title: Apprehensions and problems after laryngectomy: Patients' perspective.
abstract: OBJECTIVE
  To evaluate the apprehensions, social, sexual and financial problems in patients with advanced laryngeal cancer after total laryngectomy and the impact of attending laryngeal club on these problems.
  
  
  METHODS
  The analytical study was conducted at the Dow Medical College and Civil Hospital Karachi from January 1996 to December 2011. Patients with total laryngectomy, operated for advanced laryngeal cancer at various centres of Sindh and Balochistan, attending Laryngeal Club of Pakistan, situated at Civil Hospital Karachi, were included. All the patients were evaluated through a questionnaire covering their apprehensions regarding social, sexual and financial impact on their lives after total laryngectomy. Data was analysed using SPSS 16.
  
  
  RESULTS
  Of the 125 patients, 120(96%) were males, and 5(4%) were females; all housewives. The overall mean age was 54.8±0.5 years (range: 31-65 years). Further, 92(74%) participants were worried about financial uncertainty, while 84(67%) had regrets over loss of their voice; patients worried about losing family support and facing social rejection were 23(18%) and 15(12%) respectively. Only 7(5%) patients feared losing sexual relationship with their spouse. All these apprehensions were subdued after attending the Laryngeal Club of Pakistan. Severe financial impact was faced by 55(44%) patients due to loss of job, while 05(4%) had moderate impact due to change of job with lower income and 60(48%) patients had no financial problem. A good 102(82%) participants thought the support from their friends and family was upto their expectations; 98(78%) enjoyed satisfactory sex life although with reduced frequency of 1 to 2 intercourses per month; 21(17%) were having the frequency of 3-10 per month; and 3(2%) had more than 10 per month. Only 16(13%) patients were not involved in sexual relations with their spouses due to various reasons.
  
  
  CONCLUSIONS
  Majority of laryngectomised patients expressed apprehensions and showed some social problems after laryngectomy, especially in the initial phase which improved either with passage of time or after attending Laryngectomy Club. The main problem was financial constraints; majority had good friends and family support and enjoyed satisfactory sexual relationship with their spouse.
authors.affiliation: Department of ENT, Head & Neck Surgery, Saheed Muhtarma Benazir Bhutto Medical College & Lyari General Hospital, Karachi.
authors.forename: Ismail
authors.initials: I
authors.lastname: Hirani
authors.affiliation: Department of ENT, Head & Neck Surgery, Dow Medical College & Civil Hospital Karachi.
authors.forename: Atif Hafeez
authors.initials: AH
authors.lastname: Siddiqui
authors.affiliation: Department of ENT, Head & Neck Surgery, Dow Medical College & Civil Hospital Karachi.
authors.forename: Iqbal Abdul
authors.initials: IA
authors.lastname: Muhammad Khyani
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000523:psychology* / Q000601:surgery*; D007825:Laryngectomy / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D011788:Quality of Life; D012725:Sexual Behavior; D012919:Social Behavior; D011795:Surveys and Questionnaires
keywords: Total laryngectomy, Apprehensions, Social problems, Financial problem, Sexual relations.