Head and Neck Cancer

Single-Modality Oncology Therapy

surgery, radiation therapy, or chemotherapy

Combined Oncology Therapy

• combining treatments

• surgery + radiation (+/- chemo)

• radiation + chemo

What are acute effects of radiation therapy?

• xerostomia

• mucositis

• dysguesia

• odynophagia

• edema

• nausea

What are symptoms of radiation toxicities at 1-2 weeks?

mild symptoms

• taste changes

• changes in secretions

• pain with swallowing

• inflammation and ulcers of inner tissue (mucositis), begins at end of second week

• swelling

• redness of skin (erythema)

• fatigue

What are symptoms of radiation toxicities at 3-4 weeks?

high variability

• tissue irritation intensifies

• pain and swelling increase

• appetitie decreases

• meal intake decreases

• swallowing may become more difficult

What are symptoms of radiation toxicities at 5-7 weeks?

• increased mucositis and pain

• increased pain with swallowing

• increased difficulty swallowing (risk for aspiration)

• voice changes or loss of voice

• depression

Why is the prophylactic approach a favored pre-treatment option for HNC patients?

its effective at reducing dysphagia and related comorbidities in patients who have had chemoradiation

The ________ dysphagia therapy is initiated the better the expected outcomes for communication and swallowing

earlier

T/F: SLP involvement before, during, and after treatment directly influences long-term communication and swallowing outcomes

true

How can SLP assessment PRIOR to cancer treatment influence long-term outcomes for communication and swallowing?

Results of baseline function and MBS/FEES can help with:

• cancer treatment decision (laryngectomy vs chemoradiation)

• decisions about need for feeding tube (ie., PEG)

• radiation treatment: start preventative swallowing exercise program?

• laryngeal preservation treatment vs total laryngectomy? (trach = dysphagia)

How can SLP involvement POST-OP influence long-term outcomes for communication and swallowing?

can maximize swallowing function and PO intake by reducing risk for aspiration-related illness

How can SLP involvement DURING radiation therapy influence long-term outcomes for communication and swallowing?

implement swallowing exercises to preserve muscle mass, which decreases oxidative stress and inflammation

What makes clincal management of HNC patients differenct from other patient populations?

HNC involves abnormal anatomy, which means abnormal 'normal' function and sensation for swallowing

What is the ultimate goal in HNC swallowing management?

maximizing swallowing function and PO intake by reducing risk for aspiration-related illness, rather than the complete absence of aspiration

What do clinicians almost never recommend HNC patients? Why?

HNC patients should never be strictly NPO because…

• prolonged NPO status exacerbates swallow dysfunction

• patients are vulnerable to deconditioning and neuromuscular changes impacting swallow coordination and efficiency

How should clinicians approach aspiration in HNC patients?

• clinicians need to be okay with aspiration in HNC patients

• need to focus on risk reduction for illness rather than zero aspiration

Radiation-Associated Dysphagia (RAD)

• dysphagia from radiation therapy

• acute = <6 months

• chronic = > 6 months

• symptoms = fibrosis, atrophy, edema

Late Radiation-Associated Dysphagia (Late-RAD)

• dysphagia from radiation therapy after a longer period of normal functioning

• ≥ 5 years

• symptoms = fibrosis, atrophy, lower cranial neuropathy (X, XII)