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Speech therapist Tan Hui Yong from Mount Elizabeth Rehabilitation Centre talks about the benefits of speech therapy for head and neck cancer patients. Head and neck cancer and its treatment frequently cause changes in a patient’s voice, speech and swallowing abilities, which affect the patient’s quality of life and ability to function in society. Speech therapists, however, can help patients cope with these challenges.

What are speech therapists?

Speech therapists are allied health professionals who are involved in the management of patients with head and neck cancer to address issues related to voice, speech, and swallowing function. Patients with head and neck cancer are typically treated with surgery, radiation therapy, chemotherapy, or a combination of these treatments. Each treatment modality may have a negative impact on swallowing and communication abilities. Speech therapists will work with these patients before, during, and after their treatment to keep their communication and swallowing as normal as possible.

Communication

Head and neck cancer treatment may cause speech difficulties such as reduced speech clarity, a hypernasal voice or a soft speech. In cases where the voice box is removed (laryngectomy), patients lose his/her ability to produce voice. If communication difficulties are left untreated, patients may develop depression or isolate themselves from social situations. Speech therapists will work with patients to improve their speech precision after the treatment. In the time when they are unable to use verbal speech to communicate, an alternative method such as external communication aids can be established. In patients who have had their vocal cords removed, the speech therapist will work with them and find the most suitable method to communicate. The methods may include: (a) esophageal speech: talking by forcing the air to the food pipe (b) artificial larynx:  using external devices such as an electrolarynx to produce sound (c) tracheoesophageal prosthesis (TEP) – speaking through a small one-way valve that passes air from the windpipe to the throat

Swallowing

Dysphagia (difficulty in eating and drinking) after head and neck cancer treatment is common. The muscles used for swallowing may become weak during chemoradiotherapy and scarring after radiation may limit the patient’s ability to move adequately. These problems can lead to symptoms like taking longer to eat, difficulty in managing dry food, food sticking in the throat after swallowing, food or liquid coming out from the nose, coughing or choking during or after swallowing. If dysphagia is left untreated, it can lead to malnutrition and dehydration. In serious cases, dysphagia can also cause pneumonia and chronic lung disease. Besides that, an individual may lose interest in eating and drinking and isolate himself/herself from social situations. Speech therapists will evaluate the patients’ swallowing and help them with any difficulties they encounter. A videofluoroscopic swallow (VFS) or a fibre-optic endoscopic evaluation of swallowing (FEES) may be suggested to review the oral and pharyngeal phases of swallow. After the evaluation, the speech therapist will recommend appropriate changes to make during swallowing. These changes may include postural changes, diet changes or use of swallowing manoeuvres. If the patient is unable to swallow safely despite rehabilitation strategies, his/her medical team will discuss with him/her regarding alternative feeding methods. The speech therapist may also work with the patient to develop a programme to rehabilitate his/her swallowing muscles.

Why is speech and swallowing treatment important?

Recent studies have shown that patients who receive active speech and swallowing treatment even prior to radiation treatment, yielded better outcomes in maintaining muscle structure and swallowing function. In addition, tissue fibrosity may manifest years after radiotherapy treatment and thus affects the patient’s ability to speak clearly and swallow safely. Therefore, it is crucial to continue doing exercises to prevent or minimise the side effects.

When should one start speech and swallowing therapy?

Patients should consider starting therapy before treatment and to continue, during and after treatment. Studies have shown that speech and swallowing therapy that has been initiated prior to cancer treatment, aids in maintenance of muscle function, thus improving post-treatment quality of life.