The treatment of patients with cancer involves collaborations among many different healthcare disciplines. A patient with cancer might have several oncologists (with different specialties), a physical therapist, an occupational therapist, a mental health counselor, a pain management specialist, as well as a speech-language pathologist (often referred to as a speech therapist). Whether or not speech therapy is necessary for the treatment of a patient with cancer is dependent on the type of cancer they have, just like with any of the other disciplines.
In this article we will discuss:
Types of Cancer That Affect the Speech/Swallowing Mechanisms
Cancer that most commonly affects the speech and swallowing mechanisms is head and neck cancer. Head and neck cancer is typically a blanket term of sorts, to refer to cancer that affects the sinuses, nose, throat, and mouth (hence 'head and neck'). The cause, location, aggressiveness, and treatment for head and neck cancer vary, depending on the type of cancer that is present. Some of these might include:
Laryngeal Cancer: Cancer of the larynx (voice box).
Nasopharyngeal Cancer: Cancer of the nasopharynx.
Oropharyngeal Cancer: Cancer of the oropharynx.
Lip and Oral Cancer: Cancer of the lips and mouth.
Depending on the type of cancer and the treatment route the patient and physicians decide to take, speech therapy will be tailored to that specific situation. A few treatment options that typically result in speech therapy interventions are:
Surgery: This could involve the removal of cancer and sometimes the surrounding structures. For example, a laryngectomy might be performed to remove cancer, while also removing part or all of the larynx.
Radiation: This typically involves sending beams through the skin toward cancer. When this radiation reaches cancer, the hope is that it will destroy it. Radiation treatment may be done in partnership with surgery, or chemotherapy.
Chemotherapy: Chemotherapy is the introduction of a powerful drug to the body, with the intention that this drug will attack and kill cancer cells. There are several different types of chemotherapy drugs, and physicians will typically pick the type that is most effective against that particular type of cancer/is most beneficial to the patient.
Reduce the Impact of Cancer on Your Communication
Speech Therapy After Larynx Removal
A laryngectomy can involve either the partial or complete removal of the larynx. Without a larynx, the typical mode of producing voice is lost and an alternative method must be implemented. A speech therapist can assist the patient in learning these alternative methods and assist them in picking which one works best for them specifically. Such treatments might be provided through a hospital post-surgery or a private speech therapy facility post and mid-recovery.
Artificial Larynx (Electrolarynx): An artificial larynx, or electrolarynx is an outside device that can be utilized to help the patient produce voice. A common example is an electrolarynx that is placed against the throat (or somewhere similar, some individuals actually benefit from different placements) and utilizing the tongue and mouth to formulate/articulate speech. The electrolarynx becomes the source of the voice. A downside patients often express is that the voice can sound robotic, since the device is many times electronic. As mentioned above, a speech therapist can teach the patient how to utilize the electrolarynx correctly and provide 'practice' so the patient can feel more confident utilizing the device in their everyday life.
Tracheoesophageal Speech: Tracheoesophageal speech involves a small device that is inserted in an opening between the trachea and the esophagus. This device is known as a one-way valve. Air from the trachea can move through, but food cannot (otherwise the patient would aspirate). In order for the voice to be generated, the patient much bring air in through their stoma, which then travels through the one-way valve and causes vibration. This vibration acts as the voice.
Esophageal Speech: Similarly to tracheoesophageal speech, esophageal speech involves the use of inhaled air to create vibration against the esophagus that results in voice. However, esophageal speech does not require a device to be inserted. Instead, the patient inhales air into the upper esophagus and pushes it upward to cause a vibratory speech. Some individuals report that they are unable to utilize this method, even with practice, while others prefer it because it does not involve surgical intervention and also does not require the use of a device.
Speech Therapy Without Larynx Removal
Without the removal of the larynx or other structures (sometimes the tongue and other portions of the mouth are removed due to cancer as well), radiation and chemotherapy are much more likely to be utilized. Radiation and chemotherapy can also be utilized in addition to surgery, in order to prevent the cancer from returning or to destroy any remaining cancer that could not be removed with surgical intervention.
Radiation can often result in severe stiffness and swelling in the oral cavity, nasal cavity, throat, and head. Manual therapy might be utilized to assist in lessening this stiffness and to encourage the removal of swelling/fluid build up in these areas. In some cases, speech-language pathologists can be certified in these types of treatments.
Articulation exercises might also be utilized, as the results of the radiation might inhibit a patient's ability to accurately articulate certain speech sounds (this is especially if they have had their tongue or certain parts of their oral cavity removed). These exercises could focus on specific speech sounds that are particularly difficult, by teaching the patient new methods of creating said sounds, followed by repeated drills to make the new method habitual.
