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Evaluation and Management of Speech and Swallowing Issues in RFS

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Abstract

Purpose of Review

Delayed onset of communication and swallowing dysfunction due to radiation-associated neuromuscular injury is one of the most challenging clinical presentations in head and neck cancer rehabilitation. This review details the current literature and describes an evidence-based process for evaluating and treating this unique clinical entity.

Recent Findings

Radiation-fibrosis syndrome (RFS) is associated with lower cranial nerve palsy, dysphagia, trismus, dysarthria, dysphonia, and dyspnea. Sequelae of dysfunction can include feeding tube dependence, tracheostomy, depression, anxiety, and poor quality of life. While there is limited research evaluating rehabilitation efficacy explicitly in this population, the broader evidence base supports a multidimensional evaluation process and interventions that include compensatory approaches, skill-based training, and restorative exercises. Further evidence is forthcoming, with several ongoing randomized clinical trials exploring this topic.

Summary

Communication and swallowing dysfunction associated with RFS is debilitating, and treatment is intensive, often involving a phased approach with multiple specialties.

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Authors and Affiliations

  1. Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler St., Unit 1445, Houston, TX, 77030, USA

    Barbara M. Ebersole, Holly McMillan & Katherine Hutcheson

  2. Division of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Katherine Hutcheson

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  1. Barbara M. Ebersole
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  2. Holly McMillan
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  3. Katherine Hutcheson
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Correspondence to Katherine Hutcheson.

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Conflict of Interest

Dr. Hutcheson has received funding outside of submitted work from the National Institute of Health/National Cancer Institute, the National Institute of Health/National Institute of Dental and Craniofacial Research, the Patient-Centered Outcomes Research Institute, the Department of Defense and Atos Medical. Barbara Ebersole and Holly McMillan have no potential conflicts of interest to disclose.

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Ebersole, B.M., McMillan, H. & Hutcheson, K. Evaluation and Management of Speech and Swallowing Issues in RFS. Curr Phys Med Rehabil Rep 11, 93–104 (2023). https://doi.org/10.1007/s40141-023-00388-5

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