Factors Impacting Provider Treatment Decision-Making in Early Glottic Cancer

Matthew Shneyderman; Sarek Shen; Ved Tanavde; Carmen Kut; Ana P Kiess; Matthew R Naunheim; Lee M Akst

doi:10.1002/lary.31494

Factors Impacting Provider Treatment Decision-Making in Early Glottic Cancer

Laryngoscope. 2024 May 10. doi: 10.1002/lary.31494. Online ahead of print.

Authors

Matthew Shneyderman¹, Sarek Shen², Ved Tanavde², Carmen Kut³, Ana P Kiess³, Matthew R Naunheim⁴, Lee M Akst²

Affiliations

¹ The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
² Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
³ Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, U.S.A.
⁴ Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.

PMID: 38727258
DOI: 10.1002/lary.31494

Abstract

Objectives: Transoral laser microsurgery (TLMS) and radiotherapy (XRT) are mainstays of treatment for early glottic carcinoma (EGC). Here, we investigated case-dependent provider treatment preferences and identify factors which impact decision-making in EGC.

Methods: This cross-sectional survey of laryngologists, head-and-neck surgeons, and radiation oncologists presented five diagrammatic cases of progressively advanced EGC (T1/2, N0). Respondents indicated preference for TLMS or XRT and ranked factors which influenced their recommendation for each case. Analysis utilized descriptive statistics, Fischer's exact tests, and Kruskal-Wallis tests for nonparametric data.

Results: A total of 141 complete responses (69.5% laryngologists) were received. Most respondents practiced in academic settings (93.5%) and within multidisciplinary teams (94.0%). Anterior commissure involvement was the most important a priori tumor factor for case-independent treatment recommendation (Likert Scale: 4.22/5), followed by Laterality (Likert Scale: 4.02/5). Across all specialties, TLMS was recommended for unilateral T1a lesions. Laryngologists continued recommending TLMS in T2 lesions (41.0%) more than head-and-neck surgeons (5.0%) and radiation oncologists (0.0%). Across all cases, survival and voice outcomes were the most important clinical factors impacting treatment decisions. Radiation oncologists weighed voice more heavily than laryngologists in more complex presentations of EGC (rank: 1.6 vs. 2.7, Kruskall-Wallis: p < 0.05).

Conclusions: In more complex clinical presentations of EGC, preference for TLMS compared to XRT differed across specialists, despite similar rankings of factors driving these treatment recommendations. This may be driven by differing experiences and viewpoints on case-dependent voice outcomes following TLMS versus XRT, suggesting a need for increased understanding of how tumor location and depth impact voice outcomes.

Level of evidence: V Laryngoscope, 2024.

Keywords: early glottic cancer; shared decision‐making; treatment preferences.