Quality of Life and Decision-Regret in Palliative Airway Management
Research type
Research Study
Full title
Surgical Airway Management in Palliative Head and Neck Cancer: A Comparative Investigation into Quality of Life and Decision-Regret in Tracheostomy versus Airway Debulking Procedures
IRAS ID
323128
Contact name
Alex Rogers
Contact email
Sponsor organisation
NHS Greater Glasgow & Clyde
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
One consideration in palliative management of head and neck cancer patients is airway planning. Surgical and non-surgical (medical) palliative options exist. As well as optimising the airway, surgical management can reduce tumour bulk, pain, and bleeding, and improve swallowing and nutrition.
Suitable patients may be offered tracheostomy, a single procedure which can prolong airway patency and life by months. This procedure is not without risks, including post-operative pain, haemorrhage, pneumothorax, blocked/displaced tube, voice change and death.
Patients require an average hospital stay of 20 days post-operatively for monitoring, first tracheostomy tube change and education on phonating and maintenance of a clean and secure tracheostomy tube. Patients require a degree of learning potential, manual dexterity, and social support to care for the tube. Tube complications occasionally require emergency returns to hospital. One study found a 30-day readmission rate following tracheostomy of 13% for tracheostomy-related issues. This can be disruptive and distressing to patients.An alternative airway strategy is endoscopic tumour debulking. This involves a day-case procedure to remove airway dwelling malignancy, optimising airway patency. Patients would be suitable for discharge either same day or subsequent. Patients can contact services when they feel their airway is deteriorating and can undergo several debulking, life-prolonging procedures.
Airway debulking is not risk-free, with the main concern being bleeding, airway perforation and inability to debulk. The interval between procedures can be short and unpredictable. The need for multiple procedures and returns to hospital can be stressful for patients.
The advantages are that the in-hospital stay is short; no learning or social support required, and a semi-elective return to hospital can be organised with the patient at the centre of decision-making.
This study aims to investigate quality-of-life and decision-regret following palliative surgical airway management. We aim to compare tracheostomy, endoscopic debulking and a non-airway intervention control group.
REC name
Yorkshire & The Humber - Leeds West Research Ethics Committee
REC reference
23/YH/0279
Date of REC Opinion
23 Nov 2023
REC opinion
Unfavourable Opinion