Swallowing, speech and voice impairments in head and neck cancer patients treated at a multidisciplinary integrated patient unit

Abstract

Background: Head and neck cancer (HNC) is amongst the 10 most common cancers worldwide and has a major effect on patients' quality of life. Given the complexity of this unique group of patients, a multidisciplinary team approach is preferable. Amongst the debilitating sequels of HNC and/or its treatment, swallowing, speech and voice impairments are prevalent and require the involvement of speech-language pathologists (SLPs). In 2018, an integrated patient unit (IPU) for HNC patients was established which includes healthcare professionals from diverse fields including SLPs.

Aims: To characterize the demographic and clinical profiles of HNC patients and assess SLP therapy efficacy in these patients with respect to swallowing, speech and voice functionality.

Methods & procedures: Demographic and clinical information was collected for the first 100 HNC patients referred to SLP evaluation in the IPU. In addition, different measures of swallowing, speech and voice functionality were taken pre- and post-SLP therapy to estimate if and how the therapy improved the patients' performance in these aspects.

Outcomes & results: Analysis revealed that 84%, 36.2% and 33% of the patients suffered from swallowing, speech and voice impairments, respectively. Treatment types (surgery and radiation, chemotherapy and radiation) and the prevalence of speech and voice impairments varied amongst tumour locations (larynx, oral cavity, pharynx), whilst swallowing impairments were highly prevalent across all tumour locations. Speech impairments were more common in patients treated with a combination of surgery and radiation. Comparison between pre- and post-SLP therapy-related measures revealed that swallowing, speech and voice functionality significantly improved following SLP therapy.

Conclusions & implications: The holistic, multidisciplinary approach in the IPU contrasts with the more segmented care typically provided in out-patient/community clinics, making SLP therapy within the IPU uniquely integrated and effective. The protocol established at the IPU provides a valuable framework for SLP assessment and therapy in HNC patients exhibiting swallowing, speech and voice impairments with the ultimate goal of improving their quality of life.

What this paper adds: What is already known on the subject Many HNC patients suffer from swallowing, speech and voice impairments which have a substantial impact on their quality of life. Nevertheless, many current clinical practices do not include SLPs as an integral part of the healthcare team. Moreover, there are no common guidelines for SLP therapy in this unique group of patients. What this paper adds to the existing knowledge In this study we provide a detailed demographic and clinical profile of a large cohort of HNC patients that were referred to SLP evaluation in a newly developed and designated IPU. We provide a comprehensive description of clinical interventions that were applied based on the location of the tumour and specific impairments related to it. Additionally, SLP therapy outcomes are described, showing a significant improvement in swallowing, speech and voice functionality. What are the potential or actual clinical implications of this work? Study results support the inclusion of an SLP in HNC patients' IPUs. The multidisciplinary healthcare approach enabled the provision of a tailored SLP therapy to the specific tumour types and impairments and proved efficient, resulting in favourable outcomes.

Keywords: head and neck cancer; multidisciplinary team; speech; speech‐language pathologist; swallowing; voice.