Abstract
Head and neck cancer (HNC) and its treatment can have a significant impact on physical and psychosocial wellbeing. A multidisciplinary team (MDT) approach is critical to reduce the potential acute, long-term and late effects of treatment by optimising function at baseline, supporting people during treatment and with rehabilitation post treatment. The key focus for speech and language therapists is to support the holistic needs of people with a focus on speech, swallowing, voice and mouth opening. Effective management is reliant on working with MDT members and interventions are implemented against the background of robust multidimensional baseline evaluation. There have been significant advances in treatment modalities for both primary and recurrent HNC. These include highly conformal radiotherapy modalities, including: image-guided radiotherapy; parotid-sparing and dysphagia-optimised intensity-modulated radiotherapy; and the introduction of intensity-modulated proton therapy, as well as immunotherapy, transoral robotic surgery and surgery with advanced reconstructive techniques. Such treatment advances coupled with a changing patient demographic means that people with HNC are now living longer. However, this is not always without consequences and late treatment effects are a new challenge facing MDTs, requiring high levels of support and rehabilitation.
Key points
-
Speech and language therapists (SLTs) are key members of the multidisciplinary team.
-
All individuals should see a SLT as part of their treatment pathway if there is an existing or likely treatment-related impact on communication and/or swallowing.
-
SLTs use a combination of multidimensional assessment, education and rehabilitation interventions to optimise functional outcomes.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 24 print issues and online access
$259.00 per year
only $10.79 per issue
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Schache A G, Powell N G, Cuschieri K S et al. HPV-Related Oropharynx Cancer in the United Kingdom: An Evolution in the Understanding of Disease Etiology. Cancer Res 2016; 76: 6598-6606.
Butterworth C, McCaul L, Barclay C. Restorative dentistry and oral rehabilitation: United Kingdom national multidisciplinary guidelines. J Laryngol Otol 2016; DOI: 10.1017/S0022215116000414.
Evans M, Knott S, Hurt C et al. PATHOS: A phase II/III trial of risk-stratified, reduced intensity adjuvant treatment in patients undergoing transoral surgery for Human papillomavirus (HPV)-positive oropharyngeal cancer. J Clin Oncol 2018; 36: 15.
Goldsmith T A, Roe J W G. Human papilloma virus-related oropharyngeal cancer opportunities and challenges in dysphagia management. Cur Opin Otolaryngol Head Neck Surg 2015; 23: 185-190.
Brennan M T, Treister N S, Sollecito T P et al. Dental disease before radiotherapy in patients with head and neck cancer: Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients. J Am Dent Assoc 2017; 148: 868-877.
Restorative Dentistry UK. Predicting and Managing Oral and Dental Complications of Surgical and Non-Surgical Treatment for Head and Neck Cancer. 2016. Available at https://www.restdent.org.uk/uploads/RD-UK%20H%20and%20N%20guideline.pdf (accessed May 2022).
Van der Molen L, van Rossum M A, Burkhead L M, Smeele L E, Rasch C R N, Hilgers F J M. A randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: feasibility, compliance, and short-term effects. Dysphagia 2011; 26: 155-170.
Patterson J M, Brady G C, Roe J W. Research into the prevention and rehabilitation of dysphagia in head and neck cancer: a UK perspective. Curr Opin Otolaryngol Head Neck Surg 2016; 24: 208-214.
Schache A, Kerawala A, Ahmed O et al. British Association of Head and Neck Oncologists (BAHNO) standards (2020). J Oral Pathol Med 2021; 50: 262-273.
Clarke P, Radford K, Coffey M, Stewart M. Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016; DOI: 10.1017/S0022215116000608.
National Institute for Clinical Excellence. Improving Outcomes in Head and Neck Cancer. 2004. Available at https://www.nice.org.uk/guidance/csg6/resources/improving-outcomes-in-head-and-neck-cancers-update-pdf-773377597 (accessed June 2022).
Kalavrezos N, Cotrufo S, Govender R et al. Factors affecting swallow outcome following treatment for advanced oral and oropharyngeal malignancies. Head Neck 2014; 36: 47-54.
Barbon C E A, Peterson C B, Moreno A C et al. Adhering to Eat and Exercise Status During Radiotherapy for Oropharyngeal Cancer for Prevention and Mitigation of Radiotherapy-Associated Dysphagia. JAMA Otolaryngol Head Neck Surg 2022; DOI: 10.1001/jamaoto.2022.2313.
Karsten R T, van der Molen L, Hamming-Vrieze O et al. Long-term swallowing, trismus, and speech outcomes after combined chemoradiotherapy and preventive rehabilitation for head and neck cancer; 10-year plus update. Head Neck 2020; 42: 1907-1918.
