Clinical Care and Rehabilitation in Head and Neck Cancer

Malignancies involving structures of the head and neck frequently impact the most fundamental aspects of human existence, namely, those functions related to voice and speech production, eating, and swallowing. Abnormalities in voice production, and in some instances its complete loss, are common following treatment for laryngeal (voice box) cancer. Similarly, speech, eating, and swallowing may be dramatically disrupted in those where oral structures (e.g., the tongue, jaw, hard palate, pharynx, etc.) are surgically ablated to eliminate the cancer. Consequently, the range and degree of deficits that may be experienced secondary to the treatment of head and neck cancer (HNCa) are often substantial. This need is further reinforced by the Centers for Disease Control and Prevention who have estimated that the number of individuals who will be newly diagnosed with HNCa will now double every 10 years. This estimate becomes even more critical given that an increasing number of those who are newly diagnosed will be younger and will experience the possibility of long-term survival post-treatment. Contemporary rehabilitation efforts for those treated for HNCa increasingly demand that clinicians actively consider and address multiple issues. Beyond the obvious concerns specific to any type of cancer (i.e., the desire for curative treatment), clinical efforts that address physical, psychological, communicative, and social consequences secondary to HNCa treatment are essential components of all effective rehabilitation programs. Comprehensive HNCa rehabilitation ultimately seeks to restore multiple areas of functioning in the context of the disabling effects of treatment. In this regard, rehabilitation often focuses on restoration of function while reducing the impact of residual treatment-related deficits on the individual’s overall functioning, well-being, quality of life (QOL), and ultimately, optimize survivorship. Regardless of the treatment method(s) pursued for HNCa (e.g., surgery, radiotherapy, chemoradiation, or combined methods), additional problems beyond those associated with voice, speech, eating and swallowing frequently exist. For example, post-treatment changes in areas such as breathing, maintaining nutrition, limitations in physical capacity because surgical reconstruction such as deficits in shoulder functioning, concerns specific to cosmetic alterations and associated disfigurement, and deficits in body image are common. Those treated for HNCa also may experience significant pain, depression, stigma and subsequent social isolation. Concerns of this type have led clinicians and researchers to describe HNCa as the most emotionally traumatic form of cancer. It is, therefore, essential that clinicians charged with the care and rehabilitation of those treated for HNCa actively seek to identify, acknowledge, and systematically address a range of physical, psychological, social, and communication problems. Efforts that systematically consider this range of post-treatment sequelae are seen as critical to any effort directed toward enhanced rehabilitation outcomes. Actively and purposefully addressing post-treatment challenges may increase the likelihood of both short- and long-term rehabilitation success in this challenging clinical population. Current information suggests that successful clinical outcomes for those with HNCa are more likely to be realized when highly structured, yet flexible interdisciplinary programs of care are pursued. Yet contemporary educational resources that focus not only on management of voice, speech, eating, and swallowing disorders, but also address issues such as shoulder dysfunction due to neck dissection, the significant potential for cosmetic alterations can offer a much broader perspective on rehabilitation. Contemporary surgical treatment frequently involves reconstruction with extensive procedures that require donor sites that include both soft tissue from a variety of locations (e.g., forearm, thigh, etc.), as well as bone (e.g., the scapula). Collectively, resources that address these issues and many other concerns and the resultant social implications of HNCa and its treatment can serve to establish a comprehensive framework for clinical care. Consequently, providing a highly specialized and comprehensive educational resource specific to HNCa rehabilitation is currently needed. The proposed edited book is designed to address this void in a single authoritative resource that is also