Speech and Survival

Abstract

In Stage T3 carcinoma of the larynx (carcinoma restricted to the vocal cords, causing complete immobility of the cords but not extending to adjacent structures), laryngectomy leads to a three-year survival rate of approximately 60 per cent and the loss of normal speech. Radiation therapy, on the other hand, leads to a lower survival (30 to 40 per cent at three years) but preserves normal or nearly normal speech. We investigated attitudes toward the quantity and quality of life in 37 healthy volunteers, interviewing 12 firefighters and 25 middle and upper management executives to determine their preferences for longevity and voice preservation. We used the principles of expected utility theory to develop a method for sharpening decisions involving tradeoffs between quantity and quality of life. Our analysis indicates that to maintain their voices, approximately 20 per cent of volunteers would choose radiation instead of surgery. These results suggest that treatment choices should be made on the basis of patients' attitudes toward the quality as well as the quantity of survival. (N Engl J Med. 1981; 305:982–7.)