Swallowing Therapy for Patients with Cancer
Another area that can be affected by surgery or radiation is a patient's swallowing mechanisms. Swallowing therapy is a huge part of recovery. Unfortunately, in many cases the swallowing mechanisms are permanently altered, but speech therapy can assist in either the rehabilitation/restoration of swallowing or in learning new ways to cope with these changes.
Exercises are very important to rehabilitating the swallowing mechanisms. One might see this in radiation patients in particular, because as mentioned before, radiation can cause structural changes such as swelling and stiffness to the neck, head, and mouth (or anywhere that radiation is being applied). It is sometimes suggested that these exercises begin at the beginning of radiation treatment, as to preserve swallowing abilities. But they are also sometimes used to re-strengthen the muscles following radiation as well.
Depending on the patient, the speech therapist will choose the best swallowing exercises for that individual, as some swallowing exercises benefit some patients more than others. Some exercise examples include:
Effortful Swallow: A patient might be instructed to push down on a table or on their thighs and swallow. Pushing down assists the patient in squeezing their throat and tongue muscles, which helps to 'exercise' those muscles with the swallow.
Masako Exercise: The patient is typically instructed to put their tongue tip between their front teeth (gently) and to swallow. Sometimes, patients might be without their teeth, but the exercise can be just as beneficial placing the tongue between gums.
Mendelsohn Maneuver: A patient is asked to swallow, and when the notch or 'Adam's apple' is moved upward during their swallow, they are instructed to hold the swallow for 2-3 seconds before then completing the swallow.
These are just a few swallowing exercises a patient might be asked to do. Speech therapists may involve manual resistance with the use of their hand for some exercises to also help in the strengthening and rehabilitation of the swallowing muscles.
Cognitive Aspects of Speech Therapy and Cancer
Cognition is an aspect of speech therapy that people might not realize is within a therapist's scope of practice. A person's cognition can be affected by cancer in many different ways. Certain medications can cause issues with cognition as well as surgical procedures to remove cancer from places like the brain. Depending on the location of cancer, cognition can be affected. This might be in the form of difficulties with memory loss, emotional regulation, or problem-solving.
A speech therapist can assist in treating memory loss through a few different methods. This might involve creating memory books, writing out daily tasks with the patient that need to be completed such as what medication to take, or completing memory tasks to strengthen and exercise the memory system of the brain.
A speech therapist can also assist with emotional regulation. The brain is very complex, and often times anything that affects the brain can have an affect on a person's ability to control and regulate their emotions. A speech therapist can go through social scenarios with a patient, and discuss appropriate ways of reacting to specific social settings in a way that is socially acceptable.
And finally, a speech therapist might assist a patient in strengthening their problem-solving skills. Oftentimes, this is done through things like puzzles that are tailored specifically to the areas of difficulty. Some practical examples for everyday use could be to work on solving a map together, figuring out how much money can be spent at the store with what the patient might have in their pocket, and so on. This makes it more applicable to the patient's daily life.
How Speech Therapy Can Provide Emotional Support to Patients With Cancer
While a speech therapist is not a replacement for a mental health professional by any means, a speech therapist can help their clients navigate some of the emotions that might come with cancer's affect on their communication and swallowing. Not being able to communicate effectively and/or swallow can be a very isolating experience. One might feel left out of social situations and family gatherings, because they are unable to articulate their message. Group speech therapy also exists to help patients feel less alone in their experiences.
They may not be able to eat the same food their family or friends are eating, or may have to bring outside food to a restaurant or ask for food accommodations. Speech therapists can assist them in working through these feelings and even coming up with a plan to communicate their feelings to the people that they love or strangers. This might involve coming up with a script together or an alternative form of communication.
At Better Speech we know you deserve speech therapy that works. We have experts in your needs and assign the right therapist, not just the therapist that happens to be in your area. The impact cancer has on a person's communication can be difficult, but with the right support, you or your loved one can learn to lead a happy and successful life.
At Better Speech, we offer online speech therapy services convenient for you and tailored to your child's individual needs. Our services are affordable and effective - get Better Speech now.
Frequently Asked Questions
What is speech therapy for cancer patients?
Speech therapy is a form of treatment that helps cancer patients who have difficulties with communication or swallowing due to their cancer diagnosis and treatment.
What kind of speech problems can cancer patients experience?
What does a speech therapist do for cancer patients?
When should a cancer patient see a speech therapist?
How long does speech therapy treatment last for cancer patients?
About the Author
Denni Hickman
I am a speech-language pathologist with six years of academic experience and two years of workforce experience. I have completed a Bachelor of Science in Speech-Language Pathology and a Master of Science in Speech-Language Pathology, as well as a minor in English. I have worked with both children and adults in the school setting, private practice setting, as well as medical setting (hospital inpatient and outpatient).
I love speech-language pathology because it offers such a wide variety of experiences with so many different groups of people, with different backgrounds and ages. For fun I enjoy reading, writing, and spending time with my loved ones.
