recreational and working status, which seriously affected their postoperative recovery; while patients with tracheoesophageal fistula articulation reconstruction Patients who underwent tracheoesophageal fistula articulation reconstruction had the ability to re-enter and participate in society because their language communication was not affected and their recreational and working status was not significantly different from that of patients with subtotal laryngectomy.