Is Speech Language Pathologist Evaluation Necessary in the Non-Operative Treatment of Head and Neck Cancer?

Background

Dysphagia is a common sequelae of head and neck cancer (HNCA) and its treatment. While surgery is expected to result in predictable long-term alterations in swallowing function, the increased use of nonoperative treatment for organ preservation in recent years has led to a growing awareness of dysphagia associated with chemoradiation (CRT) secondary to radiation fibrosis and changes in innervation of the muscles of swallowing. Dysphagia can lead to poor nutrition/hydration, pulmonary complications, gastrostomy tube placement, and substandard quality of life. Evaluation and management of dysphagia is typically the purview of the speech-language pathologist (SLP). Despite the expertise of SLPs serving HNCA surgical patients, there continues to be some discord regarding the role and timing of speech-language pathology care in patients undergoing CRT. Historically, this lack of consensus was related to suboptimal evidence regarding the role of the SLP in nonsurgical care of the HNCA population; however, recent evidence provides a clearer direction for inclusion of this important care provider.

Best Practice

The best evidence strongly supports an active role for SLPs in the nonoperative management of HNCA patients that begins at the point of cancer diagnosis. Pretreatment instrumental swallowing assessments are indicated to identify silent dysphagia to optimize safe and efficient oral intake during treatment and to tailor interventional strategies. Based upon the available evidence, SLP evaluation and prophylactic swallowing intervention should be considered standard of care in the pretreatment setting for patients undergoing organ preservation treatment for HNCA to prevent dysphagia and optimize functional outcomes. Further, long-term follow-up appears appropriate given the potential for long-term sequelae following treatment. Read the full article in The Laryngoscope.