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Speech and swallowing impairments take many forms in this population and are driven by tumor burden and location, treatment modality, comorbidities, and age.
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Baseline functional assessment with speech–language pathology is best practice for most patients diagnosed with oral cavity or oropharyngeal cancers.
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Postoperative rehabilitation needs vary greatly by procedure and patient; early initiation of postoperative rehabilitation is advocated.
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Radiotherapy generally has greater impact on swallowing
Oral and Maxillofacial Surgery Clinics of North America
Framework for Speech–Language Pathology Services in Patients with Oral Cavity and Oropharyngeal Cancers
Section snippets
Key points
Nature of the problem
The complexity of the head and neck region involves an abundance of neurovascular structures responsible for breathing, speaking, and eating. Locoregional treatment modalities aim to eradicate head and neck tumors while intending to preserve these essential functions. However, treatment modalities for head and neck cancer (HNC), which include surgery, RT, and CRT, can impact both the anatomy as well as the tissue characteristics and neural inputs of the structures and muscles involved in speech
Dysphagia
The incidence of dysphagia at time of HNC diagnosis is reported as high as 40%5 and is often a direct consequence of tumor invasion into the swallowing musculature in patients with locally advanced tumors (baseline dysphagia is rare in patients with early stage disease). After diagnosis, dysphagia severity is then typically exacerbated, if present at diagnosis, or originated by oncologic treatment. Pretreatment dysphagia severity has been shown to correlate with disease stage,6, 7, 8 whereas
Speech
Deficits in speech intelligibility for oral and oropharynx patients with cancer are often a result of (1) direct surgical excision of the structures responsible for articulation and resonance and/or (2) resultant from neuromuscular effects of RT such as fibrosis or cranial neuropathies. A systematic review of the literature suggests that surgical resection of oral or oropharyngeal cancer often results in aberrant, although intelligible speech production ranging from 92% to 98% intelligibility
Baseline Functional Assessment
Owing to the significant impact of cancer treatment on functional outcomes, including speech, swallowing, and quality of life, oncology providers increasingly recognize the importance of proactive speech–language pathology services.6, 36 Many high-volume HNC programs consider it best practice to include instrumental baseline assessment of swallowing function via videofluoroscopy or flexible endoscopic evaluation of swallowing in their multidisciplinary approach to patient and symptom management
Complications and considerations
Swallowing function and speech intelligibility are critical aspects of daily functioning. As such, temporary and especially chronic speech and swallowing dysfunction can have a profound impact on quality of life. HNC-induced dysphagia is not only a significant contributor to reduced quality of life, but it is also associated with major health and financial implications. These include enteral feeding dependency, hospitalizations, economic burden, and mortality. In this section, these associated
Summary
This article provides a framework for proactive speech–language pathology services in assessment and treatment of patients with HNC. It is posited that speech pathology services initiate at diagnosis and continue throughout the continuum of survivorship. HNC and its oncologic treatment frequently disrupt speech and/or swallowing mechanisms, thus, adversely impacting an individual’s health, functional status, and quality of life. Assessments of speech and swallow function help to guide decision
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Cited by (6)
Early non-cancer mortality risk prediction after curative-intent radiotherapy or chemoradiotherapy for head and neck squamous cell carcinoma
2022, Radiotherapy and OncologyCitation Excerpt :Currently, there is a lack of evidence regarding the effect of supportive interventions in this treatment setting. Possible strategies to reduce EM-NED among high-risk patients could be intensified clinical monitoring during early follow-up, home health care team visits, self-registration of symptoms in electronic systems with built-in alert thresholds, elective hospital admissions, prophylactic antibiotic treatment [39] and/or systematic dysphagia screening [40]. The last two approaches seem particularly appealing, considering the high proportion of EM-NED that could be ascribed to pneumonia.
Effects of high-frequency speech therapy on speech-related quality of life and objective speech intelligibility of oral cancer patients
2021, Journal of Cranio-Maxillofacial SurgeryCitation Excerpt :Quality-of-life and disease-specific side-effects, such as dysglossia, have not yet been sufficiently considered, although the correlation between quality of life and speech intelligibility or articulation impairment after surgery and possible radio and/or chemotherapy is widely acknowledged (Passchier et al., 2016; Arrese et al., 2018). However, the implementation of standardized speech rehabilitation pathways remains rare (Clarke et al., 2016; Passchier et al., 2016), even when a specific focus on early speech rehabilitation is strongly recommended (Hutcheson et al., 2013; Clarke et al., 2016; Passchier et al., 2016; Arrese et al., 2018). Our study indicated that early commencement of speech therapy will not only support patients in adapting to their new situation after surgery, but will also help them learn to compensate for the possible functional deficits of dysglossia (Clarke et al., 2016).
Speech and swallowing intervention following oral cancer treatment: A survey of speech-language pathologists in Australia and New Zealand
2023, International Journal of Speech-Language PathologySpeech, Voice, and Swallowing Rehabilitation for Patients with Head and Neck Cancers
2022, Multidisciplinary Management of Head and Neck Cancer: Contemporary Applications and TechniquesEuropean white paper: oropharyngeal dysphagia in head and neck cancer
2021, European Archives of Oto-Rhino-LaryngologyEvaluation of a speech pathology service delivery model for patients at low dysphagia risk during radiotherapy for HNC
2020, Supportive Care in Cancer
Disclosure: The authors have nothing to disclose.