Social Factors Affecting Tracheoesophageal Prosthesis Abandonment: Restoring Every Voice

Tracheoesophageal prosthesis (TEP), a one-way prosthetic valve, is considered the most effective method of voice restoration following total laryngectomy (TL) but requires specialized training, close follow-up management, and practice to achieve satisfactory speech and maximize longevity of the device. Because alternative communication methods (eg, writing, esophageal speech) remain available to patients with TEP, prosthesis abandonment (removal or discontinuing use for speech) is a well-known outcome. Considering the multifactorial nature of successful TEP speech, we examined correlations between TEP abandonment and social determinants of health at an urban, safety-net hospital.

This study aims to determine the frequency of TEP abandonment in an underserved patient population, compare this to what has been reported in the literature, and to explore whether there are socioeconomic factors associated with abandonment.

A retrospective cohort study was conducted at our institution. All patients having undergone TL for laryngeal cancer or dysfunction or who were followed at our hospital following TL from June 1, 2015 to June 30, 2024 were identified. Six variables were selected for multiple binary logistic regression analysis using SPSS Version 29.0.2.0 with an α = 0.05 level of significance.

Forty-one patients with TEP were included. Pre-TL radiation therapy (P = 0.018), greater distance from hospital (P = 0.017), and homelessness or incarceration (P = 0.043) were significantly associated with TEP abandonment. Insurance coverage of supplies, state area deprivation index, and substance and/or alcohol use disorder were not significant predictors.

Housing instability/incarceration, pre-TL radiation, and geographic distance are associated with TEP abandonment, highlighting the need for further research to investigate these associations. These findings also highlight a need to improve access to long-term TE vocal rehabilitation in vulnerable populations.