HEAD AND NECK CANCER REHABILITATION
Patients who have undergone head and neck surgery may often develop speech and/or swallowing difficulties. At our speech and swallow clinic, we believe in preventative treatment. For many people, eating and communication are important for quality of life and we are here to help you maintain your quality of life after cancer treatment.
Research has shown that patients who start therapy for speech and swallowing early exhibited significantly better function of speech, voice and swallowing. Our speech and swallowing muscles may become weak and stiff after treatment.
Patients treated surgically can begin speech and swallowing therapy when the suture lines are healed. Those receiving radiotherapy should begin rehabilitation prior to the treatment. Strong evidence showed that speech and swallowing exercises need to be done throughout and after radiation to get the maximum benefit. Fibrosis (restrictive scar tissue) can happen several years after radiotherapy and patients might develop swallowing difficulties years after their treatment has been completed. Therefore, it is crucial to do exercises to prevent formation of restrictive scar tissue.
Recent research has shown that patients who continue to eat and do swallowing exercises have a 93% chance of returning to a normal diet after radiation. In comparison, if you don’t do either, you only have a 60% chance of returning to a normal diet. So what you do during treatment has a big impact on your outcomes. The speech pathologist is your partner to help you through this.
Speech and swallowing changes:
Weakness and stiffness in the lip, tongue, jaw and pharyngeal muscles can cause:
- Reduced clarity of speech
- Hyper nasal speech
- Difficulty chewing food
- Fluids coming out from the nose when swallowing
- Pain when swallowing
- Choking or coughing when eating or drinking
- Feeling food ‘stuck’ in pharynx, needing to swallow many times
- Food and fluids entering the lungs (aspiration), causing aspiration pneumonia
What is involved in the rehabilitation programme
1) Pre-treatment counselling – to inform the patient and family of the possible speech and swallowing changes during and after treatment.
2) Safe eating and drinking – it is important to keep the swallowing muscles active by continuing to eat and drink. We will help to ensure the safety of your swallowing and reduce the risk of food/drink entering the lungs. This can be done by modifying diet and fluids consistencies and following safe feeding techniques recommended by the therapist.
3) Range of motion (ROM) exercises – Both speech and swallowing functions require good range of motion of the oral, pharyngeal, and laryngeal structures. Clearly, to prevent formation of restrictive scar tissue, it is particularly critical to begin ROM exercises in the early postoperative period (for surgery patients) and before treatment (for chemo radiation therapy patients).
3) Strengthening exercises – resistance exercise to improve strength of oral and pharyngeal muscles which will help with strength of chewing and swallowing.
Patients should be encouraged to perform their exercises every day; however, as radiotherapy progresses, most patients will feel that they do not have the energy to practice. The pain associated with mucositis might also impact a patient’s desire to eat and drink. Although this reluctance is understandable, the speech therapist will continue to encourage the patient to practice as much as they can during the course of treatment in order to reduce the severity of post treatment speech and swallow disorders. Patients' cooperation in the rehabilitation process is critical to their successful rehabilitation.