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Head and neck cancer, and its treatment, frequently causes changes in a patient’s voice, speech and swallowing abilities, which affects their quality of life and ability to function in society. Speech Therapists, however, can help patients cope with these challenges.

Who are Speech Therapists and what do they do?

Speech Therapists are allied health professionals who are involved in the management of patients with speech, voice and swallowing difficulties. 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 in efforts to preserve as much of their communication and swallowing function.

Communication difficulties

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 their ability to produce voice. If such communication difficulties are left untreated, patients may develop depression or isolate themselves from social situations.

Speech Therapists will educate patients and provide consultation before treatment, and work with them on improving speech precision after treatment. During the time when patients are unable to use verbal speech to communicate, an alternative method — such as external communication aids — can be established and put in place to reduce communication difficulties.

Swallowing difficulties

Dysphagia (difficulty in eating and drinking) after head and neck cancer treatment is common. The muscles we use for swallowing may become weak during chemoradiotherapy, and scarring after radiation may limit the patient’s ability to move these muscles adequately. These problems can lead to symptoms like taking longer to eat, difficulty 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, dehydration and even pneumonia. This can also negatively impact a patient’s quality of life.

Speech Therapists will evaluate a patient’s swallowing function and recommend appropriate changes during swallowing. These may include postural changes, diet and fluid changes, or use of swallowing manoeuvres to ensure the safety of one’s swallow. Speech Therapists may also work with the patient to develop a programme to rehabilitate his/her swallowing muscles.

Why is early intervention important?

Recent studies have shown that patients who receive active speech and swallowing treatment prior to radiation treatment yielded better outcomes in maintaining muscle structure and swallowing function. This also reflects in an overall positive effect on quality of life for these patients.

In addition, tissue fibrosis — which is the hardening of tissues post-radiation — will cause affected tissues to become rigid and less elastic. This may limit movements of the tongue, jaw and throat muscles, which in turn negatively impacts on speech and swallowing functions. Studies have shown that disuse of swallowing muscles can contribute to their weakening. With increased use, muscles can adapt and grow in response. As tissue fibrosity can manifest years after radiotherapy treatment, it is crucial to continue engaging in speech therapy exercises before, during and after treatment to prevent or minimise the restrictions in muscle tissue.

Will I benefit from Speech Therapy early intervention services?

If you are a head and neck cancer patient who is about to or undergoing oncology treatment, or notice any speech, voice and/or swallowing difficulties, you may reach out to Parkway Rehab at parkwayrehab@ihhhealthcare.com. Our Speech Therapists will further advise based on the assessment of the individuals.

Speech Therapists are allied health professionals who are involved in the management of patients with speech, voice and swallowing difficulties. They will work with these patients before, during and after their treatment to preserve as much of their communication and swallowing function.