Improving the quality of life for laryngectomy patients is the core mission of Atos Medical

In response to the growing need for high-level support for laryngectomy patients, we developed the Atos Medical Case Management Department comprised of two essential teams: Clinical Navigators and Client Navigators. Client Navigators specialize in navigating insurance complexities and work directly with patients to overcome barriers to accessing necessary supplies. Clinical Navigators supplement the education patients receive from their healtcare professionals (HCPs) and SLPs by focusing on product knowledge and effective use of their prescribed products. This article will specifically focus on the work of Atos Medical Clinical Navigators.

The role of the Clinical Navigators (SLPs, RTs, and NPs) is to support our patients who breathe through a permanent tracheostoma (stoma) given their complex pulmonary and communication needs, complementing the clinical education provided by their healthcare professionals (HCP). After a total laryngectomy, the patient loses the functions of the upper airway responsible for filtering, warming, and humidifying inhaled air before it reaches the lungs. A heat and moisture exchanger (HME) is attached at the stoma with an adhesive, larytube, and/or larybutton and should be used 24/7 for optimal benefit. The HME is often referred to as the "new nose" because it helps the respiratory system by conditioning the air before it reaches the lungs. Additionally, the HME provides varying degrees of breathing resistance, which is integral to pulmonary health. Consistent daily use of HMEs provides significant health benefits. However, difficulties in accessing supplies, misunderstandings about the duration of time a single HME can be worn, attachment challenges and gaps in knowledge have been shown to limit adherence to prescribed daily HME use.

Research has shown that using two HMEs per day, (24/7) using the highest humidification tolerated, leads to the best pulmonary outcomes for patients ^{1, 2}. To address this knowledge gap and commit to meeting our patients’ needs, the Clinical Navigators developed a pilot to assess the benefits of personalized support in establishing and maintaining a day/night routine of HME use. The HME Awareness Pilot took place from July 2024 to January 2025.

Pilot details:

Criteria for participation included but were not limited to: Valid prescription form with a minimum of 60 Provox Life HMEs/month and utilization of less than two HMEs per day (24/7).

The pilot consisted of pre and post pilot surveys, a 30-day HME use tracking form, and a wrap-up questionnaire. The goal was to learn more about patients’ HME understanding, HME usage, and management of the tracheostoma. The questions targeted commonly occurring issues and problems associated with breathing, coughing, mucus, and poor sleep. Patients had the option to communicate via phone, email, and/or traditional mail.

The education provided during the enrollment period and the pilot targeted 24/7 Provox Life HME use, focusing on the importance of humidification for pulmonary health. Patients had the choice of HMEs to use during the day but were required to use a high-humidification HME (HOME or NIGHT) while sleeping, as per the pilot agreement. Clinical Navigators educated patients on the various Provox Life HME options, allowing them to self-select the HMEs that best suit their needs for both day and night use. They were encouraged to discuss their choices with their HCP before deciding, as needed. Some patients opted to use multiple types of HMEs throughout the day based on their varying activities and communication needs. Patients set individualized goals at the start of the pilot. These varied from ‘less coughing’ and ‘I don’t want to carry tissues around’ to ‘I would like to start walking in the evenings. I’m afraid to get away from my portable suction.’ Of the 42 participants who set a personal goal, 38 (90%) reported achieving their original goal during the final reflection at the end of the pilot.   

88 patients enrolled and 49 patients completed all requirements of the pilot.

Testimonials from pilot participants:

"It is a major difference when you use the nighttime HME every night."

"For the first time I was able to go to a family event with confidence I wouldn’t be coughing constantly and having to clean my stoma."

"I definitely have more energy. I’m definitely getting more sleep."

"It really does make a difference using the different HMEs at the appropriate times."

"There was a decrease in the number of times needed to suction on most days."

Learnings from pilot:

The HME Awareness Pilot demonstrated positive outcomes, highlighting the value of personalized patient education. The majority of patients in the pilot reported improvements in their pulmonary health. Building on this success, the pilot will transition into a permanent offering: the HME Awareness Program, launching later this year. Through this program, healthcare providers (HCPs) and speech-language pathologists (SLPs) will be able to refer patients who are having difficulty with consistent 24/7 HME use. Additionally, patients will have the option to self-enroll. The program maintains the same objective as the pilot: to educate and support laryngectomy patients in establishing and sustaining consistent HME use, with the aim of potentially improving pulmonary health.

Scientific poster session presentations on the HME Awareness Pilot were presented at the Mayo Clinic Multidisciplinary Head and Neck Cancer Symposium, Scottsdale, AZ, in March 2025 and the American Head and Neck Society 2025 Annual Meeting, New Orleans, LA, in May 2025. We were excited to share our HME Awareness Pilot findings with physicians and allied health professionals. An important component of these discussions was to highlight the benefits of 24/7 HME adherence on pulmonary health in the laryngectomy population. Our results will be presented in a technical session during the 2025 ASHA Convention Virtual Program as well.

References

Ward  EC, Hancock K, Boxall J, et al. Post-laryngectomy pulmonary and related symptom changes following adoption of an optimal day-and-night heat and moisture exchanger (HME) regimen. Head & Neck. 2023; 45(4): 939-951. doi:10.1002/hed.27323 

Longobardi, Y., J. Galli, T. Di Cesare, et al. (2022). "Optimizing Pulmonary Outcomes After Total Laryngectomy: Crossover Study on New Heat and Moisture Exchangers." Otolaryngol Head Neck Surg: 1945998221086200.