Head and Neck Cancer: Who can help?

by Jessica Moyer, MA, CCC-SLP

According to the American Cancer Society, head and neck cancer accounts for 4% of all cancers in the United States according to 2017 statistics.  Head and neck cancer includes cancers in the mouth, nose, sinuses, salivary glands, throat, and lymph nodes.  Although statistics show that the incidence of head and neck cancer is higher in men versus women and with people over 50 years of age, head and neck cancer can also occur in younger individuals.  Being aware of risk factors for head and neck cancer will allow individuals to make knowledgeable choices and live a more healthful lifestyle.  Risk factors that may increase chances of head and neck cancer diagnosis include:
• Tobacco use
• Frequent, heavy alcohol consumption
• Sun exposure
• HPV (human papillomavirus)
• Poor oral/dental hygiene
• Poor nutrition
• Marijuana use
• Weak immune system
• GERD/LPRD (Gastroesophageal reflux disease/Laryngopharyngeal reflux disease)
• Occupation exposure

Many healthcare professionals may participate in a patient’s care once they are diagnosed with head and neck cancer.  This team works together to discuss, plan, and implement pre, during, and post treatment plans for each individual.  Each professional is a crucial part of caring for a patient with head and neck cancer for positive outcomes and support following a difficult diagnosis.  This team may include:
• Head and Neck Surgeon
• Radiation Oncologist
• Hematology Oncologist
• Radiologist
• Otolaryngologist
• Pathologist
• Dentist
• SLP
• Nutritionist
• Nursing
• PT/OT
• Social Work

There are many treatment options available but the stage and site of the head and neck cancer impacts which treatment option is chosen.  Some treatment options include:
• Surgery (eg. Resections, laser, total laryngectomy)
• Radiation (XRT)
• Surgery followed by Radiation Therapy
• Chemotherapy and Radiation (CRT)

Dysphagia, or difficulty swallowing is a common result of head and neck cancer.  This may include the oral, pharyngeal, and/or the esophageal phases of the swallow.  Swallow function can be affected by chemotherapy and radiation with short term and/or long term effects.  Goals of the multidisciplinary treatment team include managing side effects of treatment, reduce or eliminate long term difficulty swallowing, and provide therapy before, during, and after treatment to prevent dysphagia.  A comprehensive dysphagia treatment plan conducted by a speech pathologist can assist with decreasing or preventing dysphagia.  This treatment plan may include:
• Establishing swallow baseline PRIOR to XRT
• Education (anatomy, physiology, dysphagia, aspiration)
• Establish and initiate a swallow exercise program prior to, during, and after CRT
• Establish oral hygiene program

While a speech pathologist is part of the treatment team initially, during, and after XRT and CRT, a patient’s swallow function should be evaluated not only at the beginning of treatment but re-evaluated throughout treatment process.  A speech pathologist can modify a patient’s diet for safety and to reduce risk of further medical problems.  After completion of CRT, it is important to continue education to patient and family members as well as maintain swallow safety; late effects of radiation are possible.  A maintenance program for long term continued function should be established.  When a proactive approach is utilized by the multidisciplinary treatment team, dysphagia can be minimized or prevented, increasing a patient’s quality of life by allowing patients to enjoy every aspect of eating.