Framework for Speech–Language Pathology Services in Patients with Oral Cavity and Oropharyngeal Cancers

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Key points

  • •

    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

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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