title: Total laryngectomy or laryngeal preservation for advanced laryngeal cancer. Impact of the functional risk upon the patient's preferences.
abstract: OBJECTIVE
  To analyse, based on an anonymous questionnaire, the treatment decision envisaged and the impact of the medical information delivered in patients facing the diagnosis of an advanced laryngeal cancer amenable to total laryngectomy or a laryngeal preservation protocol.
  
  
  METHODS
  Prospective study conducted in a French teaching hospital based on questionnaires filled in by 269 patients attending the otorhinolaryngology clinic.
  
  
  RESULTS
  A total of 28.6% of patients would not consider any trade-off of cure to preserve their larynx; 1.4% of patients were willing to trade all chances of cure in order to avoid total laryngectomy. The median percentage of cure that patients were ready to loose in order to preserve their larynx was 33% (range: 5 to 100%); 47.9% of patients wanted to receive additional information before making their decision with a significant increase among patients with a level of education beyond secondary school (P=0.0006) and among patients with a family history of cancer (P=0.038). The additional information most frequently requested concerned the complications related to the laryngeal preservation protocol (34.1%) and the cure rate (28.6%). After receiving information about the risk of tracheostomy and permanent gastrostomy following the laryngeal preservation protocol, the percentage of subjects who would not consider any trade-off in order to preserve their larynx increased to 31.2% and 56.1%, respectively.
  
  
  CONCLUSIONS
  Laryngeal preservation is not a major objective of treatment shared by patients filling a questionnaire devoted to the choice of treatment when facing an advanced laryngeal cancer. Specific information concerning the expected results and the inherent risks involved in the various treatment options must be provided in every case.
authors: Université Paris Descartes Sorbonne Paris Cité, Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France. Electronic address: ollivier.laccourreye@egp.aphp.fr.
authors: O
authors: O
authors: Laccourreye
authors: Université Paris Descartes Sorbonne Paris Cité, Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France.
authors: D
authors: D
authors: Malinvaud
authors: Université Paris Descartes Sorbonne Paris Cité, Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France.
authors: M
authors: M
authors: Ménard
authors: Université Paris Descartes Sorbonne Paris Cité, Service de psychiatrie, Hôpital ruropéen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France.
authors: S
authors: S
authors: Consoli
authors: Université Paris Descartes Sorbonne Paris Cité, Service de radiothérapie-oncologie, Hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France.
authors: P
authors: P
authors: Giraud
authors: Université Paris Descartes Sorbonne Paris Cité, Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France.
authors: P
authors: P
authors: Bonfils
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D057240:Patient Preference; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Cancer; Information; Laryngeal preservation; Larynx