Psychological and social issues in head and neck patients (including laryngectomees) caused by the COVID-19 pandemic

Mental health issues in head and neck patients (including laryngectomees) caused by the COVID-19 pandemic 

The current COVID-19 outbreak is spurring depression, fear, anxiety, and stress on a societal level. An increase in deaths by suicide during this quarantine period was also noted. On an individual level, it may exacerbate anxiety and psychosis-like symptoms as well as lead to non-specific mental issues (e.g., mood problems, sleep issues, phobia-like behaviors, panic-like symptoms). Head and neck cancer patients (HNCP) (including laryngectomees) are more vulnerable to these psychological issues as well as the viral infection. Laryngectomees may experience increased social isolation and loneliness.

Contributing to these are the difficulties in get medical and diagnostic care, prescription drugs, and medical supplies, and the economic situation.

HNCP with mental health issues such as obsessive compulsive disorders (OCD), post-traumatic stress disorder (PTSD), anxiety and depressive disorders, and paranoia may experience exacerbation of their symptoms.

HNCP can be proactive and alleviate some of their psychological vulnerability by:

• Reaching out and seeking support from mental health professionals (i.e., psychiatrists, psychologists, social workers)
• Getting medical and other supplies delivered to one’s residence 
• Engaging in healthy distractions such as reading, watching movies, taking walks, exercising, and learning a new skill
• Developing a routine
• Obtaining information from reliable sources
• Curbing media exposure to certain times in the day
• Being aware of what is anxiety and what is reality in one’s thoughts and conversations
• Following guidelines (i.e., using prescribed handwashing methods, avoiding touching the face, avoiding hugging and shaking hands, staying at home and contacting one’s medical provider when experiencing medical problems)
• Connecting with family and friends through the internet, social media, video calls and phone 

Following these guidelines can assist HNCP navigate through the corona virus pandemic.

How laryngectomees can cope with the COVID -19 quarantine

The forced quarantine imposed by COVID -19 can be difficult for laryngectomees. Their communication difficulties may increase their social isolation, leading to medical and psychological problems.

In addition to taking steps to improve psychological vulnerability, e.g., developing a routine, reading, watching movies, taking walks, exercising, and learning a new skill, laryngectomees may want to consider the following:

• Communicating with family, friends and support groups by speaking over the phone; and e-mailing and texting using computer, tablet and smartphone. There are several applications that allow video communication (e.g., Skype, FaceTime, Zoom) to keep in touch. The volume and quality of the voice when using telecommunication methods ) can be improved by using a hand held microphone  and placing it near the laptop, iPad or iPhone ( see picture below). It would be helpful for support groups to continue meeting using some of these methods.
• Those using tracheo-esophageal speech can learn how to communicate through other methods of speaking (e.g., esophageal speech, electrolarynx, sign language) ) in case they need to plug their leaking voice prosthesis.
• Not ignoring medical, dental and psychological issues. Continuing to receive care from physicians, dentists, mental health providers, and speech and language pathologists. If physical access to them is limited, contacting them using telemedicine.
• Having adequate supplies needed to speak and care for the airways (e.g., baseplate, HME, saline bullets).

As home confinement and other restrictions are being slowly lifted, it would be prudent for laryngectomees to continue to observe precautionary measures. As more clinical experience in managing COVID-19 infection is gained and new medications and vaccines are available the consequences of becoming infected may become less dangerous.

Placing the voice amplifier near the iPad increases voice volume 

Hopefully, following these suggestion may help laryngectomees cope with their quarantine.

Going outside during the COVID-19 pandemic. What should laryngectomees do?

Laryngectomee may experience social and medical challenges when they leave their home during the COVID-19 pandemics. Most non-neck breathers do not understand or recognize their medical condition and may react in a negative way toward them. They may be alarmed when the laryngectomee coughs or sneezes, or take care of their stoma in public.

Included are some of the steps that laryngectomees can take when in public:

• Cleaning the stoma and trachea including inserting saline into the trachea and coughing out the secretions before going out
• Taking care of the stoma and it’s secretions at a private location away from others (e.g., bathroom, separate room)
• Covering the stoma (with napkin, cloth or elbow) whenever coughing or sneezing. Preferably this is done away from other people. When coughing forcefully the stoma can produce large amount of droplets that can spread and infect others when the laryngectomee carries a respiratory virus such as COVID-19
• Keeping a distance of at least 6 feet (2 meters) from others
• A useful routine is to use the non-dominant hand to touch the stoma and the dominant hand for other activities (e.g., touching a door handle).
• Wearing a surgical mask or garment over the mouth and nose (in addition another one over the stoma). This is done to protect the laryngectomee from becoming infected, as well as others when the laryngectomee is infected. Wearing a mask over the mouth and nose in public prevent the laryngectomee from standing out from others. Wearing the mask on the stoma and face also serves in preventing laryngectomees from touching these locations with unclean hands.

Hopefully these measures can assist laryngectomees in public locations.

As home confinement and other restrictions are being slowly lifted, it would be prudent for laryngectomees to continue to observe these precautionary measures. As more clinical experience in managing COVID-19 infection is gained and new medications and  vaccines are available the consequences of becoming infected may become less dangerous.