Key takeaways
- Cancer that develops in an area of the head and neck, including the tongue or throat, is known as ‘head and neck cancer’
- Individuals with head and neck cancer are likely to have surgery, chemotherapy, radiotherapy or a combination of treatments
- Treatment for head and neck cancer typically impacts swallowing, speech and communication; the impact for everyone will be different
- A speech and language therapist supports people with head and neck cancer from diagnosis to after treatment, to reach their long-term goals
Different types of cancer can have an impact on speech and communication. For example, brain cancer and its treatment can affect cognition, which can then impact speech and swallowing, while advanced breast cancer that has spread into the chest area can affect the nerve that controls the voice box and swallowing. However, the most common cancer affecting speech and communication is head and neck cancer.
Someone with head and neck cancer might have surgery, chemotherapy or radiotherapy, or a combination of these. It’s likely that they will work with a speech and language therapist, as well as other professionals, as part of their cancer care pathway. In this article, Perci speech and language therapist Samantha Holmes, explains what to expect if you, or someone you are caring for, has head and neck cancer and needs this kind of support.
What is head and neck cancer?
Head and neck cancer is a term covering cancer of more than 30 areas within the head and neck. These include the tongue, lips, gums, tonsils, lining of the mouth and the throat. More than twice as many men get head and neck cancers as women; it is the fifth most common cancer type for men and the tenth for women. You are at a greater risk for head and neck cancer if you smoke and drink alcohol. Infection with human papillomavirus (HPV) also increases the risk of head and neck cancer.
Working with a speech and language therapist after head and neck cancer
Samantha Holmes, Speech and Language Therapist, Perci Health
With head and neck cancer, and the surgery, chemotherapy and radiotherapy used to treat it, there is always going to be some degree of impact on speech and swallowing. The extent of this impact varies and can affect people in different ways. Some will experience a minor change in the way their speech sounds or might need to eat slightly softer foods, while others will experience more significant changes in the way that they eat, drink and communicate.
I work with people from the point of their cancer diagnosis, where my role is to help them understand how their treatment will affect their speech and swallowing function. Depending on their needs, my input will then continue throughout a person’s treatment and rehabilitation.
Recovery and rehabilitation after surgery
When surgery is being discussed, the focus is often on the removal of the cancer. A speech and language therapist will be able to discuss in detail what that person’s life will look like after they have had surgery. Whether the cancer being removed is relatively small or a person is having a total glossectomy (tongue removal) and reconstruction, there are some profound questions to consider: What is important to that person? Will they be able to go back to work or use the phone? Will they ever be able to swallow again, or will they always need a feeding tube? Are they going to be able to eat their favourite foods or make a speech at their child’s wedding?
It’s really important for the person to know what they are consenting to and what their life and work is going to look like after treatment, so I try to answer these questions in as much detail as a person needs. Before surgery, another important part of my role is to understand whether there are any existing problems with speech or swallowing that may impact upon the person’s recovery.
After surgery, I will be there to support the person on the ward, and our rehabilitation work starts as soon as the doctors are happy with the healing of the surgical area. My role is to ensure the person has a way to communicate their needs, and to reintroduce swallowing food and drink, when they are ready. Generally, the larger the cancer or the more extensive the treatment, the greater the impact is going to be on speech and swallowing. However everyone is an individual and people respond very differently to changes in function. Some people will experience little distress, while others will understandably be very distressed, and need more support and rehabilitation.
Generally, the larger the cancer or the more extensive the treatment, the greater the impact is going to be on speech and swallowing, but people also respond very differently to changes in function.
Samantha Holmes, Speech and Language Therapist
We work with people on goals that are meaningful to them, and the aim is to restore as much function as possible. If someone is having further treatment after surgery, such as radiotherapy, this affects how much rehabilitation can happen before the next treatment starts.
There is generally a window of 12–18 months after treatment where someone will see the most progress in their rehabilitation. So we will be working really hard within this timeframe, perhaps on specific exercises to strengthen parts of the swallow, speech exercises to make certain sounds clearer or ways to help their friends and family understand what they are saying.
Recovery and rehabilitation after radiotherapy and chemotherapy
Radiotherapy treatment affects both healthy and cancerous tissue. If someone has chemotherapy as well as radiotherapy, this will increase the impact of radiotherapy on their body. Side-effects become more noticeable as the treatment goes on. The short-term side-effects usually peak at around two weeks after the end of radiotherapy but there are also long-term effects.
The short-term effects of radiotherapy include a painful inflamed lining of the mouth and throat, a loss or change in taste, and a loss of saliva, which usually acts to help move food from the mouth to the stomach when swallowing. These side-effects can interfere with a person’s ability to eat and enjoy food while they are having treatment.
During treatment, a speech therapist and dietitian will usually work together with the person to help them continue eating for as long as it is safe and comfortable to do so and, where necessary, consider other options such as tube-feeding. Alongside other members of the team, they will suggest ways to cope with the acute symptoms of radiotherapy, such as changing the texture of food, or different types of mouthwash and pain relief options.
The speech therapist will assess the person’s swallowing because food or fluid going down the wrong way can lead to illness. They will also provide exercises for the jaw muscles, tongue and soft palate, aimed at keeping the muscles of speech and swallowing moving, even if the person is unable to eat and drink by mouth for a period of time.
The long-term effects of radiotherapy include stiffening of the tissues that have been treated. This can affect speech and swallowing for years after treatment has ended. As with all muscles, if you don’t use it, you lose it. We know from research that the longer-term impact of radiotherapy on the muscles of speech and swallowing is reduced if a person is able to keep using those muscles during treatment.
What does long-term recovery look like?
Long-term, my work with a person is about supporting them to achieve their goals around speech and swallowing, but also helping them balance these goals against realistic expectations of the function they are going to be able to get back.
As time goes on and someone moves towards longer-term recovery, their goals often become more focused on their everyday life. Are they able to go back to work? Might they need a phased return? Will they need ongoing speech therapy to be able to use the telephone? What support might they need at home? Is there a certain type of food they want to work towards being able to eat? My support is available as long as that person has goals to work on.
Head and neck cancer, as well as its treatment and impact, can have a real impact on quality of life – not just for the person going through it, but for those caring for them. Our Cancer Nurse Specialists listen, provide guidance and coping strategies, and can point you to resources that can help. They also connect individuals with other Perci professionals, including speech and language therapists and dietitians, who are trained to support recovery and rehabilitation.
While we have ensured that every article is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns, please talk to one of our healthcare professionals or your primary healthcare team.
References
‘Head and neck cancer’, World Cancer Research Fund, accessed October 2023, https://www.wcrf-uk.org/cancer-types/head-and-neck-cancer/
Maggie A Kuhn et al., ‘Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients’, PubMed, April 2023, https://pubmed.ncbi.nlm.nih.gov/36965195/