This presentation has dealt with the question of when to perform conservation surgery of the larynx for cancer. The authors included a recommendation for the use of radiotherapy because it is an obvious extension of the issue. It should be clear that this is a complex problem involving relatively few patients compared with the number of radiation therapists and head and neck surgeons throughout the country. Eligibility for conservation surgery of the larynx is dependent upon many factors in addition to the gross extent of the tumor. Since radiation will be one of the choices of therapy, it is imperative that the head and neck surgeon dealing with these problems have an excellent working relationship with a radiation oncologist. A surgical pathologist with a specific interest in head and neck diseases is a required member of the team. As with any other team endeavor, no one member can assume that his talents alone can win the game.
: When it is discovered that cancer has recurred, patients experience a period of acute emotional distress, with increased anxiety, fear, a sense of helplessness, and depression. Well meaning colleagues, friends and relatives feel compelled to tell them about unorthodox their cancer "cures," including anecdotes about their success. These unproven remedies currently tend to fit with holistic health concepts and are aimed at enhancing the body's own defenses; most involve the use of chemicals or drugs, nutritional supports and vitamins, vaccines and mind-body techniques. Laetrile has been the most popular unorthodox remedy in the past decade. The distraught patient and family are deluged with information and have trouble evaluating the valid approach from the invalid. Physicians who treat with cancer should make sure they themselves understand the emotional basis for a patient's need to pursue unorthodox remedies. The risk is heightened when the patient senses the doctor has "given up" and has "nothing more to offer." They should feel able to ask questions about unproven remedies without fear that the physician will be judgmental or punitive. Participation in a clinical trial of a new and promising treatment under investigation, within the full protection of ethical guidelines, should be suggested as an alternative to unproven treatments outside the medical system which are not subject to the same constraints.
