Kandelshine-Waldman Osnat, Levy-Kardash Omer, Hamburger Anat, Alon Eran, Henkin Yael
Hearing, Speech & Language Center, Sheba Medical Center, Tel Hashomer, Israel.
Department of Communication Disorders, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv, Israel.
Int J Lang Commun Disord. 2025 Jan-Feb;60(1):e13145. doi: 10.1111/1460-6984.13145.
Head and neck cancer (HNC) is amongst the 10 most common cancers worldwide and has a major effect on patients' quality of life. Given the complexity of this unique group of patients, a multidisciplinary team approach is preferable. Amongst the debilitating sequels of HNC and/or its treatment, swallowing, speech and voice impairments are prevalent and require the involvement of speech-language pathologists (SLPs). In 2018, an integrated patient unit (IPU) for HNC patients was established which includes healthcare professionals from diverse fields including SLPs.
To characterize the demographic and clinical profiles of HNC patients and assess SLP therapy efficacy in these patients with respect to swallowing, speech and voice functionality.
METHODS & PROCEDURES: Demographic and clinical information was collected for the first 100 HNC patients referred to SLP evaluation in the IPU. In addition, different measures of swallowing, speech and voice functionality were taken pre- and post-SLP therapy to estimate if and how the therapy improved the patients' performance in these aspects.
OUTCOMES & RESULTS: Analysis revealed that 84%, 36.2% and 33% of the patients suffered from swallowing, speech and voice impairments, respectively. Treatment types (surgery and radiation, chemotherapy and radiation) and the prevalence of speech and voice impairments varied amongst tumour locations (larynx, oral cavity, pharynx), whilst swallowing impairments were highly prevalent across all tumour locations. Speech impairments were more common in patients treated with a combination of surgery and radiation. Comparison between pre- and post-SLP therapy-related measures revealed that swallowing, speech and voice functionality significantly improved following SLP therapy.
CONCLUSIONS & IMPLICATIONS: The holistic, multidisciplinary approach in the IPU contrasts with the more segmented care typically provided in out-patient/community clinics, making SLP therapy within the IPU uniquely integrated and effective. The protocol established at the IPU provides a valuable framework for SLP assessment and therapy in HNC patients exhibiting swallowing, speech and voice impairments with the ultimate goal of improving their quality of life.
What is already known on the subject Many HNC patients suffer from swallowing, speech and voice impairments which have a substantial impact on their quality of life. Nevertheless, many current clinical practices do not include SLPs as an integral part of the healthcare team. Moreover, there are no common guidelines for SLP therapy in this unique group of patients. What this paper adds to the existing knowledge In this study we provide a detailed demographic and clinical profile of a large cohort of HNC patients that were referred to SLP evaluation in a newly developed and designated IPU. We provide a comprehensive description of clinical interventions that were applied based on the location of the tumour and specific impairments related to it. Additionally, SLP therapy outcomes are described, showing a significant improvement in swallowing, speech and voice functionality. What are the potential or actual clinical implications of this work? Study results support the inclusion of an SLP in HNC patients' IPUs. The multidisciplinary healthcare approach enabled the provision of a tailored SLP therapy to the specific tumour types and impairments and proved efficient, resulting in favourable outcomes.
头颈癌（HNC）是全球十大常见癌症之一，对患者的生活质量有重大影响。鉴于这类特殊患者群体情况复杂，多学科团队协作的治疗方法更为可取。在头颈癌及其治疗带来的诸多使人衰弱的后遗症中，吞咽、言语和嗓音障碍很常见，需要言语治疗师（SLP）参与。2018年，为头颈癌患者设立了一个综合诊疗单元（IPU），其中包括来自包括言语治疗师在内的不同领域的医疗专业人员。
描述头颈癌患者的人口统计学和临床特征，并评估言语治疗师对这些患者在吞咽、言语和嗓音功能方面的治疗效果。
收集了综合诊疗单元中首批100名接受言语治疗师评估的头颈癌患者的人口统计学和临床信息。此外，在言语治疗师治疗前后，对头颈癌患者的吞咽、言语和嗓音功能进行了不同指标的测量，以评估治疗是否以及如何改善了患者在这些方面的表现。
分析显示，分别有84%、36.2%和33%的患者存在吞咽障碍、言语障碍和嗓音障碍。治疗类型（手术和放疗、化疗和放疗）以及言语和嗓音障碍的患病率在不同肿瘤部位（喉、口腔、咽）有所不同，而吞咽障碍在所有肿瘤部位都非常普遍。言语障碍在接受手术和放疗联合治疗的患者中更为常见。言语治疗师治疗前后相关指标的比较显示，言语治疗师治疗后，吞咽、言语和嗓音功能有显著改善。
综合诊疗单元采用的整体、多学科方法与门诊/社区诊所通常提供的更分散的护理形成对比，使综合诊疗单元内的言语治疗师治疗具有独特的综合性和有效性。综合诊疗单元制定的方案为患有吞咽、言语和嗓音障碍的头颈癌患者的言语治疗师评估和治疗提供了一个有价值的框架，最终目标是改善他们的生活质量。
关于该主题已知的信息 许多头颈癌患者存在吞咽、言语和嗓音障碍，这对他们的生活质量有重大影响。然而，目前许多临床实践并未将言语治疗师纳入医疗团队的组成部分。此外，对于这类特殊患者群体，尚无言语治疗师治疗的通用指南。本文对现有知识的补充 在本研究中，我们提供了一大群被转介到新设立的指定综合诊疗单元进行言语治疗师评估的头颈癌患者的详细人口统计学和临床特征。我们基于肿瘤位置及其相关的特定障碍，全面描述了所采用的临床干预措施。此外，还描述了言语治疗师的治疗结果，显示吞咽、言语和嗓音功能有显著改善。这项工作的潜在或实际临床意义是什么？研究结果支持在头颈癌患者的综合诊疗单元中纳入言语治疗师。多学科医疗方法能够针对特定肿瘤类型和障碍提供量身定制的言语治疗师治疗，并被证明是有效的，从而产生了良好的治疗效果。
