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Video

Care Equity, Quality, and Safety

(A146) Social Factors in TEP Abandonment: Restoring Every Voice

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Jillian L. Chen, MS

    Medical Student
    Boston University Chobanian and Avedisian School of Medicine
    Boston, Massachusetts, United States

    • Senior Author(s)

  • Heather A. Edwards, MD

    Director of Head and Neck Surgery, Associate Professor of Otolaryngology - Head and Neck Surgery
    Boston Medical Center
    Boston, MA, United States

    • Co-Author(s)

  • MB

    Meredith Bosley O'Dea, MS, CCC-SLP

    Senior Speech-Language Pathologist, Adjunct Assistant Professor of Otolaryngology
    Boston Medical Center
    Boston, Massachusetts, United States

  • Kailey Vitale, MA, CCC-SLP, BCS-S

    Speech-Language Pathologist
    InHealth Technologies
    New York, New York, United States

Disclosure(s):
Jillian L. Chen, MS: No relevant relationships to disclose.
Kailey Vitale, MA, CCC-SLP, BCS-S: No relevant relationships to disclose.


Introduction: Tracheoesophageal prosthesis (TEP) placement is generally considered the most effective voice restoration method for patients who undergo total laryngectomy (TL) for treatment of laryngeal cancer or dysfunction. However, various circumstances may result in TEP abandonment (TEP removal or discontinued use of the TEP to voice). Understanding the impact of social determinants of health on rates of TEP abandonment may allow for identification of gaps in post-surgical care and promote greater equity in clinical care.

Methods: This was an observational, retrospective cohort study of patients with laryngeal cancer or dysfunction who underwent TL and TEP placement and were followed at a large, academic, safety-net hospital, from 06/01/2015 – 06/30/2024. 30 demographic and medical factors, 12 factors related to the patient’s cancer and treatment, 11 factors related to TEP placement, and 11 factors affecting treatment outcomes were collected from the medical record. We aimed to determine the correlation between specific socioeconomic and demographic variables and rate of TEP abandonment.

Results: Our cohort included 44 patients who underwent TEP placement. Summary statistics were calculated for the data collected. 6 variables were included in the multivariate analysis. History of pre-TL radiation therapy (p = 0.033) and increased distance from hospital (p = 0.041) were statistically significant predictors of TEP abandonment. Insurance coverage of laryngectomy supplies, state area deprivation index (ADI), housing status, and history of substance and/or alcohol use disorder were not significantly correlated with TEP abandonment.

Conclusions: Distance between patients’ place of residence and the hospital is positively correlated with TEP abandonment, highlighting a need for improved access to post-surgical SLP care. Pre-laryngectomy radiation was also a significant predictor of TEP abandonment. Other variables were not associated with TEP abandonment, but showed trends that may demonstrate significance in a larger patient sample. These factors warrant exploration in a larger multi-institutional study.