The Impact of Head and Neck Cancer on Communication and Swallowing
Patients affected by head and neck cancer suffer significant short- and long-term post-treatment morbidity which affects their daily functioning and quality of life. Most head and neck cancers and their treatments affect the person’s speech production skills and their swallowing.
Swallowing and communication difficulties may arise secondary to the presence of tumours, from damage or resection of related soft tissues and nerves during surgical intervention, as well as from the side effects and long-term tissue damage following chemoradiation. Appetite can also be affected by a significant loss of ability
to taste and smell which can result in additional weight-loss. Reduced ability to communicate with loved once and engage in social elements of mealtimes can also result in anxiety and depression.
The Role of Speech Therapists in Treating Head and Neck Cancer Patients
Speech therapists play an important role in assessing, diagnosing, and managing communication, speech,
voice, and swallowing problems resulting from head and neck cancer. Ideally the speech therapist’s care of a patient begins at the time of diagnosis. Prophylactic swallowing therapy begins prior to and during medical intervention and patients are encouraged to do daily exercises with the focus being about not letting muscles weaken and lose their function during the discomfort of treatment. These exercises are modified during and post treatment. While it seems intuitive that pre-treatment exercises should be helpful in increasing physiological reserve, reduce disuse atrophy, and possibly delay the onset of radiation induced fibrosis, many
patients are not referred for speech therapy.
The role of the speech therapist in managing patients with head and neck cancer includes the following:
• To provide patients and their families with information regarding the potential impact of treatment on
their functioning.
• Provide pre-treatment strategies to reduce the impact of radiotherapy on swallowing ability.
• Develop and support the communication skills of both the patient and loved ones.
• Assess and provide therapy for speech production and voice changes following treatment.
• Identify and treat swallowing difficulties and manage the associated risks of persistent swallowing
problems.
• Contribute to palliative and end-of-life care, maximising and facilitating communication and managing
swallowing problems, thereby promoting quality of life.
Benefits of Starting with Speech Therapy Early On
1. Promotes Positive Outcomes
Speech therapy focuses on the health and safety of patients through the diagnosis and management of swallowing difficulties, reducing the severity of side effects, while facilitating optimal communication and encouraging patients to achieve their full potential.
2. Reduces Negative Outcomes
Intervention can reduce medical complications such as aspiration pneumonia, reduce hospital admissions and length of stay through timely assessment and management of swallowing problems. Speech and language therapy can also help reduce isolation and anxiety by maximising communication effectiveness.
Current international guidelines recommend that patients with head and neck cancers should start speech therapy before treatments that may result in swallowing and/ or communication difficulties. In order to achieve the best
possible functional outcome and quality of life speech therapists should be involved:
• Pre-diagnosis
• Diagnosis and care planning
• Treatment
• Post-treatment
• Monitoring
• Palliative care
• End of life