Improving personalized medicine in head and neck oncology ‘Shared decision making and rehabilitation’

This thesis addresses two distinct topics in head-and-neck cancer (HNC) care: shared decision-making and rehabilitation for patients following total laryngectomy (TL).
The first part investigates shared decision-making processes in patients with advanced laryngeal cancer and operable oropharyngeal carcinoma. Chapter 2 presents a systematic review on the prevalence of decisional conflict and regret among HNC patients. In Chapter 3, decision-making dynamics between surgeons, patients, and relatives are analyzed within our institute. Chapter 4 examines decisional conflict specifically in patients with advanced laryngeal carcinoma, as part of a larger multicenter study assessing a Patient Decision Aid (PDA) tailored for this group. Chapter 5 assesses the impact of this PDA on patient knowledge, decisional conflict, and shared decision-making. Chapter 6 describes the development of a similar PDA for patients with operable oropharyngeal carcinoma, aiming to facilitate active patient involvement in treatment choices.
The second part focuses on rehabilitation after Total Laryngectomy (TL), specifically on enhancing voice prostheses and related assistive devices. Chapter 7 evaluates strategies for prophylactic replacement of voice prostheses, while Chapter 8 examines a new prosthesis designed to resist biofilm formation, assessing its effectiveness and user satisfaction. Chapter 9 investigates the feasibility of cardiopulmonary exercise testing in TL patients and the role of Heat and Moisture Exchangers (HMEs) in supporting respiratory function during exercise. Chapter 10 concludes with an inspiring story of a TL patient who demonstrates exceptional abilities in singing and playing guitar.