The TV and radio presenter Jamie Theakston recently returned to his radio show to announce he is cancer free. He had been off air for a year after having surgery to treat early-stage laryngeal cancer. His diagnosis was made when his voice change was noted by listeners to his radio show, which prompted him to have it checked. Early identification and diagnosis of cancer results in better outcomes, not least of which relate to identification of early-stage disease. The global survival rates for laryngeal cancer have, however, not improved despite the drive towards early referral. Jamie Theakston does not fit the general demographic for a laryngeal cancer patient – the traditional head and neck cancer patient comes from an area of socio-economic deprivation, has a significant smoking and alcohol history and has additional comorbidities resulting in a poor performance status. This month’s editors’ choice is a review of laryngeal cancer in West Scotland. The team found that survival rates in this area are lower than other European nations due to the very factors mentioned above. They recommend that tackling these concerns are essential to improving the outcomes for larynx cancer. Theakston was fortunate to be in a position whereby his signs and symptoms were picked up and acted on quickly – the majority of our patients will unfortunately not be in such a privileged position, which we, as the treating doctors, need to be ever mindful of and diagnose and treat as quickly as we can. As always, the editors are very grateful for all the hard work and contributions from our reviewers.
Hannah and Nazia
Despite a reduction in incidence, global survival rates for laryngeal squamous cell cancer (LSCC) have not improved over recent decades, with smoking and alcohol consumption remaining as significant risk factors. In this study, the authors hypothesised that survival outcomes in the West of Scotland are even lower than other European nations due to socioeconomic deprivation. The authors completed a retrospective cohort study of 867 patients diagnosed with LSCC within a six-year period. They included demographics, tumour staging, performance status, treatments and socioeconomic status in the analysis. The cohort was characterised by a higher percentage of men (76.1%) than women (23.9%) with a mean age of 65.5 years. Notably, 70.7% lived in the most deprived areas of West Scotland, and over half of the cohort (56%) presented with advanced disease. Glottic cancers had better outcomes (64%) than other LSCC subsites. The authors have also demonstrated an increase in supraglottic subsite laryngeal cancer that contrasts with population-based analysis from the US. Five-year overall survival was 46% with predictors of survival identified as deprivation, age, subsite, performance status, alcohol use and treatment modality (tri-modality treatment had worse survival outcomes). This study demonstrates that LSCC survival in Western Scotland is lower than elsewhere in Europe and hypothesises that this relates to deprivation, advanced disease and lower performance status with the recommendation that tackling these factors is key to improved outcomes for LSCC.