Langmore S E, Terpenning M S, Schork A et al. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia 1998; 13: 69-81.
Kawashita Y, Morimoto S, Tashiro K et al. Risk factors associated with the development of aspiration pneumonia in patients receiving radiotherapy for head and neck cancer: retrospective study. Head Neck 2020; 42: 2571-2580.
Farquhar D R, Divaris K, Mazul A L, Weissler M C, Zevallos J P, Olshan A F. Poor oral health affects survival in head and neck cancer. Oral Oncol 2017; 73: 111-117.
Roe J W G, Drinnan M J, Carding P N, Harrington K, Nutting CM. Patient-reported outcomes following parotid-sparing intensity-modulated radiotherapy for head and neck cancer. How important is dysphagia? Oral Oncol 2014; 50: 1182-1187.
Bhayani M K, Hutcheson K A, Barringer D A et al. Gastrostomy tube placement in patients with oropharyngeal carcinoma treated with radiotherapy or chemoradiotherapy: factors affecting placement and dependence. Head Neck 2013; 35: 1634-1640.
Paleri V, Patterson J, Rousseau N et al. Gastrostomy versus nasogastric tube feeding for chemoradiation patients with head and neck cancer: the TUBE pilot RCT. Health Technol Assess 2018; 22: 1-144.
Owadally W, Hurt C, Timmins H et al. PATHOS: a phase II/III trial of risk-stratified, reduced intensity adjuvant treatment in patients undergoing transoral surgery for Human papillomavirus (HPV) positive oropharyngeal cancer. BMC Cancer 2015; 15: 602.
Petkar I, Rooney K, Roe J W G et al. DARS: a phase III randomised multicentre study of dysphagia-optimised intensity-modulated radiotherapy (Do-IMRT) versus standard intensity-modulated radiotherapy (S-IMRT) in head and neck cancer. BMC Cancer 2016; 16: 770.
Paleri V, Hardman J, Brady G, George A, Kerawala C. Transoral Robotic Surgery for Residual and Recurrent Oropharyngeal Cancers. Otolaryngol Clin North Am 2020; 53: 1091-1108.
Dawson C, Pracy P, Patterson J, Paleri V. Rehabilitation following open partial laryngeal surgery: key issues and recommendations from the UK evidence based meeting on laryngeal cancer. J Laryngol Otol 2019; 133: 177-182.
Royal College of Speech and Language Therapists. Prosthetic Surgical Voice Restoration. Available at https://www.rcslt.org/wp-content/uploads/media/Project/RCSLT/surgical-voice-restoration-recommended-knowledge-and-skills.pdf (accessed May 2022).
Vissink A, Jansma J, Spijkervet F K L, Burlage F R, Coppes R P. Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med 2003; 14: 199-212.
Anderson G, Ebadi M, Vo K, Novak J, Govindarajan A, Amini A. An Updated Review on Head and Neck Cancer Treatment with Radiation Therapy. Cancers (Basel) 2021; 13: 4912.
Chiu Y-H, Tseng W-H, Ko J-H, Wang T-G. Radiation-induced swallowing dysfunction in patients with head and neck cancer: A literature review. J Formos Med Assoc 2022; 121: 3-13.
Lalla R V, Bowen J, Barasch A et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 2014; 120: 1453-1461.
Hutcheson K A, Bhayani M K, Beadle B M et al. Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it. JAMA Otolaryngol Head Neck Surg 2013; 139: 1127-1134.
Martino R, Fitch M I, Fuller C D et al. The PRO-ACTIVE trial protocol: a randomized study comparing the effectiveness of PROphylACTic swallow InterVEntion for patients receiving radiotherapy for head and neck cancer. BMC Cancer 2021; 21: 1100.
Gunn L, Gilbert J, Nenclares P et al. Taste dysfunction following radiotherapy to the head and neck: A systematic review. Radiother Oncol 2021; 157: 130-140.
Nutting C M, Rooney K, Foran B et al. Results of a randomized phase III randomised multicentre study of dysphagia-optimised intensity-modulated radiotherapy (Do-IMRT) versus standard intensity-modulated radiotherapy (S-IMRT) in head and neck cancer. J Clin Oncol 2016; 38: 6508.
Wang X, Eisbruch A. IMRT for head and neck cancer: reducing xerostomia and dysphagia. J Radiat Res 2016; DOI: 10.1093/jrr/rrw047.
Vainshtein J M, Moon D H, Feng F Y, Chepeha D B, Eisbruch A, Stenmark M H. Long-term quality of life after swallowing and salivary-sparing chemo-intensity modulated radiation therapy in survivors of human papillomavirus-related oropharyngeal cancer. Int J Radiat Oncol Biol Phys 2015; 91: 925-933.
