In This Article

Abstract and Introduction

Abstract

Background: Dysphagia is a common symptom of head and neck cancer or sequelae of its management. Swallowing disorders related to head and neck cancer are often predictable, depending on the structures or treatment modality involved. Dysphagia can profoundly affect posttreatment recovery as it may contribute to aspiration pneumonia, dehydration, malnutrition, poor wound healing, and reduced tolerance to medical treatments.
Methods: The author reviewed the normal anatomy and physiology of swallowing and contrasted it with the commonly identified swallowing deficits related to head and neck cancer management. Evaluation methods and treatment strategies that can be used to successfully manage the physical and psychosocial effects of dysphagia are also reviewed.
Results: Evaluation of dysphagia by the speech pathologist can be achieved with instrumental and noninstrumental methods. Once accurate identification of the deficits is completed, a range of treatment strategies can be applied that may return patients to safe oral intake, improve nutritional status, and enhance quality of life.
Conclusions: To improve safety of oral intake, normalize nutritional status, reduce complications of cancer treatment and enhance quality of life, accurate identification of swallowing disorders and efficient management of dysphagia symptoms must be achieved in an interdisciplinary team environment.

Introduction

Dysphagia, derived from the Greek phagein, meaning "to eat," is a common symptom of head and neck cancer and can be an unfortunate sequelae of its treatment. Dysphagia is any disruption in the swallowing process during bolus transport from the oral cavity to the stomach. In head and neck cancer patients, dysphagia may be caused by surgical ablation of muscular, September/October 2002, Vol. 9, No. 5 Cancer Control 401 bony, cartilaginous, or nervous structures or may be attributable to the effects of antineoplastic agents including radiation and/or chemotherapy. The severity of the swallowing deficit is dependent on the size and location of the lesion, the degree and extent of surgical resection, the nature of reconstruction, or the side effects of medical treatments. Evaluation and treatment of swallowing disorders present unique challenges to the speech pathologist working with the head and neck cancer population. Successful management requires interdisciplinary collaboration, accurate diagnostic workup, effective therapeutic strategies, and consideration for unique patient characteristics.

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