Are we different?
There is plenty of anecdotal evidence that a laryngectomee’s altered breathing mechanism affects the vulnerability to respiratory infections. The nose and mouth are redundant when air is taken in or exhaled; instead the neck stoma is the entry and exit point. I have not had a cold or the flu since my surgery 20 years ago, and I know of others with the same experience.

Covid Tests
To check for current infection, PCR tests were the first to be employed. The latest guidance on the NHS England website, as of December 23^rd, is that samples need to be taken from both the tonsil area and the nose. The first lateral flow test kits gave the same advice.

Laryngectomees?
Clinical opinion in the UK and elsewhere, including USA, was that the stoma needs to be swabbed. NALC, with the help of University College Hospital London, produced guidance recommending swabs be taken from the nose and additionally the stoma, rather than the throat. (See earlier post)

Newer Lateral Flow Tests
The test kits supplied in recent months provide different instructions. No longer are samples to be taken from the throat, only from the nose. Swabbing the tonsil area is difficult and uncomfortable, especially for schoolchildren, who needed to carry out these tests from last autumn. Making testing easier was perhaps a necessity to ensure tests were carried out as required.

Will the Newer Tests Work for Laryngectomees?
Lateral flow tests are not 100% reliable for people with a normal airway. There are many anecdotal reports from people who have tested the nose and then soon after sampled both the nose and throat with contradictory outcomes. Will only testing the nose and ignoring the stoma give less reliable results for our community, given our different breathing mechanism?

The article here illustrates some recent concerns from Prof. Jennifer Rohn (UCL)

LINK

Also some research has suggested nasal swabs are less effective for detecting infection with the Omicron variant and the rapid tests give a positive result several days later than a PCR test would do.

LINK 2

Priority for Early 2022

NALC will be seeking advice from our medical advisors and partners about effective Covid testing. My personal inclination, if carrying out a lateral flow test, is to continue to sample both the nose and stoma but definitive clinical guidance is needed.

Probably just in time before the Covid Omicron variant really took hold we gathered for a Christmas Social. We chose a location where we would not be mixing with the public as we would at our base at The Olde House.

It wasn’t business as usual however. We followed the guidance as best we could by taking lateral flow tests, wearing masks for some of the time and ventilating the space throughout. Nonetheless the attendance was a bit lower than usual as some members have been severely restricting social contacts.

(click to enlarge)

We are currently helping 3 patients undergoing treatment and supporting them at this time is far from easy whilst keeping people as safe as possible from Covid.

The development of effective vaccines for Covid has saved tens of thousands of lives to date and will save even more in the future. Twelve months ago we were uncertain about the effectiveness of any of the various vaccines under development but now have several that have proved to be effective at defending against serious illness or death. Science at its best!

Cancer presents a more difficult challenge than combatting a new virus, even one that causes a pandemic. Cancer arises from cell changes through damage, but these can have a myriad of triggers or causes. It can be radiation such as ultra-violet from the Sun or chemicals such as those ingested when smoking a cigarette. Treatments starting with surgery and later radiotherapy and chemotherapy have saved many lives but are not as yet a “cure”. The latest arrival on the scene is immunotherapy. It is a type of treatment that helps your immune system, which combats other diseases and infections, fight cancer.

New Treatment Destroys Head and Neck Cancer Tumours in Trial

This was the headline for an article in the Guardian newspaper in October. The trial looked at the benefit of combining two immunotherapy agents compared to the current chemotherapy regime for patients with recurrent or advanced head and neck cancer. The agents were nivolumab and ipilimumab.

There were some remarkable patients’ stories, when having had a terminal cancer diagnosis they were now cancer free and enjoying life to the full, several years later.

Sadly the reports do not present the complete picture. Overall the survival statistics were not significantly better. The benefits of the treatment were seen only in some patients – those who carried a particular genetic marker PD-L1.

Professor Kevin Harrington, of the Royal Marsden and Institute of Cancer Research, said “despite the lack of statistical significance, these results are clinically meaningful. We will need to do a longer follow-up to see if we can demonstrate a survival benefit across all patients in the trial.”

On Monday December 6^th NICE reported some significant news:

As you will be aware the Department for Health and Social Care has asked NICE to carry out an appraisal of nivolumab with ipilimumab for untreated recurrent or metastatic squamous cell cancer of the head and neck cancer.
For information, the company have advised that they will no longer be pursuing a marketing authorisation application in this indication at this time.
Therefore, NICE has decided to suspend this appraisal from its current work programme.

So the headlines may have been a bit overblown. However there is no doubting the benefit of continuing to develop immunotherapy treatments, not least because they are far kinder to the patients than the usual chemotherapy agents.