Kam M K, Leung S-F, Zee B et al. Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients. J Clin Oncol 2007; 25: 4873-4879.
Burtness B, Harrington K J, Greil R et al. Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study. Lancet 2019; 394: 1915-1928.
Nenclares P, Rullan A, Tam K, Dunn L A, St John M, Harrington K J. Introducing Checkpoint Inhibitors Into the Curative Setting of Head and Neck Cancers: Lessons Learned, Future Considerations. Am Soc Clin Oncol Educ Book 2022; 42: 1-16.
Nichols A C, Theurer J, Prisman E et al. Radiotherapy versus transoral robotic surgery and neck dissection for oropharyngeal squamous cell carcinoma (ORATOR): an open-label, phase 2, randomised trial. Lancet Oncol 2019; 20: 1349-1359.
Tretiakow D, Skorek A. First bite syndrome: the complication to keep in mind. Pol Otorhino Rev 2019; 8: 1-3.
Brady G C, Hardman J C, Paleri V, Harrington K J, Roe J W G. Changing paradigms in the treatment of residual/recurrent head and neck cancer: implications for dysphagia management. Curr Opin Otolaryngol Head Neck Surg 2020; 28: 165-171.
Brady G, Leigh-Doyle L, Riva F, Kerawala C, Roe J. Early Post-operative Feeding: An Investigation of Early Functional Outcomes for Oral Cancer Patients Treated with Surgical Resection and Free Flap Reconstruction. Dysphagia 2022; 37: 1008-1013.
Starmer H, Edwards J. Clinical Decision Making with Head and Neck Cancer Patients with Dysphagia. Semin Speech Lang 2019; 40: 213-226.
Pauloski B R, Rademaker A W, Logemann J A et al. Relation of mucous membrane alterations to oral intake during the first year after treatment for head and neck cancer. Head Neck 2011; 33: 774-779.
Lalla R V, Latortue M C, Hong C H et al. A systematic review of oral fungal infections in patients receiving cancer therapy. Support Care Cancer 2010; 18: 985-992.
Dijkstra P U, Huisman P M, Roodenburg J L N. Criteria for trismus in head and neck oncology. Int J Oral Maxillofac Surg 2006; 35: 337-342.
MD Anderson Head and Neck Cancer Symptom Working Group. Dose-volume correlates of the prevalence of patient-reported trismus in long-term survivorship after oropharyngeal IMRT: A cross-sectional dosimetric analysis. Radiother Oncol 2020; 149: 142-149.
Lee R, Yeo S T, Rogers S N et al. Randomised feasibility study to compare the use of Therabite with wooden spatulas to relieve and prevent trismus in patients with cancer of the head and neck. Br J Oral Maxillofac Surg 2018; 56: 283-291.
Fedele S. PentoxIfylline and Tocopherol for the treatment of poST radiotherapy fibrOsis in Head and Neck Cancer Patients: a feasibility study (PIT-STOP). 2022.
Scott B, Butterworth C, Lowe D, Rogers S N. Factors associated with restricted mouth opening and its relationship to health-related quality of life in patients attending a Maxillofacial Oncology clinic. Oral Oncol 2008; 44: 430-438.
Hutcheson K A, Yuk M M, Holsinger F C, Gunn G B, Lewin J S. Late radiation-associated dysphagia with lower cranial neuropathy in long-term oropharyngeal cancer survivors: video case reports. Head Neck 2015; DOI: 10.1002/hed.23840.
Ciucci M, Jones C A, Malandraki G A, Hutcheson K A. Dysphagia Practice in 2035: Beyond Fluorography, Thickener, and Electrical Stimulation. Semin Speech Lang 2016; 37: 201-218.
Hutcheson K A, Barrow M P, Plowman E K et al. Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: A case series. Laryngoscope 2018; 128: 1044-1051.
Author information
Authors and Affiliations
Contributions
Justin W. G. Roe developed the concept for the paper and along with Sinead Rothrie. Eavan Fitzgerald and Grainne C. Brady contributed material to the manuscript with multiple rounds of comments and revisions, with Sinead Rothrie coordinating the process. Sinead Rothrie wrote the initial draft which was revised by Justin W. G. Roe, Eavan Fitzgerald and Grainne C. Brady. Sinead Rothrie coordinated the final versions for print publication.
Corresponding author
Ethics declarations
The authors declare no conflicts of interest.
Rights and permissions
About this article
Cite this article
Rothrie, ., Fitzgerald, E., Brady, G. et al. The role of the speech and language therapist in the rehabilitation of speech, swallowing, voice and trismus in people diagnosed with head and neck cancer. Br Dent J 233, 801–805 (2022). https://doi.org/10.1038/s41415-022-5145-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41415-022-5145-2