Cost-Effective Management of Laryngeal Cancer in Rural Areas

Management of Laryngeal Carcinoma in Rural Area

dr. Suwardi, Sp.THT-BKL

Main Goal Controlling the disease

1. Preserving speech function 2. Preserving swallowing function 3. Avoiding tracheostomy

Other Functions

Management of Laryngeal Cancer

Machiels JP, René Leemans C, Golusinski W, Grau C, Licitra L, Gregoire V, et al. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020 Nov;31(11):1462–75.

THE LACK OF HEALTH INSURANCE

In urban areas like Jakarta, RSCM hospitals is type A hospitals as top referral hospital that receive a large

number of insurance claims.

In rural areas, the highest referral hospital is type B, which does not

have a large budget of funds.

Therefore, cost-effective considerations are needed in the

management of cancer.

Solution: we do a lot of modifications

Urban-Rural Disparities in Management of Ca Laryngeal

THE LACK OF HEALTH INSURANCE

Postoperative patients can be treated for more than 10 days so that various

postoperative management can be carried out

Urban Area

postoperative patients can only be treated for 3-5 days

Rural Area

To prevent infection → double antibiotic (levofloxacin metronidazole)

IV for 3 days and continue per oral

THE LACK OF HEALTH INSURANCE

Urban Area

A CT scan cannot be done simultaneously during the initial diagnosis because it is related to health system/national insurance policy, so it must be

done in the following month. This condition also delays the laryngectomy procedure, which can only be performed 3 months after the tracheostomy.

Rural Area

Urban-Rural Disparities in Management of Ca Laryngeal

LIMITED FACILITIES

Lots of advanced equipment

Urban Area

Due to limited funds, many equipment need to be modified,

such as drains

Rural Area

LIMITED FACILITIES

Usually, radiotherapy is given 8 weeks after the therapy, but due to the availability of radiotherapy in only one hospital, it can only be performed

at the earliest 12 weeks after the surgery.

Urban Area Rural Area

Conclusion: In rural areas, laryngectomy can still be performed but requires

modification, with the same goal of

providing the best management

A man, 54 years of age, presented with complaints of shortness of

breath and hoarseness. Fiber optic laryngoscopy was performed,

revealing a glottic mass with bilateral vocal cord fixation and airway

obstruction. Subsequently, a tracheostomy and biopsy were carried out

using direct laryngoscopy. The biopsy results indicated squamous cell

carcinoma (SCC) of the larynx, well-differentiated type. A CT scan

was conducted, and 3 months after the tracheostomy, a total

laryngectomy was performed.