Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The disease itself and the treatment can have far reaching effects on speech and swallow function, which are consistently prioritised by survivors as an area of concern. This paper provides recommendations on the assessments and interventions for speech and swallow rehabilitation in this patient group. Recommendations • All multidisciplinary teams should have rehabilitation patient pathways covering all stages of the patient's journey including multidisciplinary and pre-treatment clinics. (G) • Clinicians treating head and neck cancer patients should consult the National Cancer Rehabilitation Pathway for head and neck cancers. (G) • All head and neck cancer patients should have a pre-treatment assessment of speech and swallowing. (G) • A programme of prophylactic exercises and the teaching of swallowing manoeuvres can reduce impairments, maintain function and enable a speedier recovery. (R) • Continued speech and language therapist input is important in maintaining voice and safe and effective swallow function following head and neck cancer treatment. (R) • Disease recurrence must be ruled out in the management of stricture and/or stenosis. (R) • Continuous radial expansion balloons offer a safe, effective dilation method with advantages over gum elastic bougies. (R) • Site, length and completeness of strictures as well as whether they are in the presence of the larynx or not, need to be assessed when establishing the likelihood of surgically improved outcome. (G) • Primary surgical voice restoration should be offered to all patients undergoing laryngectomy. (R) • Attention to surgical detail and long-term speech and language therapist input is required to optimise speech and swallowing after laryngectomy. (G) • Patients should commence wearing heat and moisture exchange devices as soon as possible after laryngectomy. (R).
Highlights
Most head and neck cancers and their treatments affect speech and swallowing and this section concentrates on the rehabilitation of these functions.[1,2,3,4,5,6] Allied health professional (AHP) head and neck cancer rehabilitation pathways are required as part of the implementation of the Improving Outlines Guidance rehabilitation measures and are required for peer review
Continued speech and language therapist input is important in maintaining voice and safe and effective swallow function following head and neck cancer treatment. (R)
Continued speech and language therapist input is important in maintaining voice and safe and effective swallow function following head and neck cancer treatment (R)
Summary
Most head and neck cancers and their treatments affect speech and swallowing and this section concentrates on the rehabilitation of these functions.[1,2,3,4,5,6] Allied health professional (AHP) head and neck cancer rehabilitation pathways are required as part of the implementation of the Improving Outlines Guidance rehabilitation measures and are required for peer review. A strict programme of prophylactic exercises and the teaching of swallowing manoeuvres can reduce specific impairments, maintain functions and enable a speedier recovery ensuring post-treatment rehabilitation is more successful.[8] For those undergoing surgery the teaching of swallow strategies beforehand can reduce risk and maximise function. All head and neck cancer patients should have a pretreatment assessment of speech and swallowing.[1,2,3,4,5,6] Baseline assessments should be undertaken by the speech and language therapist and appropriate interventions to maintain functions before treatment should be undertaken. Continued speech and language therapist input is important in maintaining voice and safe and effective swallow function following head and neck cancer treatment (R)
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