How to Deal With Speech and Eating Problems After Head and Neck Cancer
Head and neck cancer and its treatments can present challenges for those diagnosed, including problems with talking and eating. HealthCentral spoke with Head and Neck Cancer Alliance board member and speech-language pathologist Meryl Kaufman about how to manage these effects. Read on for helpful information from Kaufman, who also founded the Georgia Speech and Swallowing, LLC, in Atlanta. The more you know, the easier it will be for you to lead your normal lifestyle after treatment.
Even the warning signs can affect eating and speech
Head and neck cancer is a category of cancers that includes those that arise in the nasal cavity, sinuses, lips, mouth, thyroid gland, salivary glands, throat, or larynx (voice box). Changes in speech or swallowing are themselves warning signs, Kaufman says. Maybe it's a lump in your throat or neck, or a change in voice that doesn't subside in two weeks. Pain when swallowing, ear pain, and tightness in the jaw can also signal cancer, among other warning signs.
Help is available for speech and eating problems
Your therapy will be delivered by a speech-language pathologist (therapist), like Kaufman. "Ideally, we consult with a patient before any treatment starts so we can establish a baseline function and determine the extent of deficits at diagnosis," she says. "We then counsel you on what to expect from your treatment, and provide tips and strategies for mitigating side effects now and later. Our primary goal is to preserve the best quality of life and swallowing function for you while beating this cancer."
Head and neck cancer treatment options
Treatments may include surgery to remove cancerous tissue, or non-surgical options, including radiation or radiation with chemotherapy. Sometimes all three options are used. Targeted immunotherapy is the newest treatment under investigation for head and neck cancer. Treatment depends upon size, location, and stage, along with your age and health. Each treatment comes with its own complications — some of which can lead to swallowing problems (called dysphagia) and speech problems.
Complications vary with treatment type
Different treatments can cause swallowing and speech problems in different ways. For example, surgery can cause changes in the anatomy of the mouth and/or throat that can make chewing and swallowing food and liquids difficult. With radiation, your anatomy may remain intact but the function of the mouth and throat can be affected by loss of saliva, changes in taste, or stiffening of tissue. Chemotherapy doesn't affect swallowing directly but may alter appetite, resulting in weight loss.
How surgery can affect your speech and eating abilities
Surgery may alter the way you chew, swallow or talk. For example, if all or part of your larynx or voice box was removed, you may retain some speech or you may lose your natural voice completely, and will work with a speech-language therapist to learn to speak again — possibly in a new way. In the case of laryngectomy surgery (removal of the voice box), you may do this after another procedure called trachea-esophageal puncture, or if you use an electrolarynx or esophageal speech.
Strategies to reduce complications from surgery
Surgery to your tongue, jaw, or palate may also affect your speech and swallowing, and the speech pathologist can help you with strategies to overcome those deficits as well. As your treatment team will tell you, this important work also helps maintain your quality of life by making sure you also get good nutrition, and helps keep any potential issues at bay, including being dehydrated or having to use a feeding tube.
Treatments for dry mouth
Radiation that affects the salivary glands can cause dry mouth (called xerostomia). You may have "tacky" saliva, an ongoing need to drink, challenges eating and speaking, and a decline in oral and dental health. Dry mouth increases your risk of cavities, requiring proactive oral hygiene at home, regular dental exams, and possibly, fluoride treatments. You may be able to use saliva substitutes in the form of gels, sprays or rinses or the prescription, Salagen. Try sugar-free lozenges or gum.
Treatments for swallowing problems
Swallowing therapy can include swallowing evaluations with video x-rays of swallowing or endoscopic swallowing exams, swallowing exercises, and discussions about what to eat to avoid aspiration (breathing or swallowing food or liquid into your lungs).
Treatments for sense of taste problems
If your sense of taste has changed, talk to your team about changes you can make in your diet to heighten your enjoyment when eating and improve your swallowing function during meals. Good nutrition helps you maintain your weight, Kaufman says.
Treatments for lockjaw
Lockjaw, or trismus, is a condition that occurs in up to one-third of head and neck cancer patients, when muscles used for chewing get stiff, making it difficult to open your mouth. "Research shows you should be proactive and start therapy when you start treatment," Kaufman says. "You'll do stretching, swallowing, and strengthening movements. They work better if you don't already have jaw stiffness." Studies show trismus can exacerbate dental problems and dry mouth.
You have choices
It's important to understand all of your treatment and rehabilitation choices, says Kaufman. "You may choose to attend a survivor support program, to meet patients who've undergone the same procedure as you. Try to form realistic expectations and create a support network. Communicate your preferences with your treatment team and be sure to follow therapy instructions and show up for appointments to maximize your best outcome."