Patient Reflections on Decision Making for Laryngeal Cancer Treatment

Andrew G Shuman; Knoll Larkin; Dorothy Thomas; Frank L Palmer; Joseph J Fins; Shrujal S Baxi; Nancy Lee; Jatin P Shah; Angela Fagerlin; Snehal G Patel

doi:10.1177/0194599816683377

Patient Reflections on Decision Making for Laryngeal Cancer Treatment

Otolaryngol Head Neck Surg. 2017 Feb;156(2):299-304. doi: 10.1177/0194599816683377. Epub 2017 Jan 24.

Authors

Andrew G Shuman^{1

2

3}, Knoll Larkin³, Dorothy Thomas¹, Frank L Palmer¹, Joseph J Fins², Shrujal S Baxi⁴, Nancy Lee⁵, Jatin P Shah¹, Angela Fagerlin^{3

6

7}, Snehal G Patel¹

Affiliations

¹ 1 Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
² 2 Division of Medical Ethics, Weill Cornell Medical College, New York, New York, USA.
³ 3 Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA.
⁴ 4 Head and Neck Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
⁵ 5 Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
⁶ 6 Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
⁷ 7 VA Ann Arbor Center for Clinical Research Management, Washington, DC, USA.

Abstract

Objective To describe the reflections of patients treated for laryngeal cancer with regard to treatment-related decision making. Study Design Cross-sectional survey-based pilot study. Setting Single-institution tertiary care cancer center. Subjects/Methods Adults with laryngeal carcinoma were eligible to participate (N = 57; 46% treated surgically, 54% nonsurgically). Validated surveys measuring decisional conflict and regret explored patients' reflections on their preferences and priorities regarding treatment-related decision making for laryngeal cancer and how patient-reported functional outcomes, professional referral patterns, and desired provider input influenced these reflections. Results When considering the level of involvement of surgeons, radiation oncologists, and medical oncologists in their care, patients were more likely to believe that the specialist whom they saw first was the most important factor in deciding how to treat their cancer (Fisher's exact, ~χ² = 16.2, df = 6, P = .02). Patients who were treated for laryngeal cancer who reported worse voice-related quality of life recalled more decisional conflict ( P = .01) and experienced more decisional regret ( P < .001). Of the patients for whom speech was a top priority prior to treatment, better voice-related quality of life overall scores were correlated with less decision regret about treatment decisions ( P < .02). Of the patients for whom eating and drinking were top priorities prior to treatment, better MD Anderson Dysphagia Inventory global scores were correlated with less decision regret about treatment decisions ( P < .002). Conclusion Patient priorities and attitudes, coupled with functional outcomes and professional referral patterns, influence how patients reflect on their choices regarding management of laryngeal cancer. Better understanding of these variables may assist in ensuring that patients' voices are integrated into individualized laryngeal cancer treatment planning.

Keywords: larynx cancer; patient-reported outcomes; quality of life; shared decision making.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Decision Making*
Female
Humans
Laryngeal Neoplasms / therapy*
Male
Middle Aged
Patient Participation*
Pilot Projects
Surveys and Questionnaires

Grants and funding

P30 CA008748/CA/NCI NIH HHS/United States