Laryngeal cancer: quality-of-life and cost-effectiveness

The need to account for the cost of care is being imposed on clinicians by the corporate purchasers of health care. The cost-effectiveness of treatment for laryngeal cancer should be based on measurable and relevant clinical outcomes. Quality-of-life (QL) is a very important outcome, especially if survival is similar between two treatments.

Using QL data gathered prospectively from a group of 46 patients with glottic cancer, the effects of radiotherapy (RT) are compared with those of surgery (total laryngectomy).

Surgery results in greater measurable dysfunction, especially of speech, but with respect to psychological functioning and general well-being, there are no major QL differences between patients treated surgically and those receiving RT.

Cost-effectiveness of surgery, from the perspective of patient-based QL outcome, is very similar to that for RT in advanced cancer of the larynx. Each center needs to carefully consider its outcomes and overall average costs per patient before deciding which treatment regimen is to be preferred. These results have implications for the organ-sparing regimens in the treatment of advanced laryngeal cancer.