title: Trade-off between survival and laryngeal preservation in advanced laryngeal cancer: the otorhinolaryngology patient's perspective.
abstract: OBJECTIVE
  We performed a prospective study to evaluate, from the patient's perspective, the trade-off between speech and survival that individuals face when given a diagnosis of advanced-stage laryngeal cancer amenable to either total laryngectomy or a laryngeal preservation protocol using chemotherapy and radiotherapy.
  
  
  METHODS
  Volunteers (309) consecutively seen at the otorhinolaryngology clinic of a university teaching hospital in France completed an anonymous questionnaire designed to determine their position if they faced the diagnosis of an advanced-stage laryngeal cancer. Univariate analysis was performed for potential statistical relationships with various variables.
  
  
  RESULTS
  We found that 12.9% of patients were unable to determine their position regarding the two treatment options offered, and this group had a significant statistical relationship with four variables (age, education, professional status, and history of cancer among relatives). We found that 24.6% of patients made survival their main consideration and would not consider any trade-off. Among the 62.5% who considered the trade-off, the percentage of cure that patients were ready to lose in order to preserve their larynx varied from 5% to 100% (mean, 33%; SD, 23%). Aside from the undecided group, none of the variables analyzed was related either to the decision as to whether to consider a trade-off or to the percentage of c re that patients agreed to trade to preserve their larynx.
  
  
  CONCLUSIONS
  In patients with advanced-stage laryngeal cancer, treatment should be initiated only after careful evaluation of the patient's attitude toward both laryngeal preservation and survival.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Université Paris Descartes Sorbonne Paris Cité, APHP, HEGP, Paris, France.
authors.forename: Ollivier
authors.initials: O
authors.lastname: Laccourreye
authors.forename: David
authors.initials: D
authors.lastname: Malinvaud
authors.forename: F Christopher
authors.initials: FC
authors.lastname: Holsinger
authors.forename: Silla
authors.initials: S
authors.lastname: Consoli
authors.forename: Madeleine
authors.initials: M
authors.lastname: Ménard
authors.forename: Pierre
authors.initials: P
authors.lastname: Bonfils
mesh_terms: D001294:Attitude to Health; D003657:Decision Making; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D007825:Laryngectomy; D008297:Male; D017060:Patient Satisfaction; D011446:Prospective Studies