Lauren Meffen, MA, CCC-SLP, CLT
Dysphagia or swallowing difficulty is a common side effect following treatment of tumors located in the head and neck. The swallowing symptoms may have been present at diagnosis and then potentially worsened during chemotherapy and radiation treatment. These patients often feel overwhelmed and frustrated with their side effects following the completion of their treatment.
As clinicians, we work to improve the quality of life of our patients every day. There are times when our patients come to us not only for therapeutic guidance but also for hope. We work so closely with our patients, who have undergone head and neck cancer treatment, that they often become friends.
Side effects following head and neck cancer treatment include lymphedema, trismus, difficulty clearing the airway or aspirating food or liquids during swallowing, feeding tube placement, loss of taste, and dry mouth is (xerostomia). While the patient’s cancer is cured, the battle to return to routine continues.
At our clinic, we often receive patients at the time of their diagnosis. This is the highest level of evidence-based practice. We work closely with ear, nose, and throat (ENT) specialists, radiation oncologists, and oncologists to provide the highest level of multidisciplinary care.
One of my responsibilities is to educate my patients, but often, I learn as much from them as they do from me. One patient shares his story with us. Dwight, a chef, is 19 months recovering from combined chemotherapy and radiation therapy for the tumor staged as T4N2cMO SCCA originating at the right base of the tongue with neck lymph node involvement. A feeding tube was necessary towards the end of Dwight’s definitive radiation and chemotherapy treatment to help him sustain his nutrition and hydration… The tube was placed once he could no longer meet his caloric needs by mouth due to the pain he experienced with swallowing during treatment.
Over the two years post-treatment, Dwight has undergone a series of treatments to decrease his feeding tube dependency and improve his swallowing abilities. He continues to be followed by his team of speech pathologists, ENT, radiation oncologist, oncologist and gastroenterologist. He developed side effects post-treatment that included pharyngoesophageal dysphagia. He required the aid of speech therapists and the help of GI physicians for dilation of the esophagus. Dwight completed several swallowing studies, including modified barium swallow and fiber endoscopic swallowing. During speech therapy sessions, we worked on a series of exercises to improve airway clearance of aspirated food and liquids. His therapy included respiratory muscle strength training (EMST150) for a supraglottic strategy when needed and exercises to strengthen pharyngeal clearance of food with each swallow. These tools were compensatory (working with his current state of muscles) and rehabilitative (restoring the loss of muscle mass). There was medical intervention for esophageal dilations once the food passed through the pharynx.
His perseverance was evident, “This will get you down and make you want to give up. If I can help someone understand, going to therapy and coming here helps, I want to. This is hard stuff. But things can get better.”
A person who loves the art of food and flavors, Dwight shared the side effects of dysgeusia (losing the loss of taste), one of the most challenging. “Foods just don’t taste the same. But I don’t want this tube forever”. A low point was when he relied on 7 cans of tube feedings a day for his nutrition and could only take tiny sips of water by mouth. During Dwight’s treatment, he never stopped swallowing when the pain was high. He continued to try to sip and eat ice chips and water…
Every day we wake up with the choice as clinicians and as patients. As clinicians, we can choose the highest level of evidence-based practice we can use for our patients. This includes respiratory muscle strength training. Our patients choose to attend therapy, complete the home exercises, and trust us for guidance with improving their quality of life.
Dwight continues his home exercise regimen and recommended exercises, including EMST150 training. Today, he is eating soft, moist chewable foods and drinking thin liquids for pleasure while remaining free of any adverse pulmonary infections.
About the Author
Lauren Meffen is a speech-language pathologist specializing in voice and swallowing disorders. She has remained local to Gainesville running her own practice, after receiving her schooling with Bachelors’s and Masters’s degrees from the University of Florida. Although Lauren has worked in various settings, including hospitals, skilled nursing, home health, her passion is working in the outpatient setting. In the outpatient setting Lauren offers high level of individualized, quality care for each patient and their family.
Over the years, Lauren has developed a love and specialization in working with the oncology population. She has advanced training in managing lymphedema of the head and neck, muscle tension dysphonia, and myofascial release techniques. Lauren is the owner of Wildflower Voice and Swallow Therapy in Gainesville, Florida, where she champions a comprehensive approach toward treating the whole patient with a skilled, multi-disciplinary team.
References:
Katherine A. Hutcheson, Martha P. Barrow, Emily K. Plowman, Stephen Y. Lai, Clifton David Fuller, Denise A. Barringer, George Eapen, Yiqun Wang, Rachel Hubbard, Sarah K. Jimenez, Leila G. Little, Jan S. Lewin. (22 August 2017). Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: A case series. Laryngoscope, 128:1044–1051, 2018. https://doi.org/10.1002/lary.26845
M Louise Kent 1, Michael T Brennan, Jenene L Noll, Philip C Fox, Stuart H Burri, Jane C Hunter, Peter B Lockhart. (2007 Oct 27) Radiation-induced trismus in head and neck cancer patients. 16(3):305-9. doi: 10.1007/s00520-007-0345-5.Epub
Brad G. Smith, MS*, Katherine A. Hutcheson, PhD*, Leila G. Little, MS. (November 14, 2011). Lymphedema Outcomes in Patients with Head and Neck Cancer. https://doi.org/10.1177/0194599814558402
Brad G. Smith, M.S., CCC-SLP and Jan S. Lewin, Ph.D. (June 2010). The Role of Lymphedema Management in Head and Neck Cancer. Otolaryngology Head Neck Surgery. 18(3): 153–158.