Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Tracheoesophageal puncture (TEP) and subsequent prosthesis insertion is a procedure that many patients undergo following total laryngectomy (TL). This procedure can occur in conjunction with TL, or at another date. Optimal timing continues to be debated. This study evaluates the incidence of mental health disorders as a function of TEP timing after undergoing TL.
Methods: The TriNetX Research Network was queried from 2010 to 2022 for patients who underwent TL following laryngeal cancer diagnosis. Patients were divided into three cohorts: those who received TEP on the same day of TL (primary TEP, PTEP), those that received TEP any time after TL (secondary TEP, STEP), and those that never received a TEP after TL (NTEP). Documented visit up to one year after surgery was ensured within the network. Within PTEP and STEP groups, patients were further divided into those who received a flap reconstruction (FR) or did not receive FR. Patients with diagnoses of depression/anxiety or use of antidepressants/anxiolytics 6 months prior to the index event were excluded. Primary outcomes included the incidence of depressive episodes, anxiety, antidepressant use, anxiolytic use. Evaluated time points were as follows: 1 day- 3 months, 3-6 months, and 6-12 months postoperatively. Measures of association tests were conducted, and statistical significance was measured at p<0.05.
Results: Overall, when comparing all NTEP patients (n=1678) to PTEP patients (n= 784), PTEP patients had higher associated risk of antidepressant use (1-3 months, 6-12 months) and anxiolytic use (6-12 months) (RR 1 day-3 months: 1.2, p = 0.03; RR 6- 12 months: 1.3, p = 0.02). Compared to all NTEP, STEP (n=532) had higher associated risks of antidepressant use (6-12 months) (RR: 1.4, p = 0.02). NTEP patients with FR (n=527) had higher associated risks of anxiolytic use (1 day- 6 months), compared to STEP patients with FR (n=227) (RR 1 day-3 months: 2.1, p = 0.0001; RR 3-6 months: 1.9, p = 0.04). Lastly, when comparing STEP and PTEP patients with FR, PTEP patients had a higher associated risk of anxiolytic use (1 day-3 months) (RR: 2.1, p= 0.0005).
Conclusion: Patients undergoing flap reconstruction at time of surgery may benefit from STEP as opposed to PTEP. STEP patients with FR had lower associated risks of mental health disturbances compared to NTEP and PTEP patients with FR. Additional analyses are required to further elucidate why PTEP and STEP patients overall have mental health disturbances at various time points. To our knowledge, this is the first study examining the relationship between time of TEP and mental health disturbances.