title: Practice of laryngectomy rehabilitation interventions: a perspective from South America.
abstract: OBJECTIVE
  Treatment of laryngeal cancer will depend on several factors, including tumor factors, patient factors, as well as the technical resource and expertise of the surgical team and treatment center. In developing countries, most patients have their diagnosis performed at advanced stages, with a significant proportion at very advanced locoregionally, which results in a limitation to the use of organ-preserving approaches. A total laryngectomy is still the most frequent treatment for larynx cancer patients. The rehabilitation in such scenarios can be more demanding and can cost more compared with developed countries.
  
  
  RESULTS
  For early-stage tumors, function-preserving strategies are mandatory, and can include partial laryngectomies and radiation therapy. In such cases, functional rehabilitation usually is easily achieved, with lower negative impact on the patient's daily life. For advanced tumor stages, a treatment shift toward a more conservative management has been observed. However, the success rates of organ-preserving strategies, mainly with chemoradiation approaches, will rely on a rigorous patient selection process.
  
  
  CONCLUSIONS
  The rehabilitation of laryngectomy patients in developing countries can be more demanding and can cost more compared with developed countries. In such scenarios, some strategies can be employed by the multidisciplinary team, mainly by the surgical and speech-pathology teams, aiming to decrease the costs involved in the rehabilitation of total laryngectomy patients in developing countries.
authors.affiliation: Head and Neck Surgery and Otorhinolaryngology Department, Hospital A.C. Camargo, Sao Paulo, Brazil.
authors.forename: José Guilherme
authors.initials: JG
authors.lastname: Vartanian
authors.forename: Elisabete
authors.initials: E
authors.lastname: Carrara-de-Angelis
authors.forename: Luiz Paulo
authors.initials: LP
authors.lastname: Kowalski
mesh_terms: D003906:Developing Countries; D004947:Esophagus; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery / Q000628:therapy; D007825:Laryngectomy / Q000379:methods / Q000534:rehabilitation*; D007831:Larynx, Artificial; D012380:Role; D013020:South America; D013071:Speech, Alaryngeal / Q000379:methods; D013066:Speech-Language Pathology / Q000193:education