The role of the speech therapist in head and neck cancer

Azra Hoosen educates us on how a speech therapist supports and empowers head and neck cancer patients with speech, voice, communication and swallowing difficulties.

Many patients diagnosed with head and neck cancer may present with speech, communication, voice or swallowing difficulties which hugely impact activities of daily living and quality of life. 

A speech therapist is a health professional that is involved in the screening, assessment and ongoing management of individuals with the abovementioned difficulties.

Assessment, treatment and beyond

The speech therapist will assist with the following areas of assessment:

• Providing education and counselling regarding anticipated changes in communication and swallowing.
• Providing counselling prior to surgical procedures.
• Obtaining a baseline of communication, voice and swallowing skills prior to intervention decisions.
• Assessment of candidacy to use an alternative and augmentative communication (AAC) device.
• Evaluation of the anticipated impact on quality of life as well as future participation and engagement.

Tests for assessment of voice and swallowing difficulties

To evaluate the vocal cords, a test, called a videostroboscopy, is used to provide a magnified, slow-motion recording of the voice box. These recordings can be reviewed later.

There are two main tests used for swallowing evaluations. Video fluoroscopy is a motion X-ray study which measures swallowing ability from the mouth to the throat. Video endoscopy is done by using a small flexible scope which allows us to look at the swallowing area from the top of the throat.

Speech and voice rehabilitation

A variety of therapy options are available for patients who undergo laryngectomy surgery (removal of voice box), such as training patients to communicate by forcing air through the food pipe (oesophageal speech); using external devices, such as an electrolarynx to produce sound; and speaking while using a tracheoesophageal voice prosthesis (small valve that passes air from the windpipe to the throat allowing vocalisations). 

With regards to head and neck cancer in the oral cavity, patients may present with reduced intelligibility of speech due to surgical removal of various articulators (tongue, lips, etc.). One example of treatment will include a compensatory approach to therapy. Another option includes the selection of an AAC system. AAC systems are typically used on a temporary basis in the acute post-surgical phase, or as a long-term option in cases of extensive surgical resection.

Swallowing rehabilitation

Many patients with head and neck cancer usually undergo either surgical resection or chemo-radiation as medical treatment.

For patients that have undergone surgery, the speech therapist provides compensatory strategies to alleviate symptoms of dysphagia (swallowing difficulties). This may include diet modifications, postural changes and modification of feeding equipment. 

Post-operatively, exercise-based (resistance) training can also be implemented to improve strength and range of motion of oral structures. 

For patients that undergo radiation, maintaining quality of life during and particularly after radiation is of utmost importance. The muscles used for swallowing may become weak during radiation, and scarring after radiation may limit the ability to move freely. Active use of the swallowing muscles before, during and even after radiation has been shown to protect them from weakening and scarring. 

There are two activities to use these muscles. The first is to continue eating and drinking by mouth. The speech therapist can make suggestions on ways to continue eating safely during treatment. 

The second activity is swallowing therapy where appropriate exercises are provided to patients to preserve swallowing muscle function.

An integral member

The speech therapist is an integral member of the multi-disciplinary team responsible for assisting patients through their journey of head and neck cancer. Eating and drinking are more than just activities of daily living, they also allow for interpersonal connection and social bonding.

Furthermore, the ability to communicate is a basic human right which all individuals should have access to, through all stages of their lives. 

The speech therapist, in conjunction with the patient, their family members as well as other health professionals can tailor an individualised-care pathway that focuses on the patient’s needs as well as their participation and reintegration requirements.

MEET THE EXPERT  – Azra Hoosen

Azra Hoosen is currently a chief speech therapist and audiologist at Chris Hani Baragwanath Academic Hospital. She lectures part time at Wits University and has a special interest in the areas of head and neck cancer and tracheostomised individuals, the latter being the area in which she completed her master’s degree in 2012.