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

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.

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.