accessible to the clinical readership. Integral to this proposed book is information that guides clinical approaches to HNCa rehabilitation, in addition to offering emphasis on the direct impact of changes in voice, speech, and swallowing and the impact of such losses on outcomes. Finally, while several other published sources currently exist (see attached list), the emphasis of these books is directed either toward the identification and diagnosis of malignant disease, clinical and surgical pathology, associated efforts directed toward biomedical aspects of cancer and its treatment, or those with a focus on a single clinical problem or approach to rehabilitation. Therefore, the content of the proposed multi-chapter text centers on delivering a systematically structured, comprehensive, and clinically-oriented presentation on a range of topics that will provide readers at a variety of levels with a strong, well-integrated, and empirically driven foundation to optimize the clinical care of those with HNCa. The primary audience for this textbook is undergraduate and graduate-level students in Speech-Language Pathology, as well as practitioners, especially hospital-based practitioners, in Speech-Language Pathology; other key audiences include junior and senior level otolaryngology residents and fellows, translational researchers in head and neck cancer, related medical specialists (e.g., radiation oncology), oncology nurses, and potentially other rehabilitation professionals such as occupational therapists, counseling psychologists, social workers, and rehabilitation counselors. Front Matter ....Pages i-xxiv Front Matter ....Pages 1-1 General Principles of Head and Neck Cancer Treatment (Axel Sahovaler, David H. Yeh, Kevin Fung)....Pages 3-14 Surgical Reconstruction for Cancer of the Oral Cavity (David H. Yeh, Axel Sahovaler, John Yoo)....Pages 15-32 Complications Following Total Laryngectomy (Edward J. Damrose, Philip C. Doyle)....Pages 33-44 Human Papillomavirus-Related Head and Neck Cancer (Julie A. Theurer)....Pages 45-68 Distress as a Consequence of Head and Neck Cancer (Catherine C. Bornbaum, Philip C. Doyle)....Pages 69-84 Optimizing Clinical Management of Head and Neck Cancer (Barbara Pisano Messing, Elizabeth Celeste Ward, Cathy L. Lazarus)....Pages 85-100 Front Matter ....Pages 101-101 Postlaryngectomy Respiratory System and Speech Breathing (Todd Allen Bohnenkamp)....Pages 103-117 Clinical Intervention for Airway Improvement: Establishing a New Nose (W. J. Bryan Lewis)....Pages 119-128 Elements of Clinical Training with the Electrolarynx (Kathleen F. Nagle)....Pages 129-143 Teaching Esophageal Speech: A Process of Collaborative Instruction (Philip C. Doyle, Elizabeth A. Finchem)....Pages 145-161 Voice Restoration with the Tracheoesophageal Voice Prosthesis: The Current State of the Art (Donna J. Graville, Andrew D. Palmer, Rachel K. Bolognone)....Pages 163-187 Clinical Problem-Solving in Tracheoesophageal Puncture Voice Restoration (Jodi Knott)....Pages 189-207 Alaryngeal Speech Aerodynamics: Lower and Upper Airway Considerations (Jeff Searl)....Pages 209-230 Intelligibility in Postlaryngectomy Speech (Lindsay E. Sleeth, Philip C. Doyle)....Pages 231-246 Communication Support Before, During, and After Treatment for Head and Neck Cancer (Jana M. Childes, Andrew D. Palmer, Melanie B. Fried-Oken)....Pages 247-264 Speech Deficits Associated with Oral and Oropharyngeal Carcinomas (Gabriela Constantinescu, Jana M. Rieger)....Pages 265-279 Documenting Voice and Speech Outcomes in Alaryngeal Speakers (Philip C. Doyle)....Pages 281-297 Swallowing Disorders and Rehabilitation in Patients with Laryngeal Cancer (Heather M. Starmer)....Pages 299-312 Dysphagia Management of Head and Neck Cancer Patients: Oral Cavity and Oropharynx (Loni C. Arrese, Heidi Schieve)....Pages 313-328 Front Matter ....Pages 329-329 Acute and Long-Term Effects of Chemoradiation Therapy in Head and Neck Cancer (Ann Kearney, Patricia W. Cavanagh)....Pages 331-349 Oral Considerations for the Head and Neck Cancer Patient (Richard C. Cardoso, Mark S. Chambers)....Pages 351-375 Lymphedema in Head and Neck Cancer (Brad G. Smith)....Pages 377-396 Shoulder Dysfunction and Disability Secondary to Treatment for Head and Neck Cancer (Angelo Boulougouris, Philip C. Doyle)....Pages 397-411 Factors Influencing Adherence to Treatment for Head and Neck Cancer (Heather M. Starmer)....Pages 413-422 The Role of the Clinical Nurse Specialist in Head and Neck Oncology (Wendy Townsend)....Pages 423-432 The Acquisition of Practice Knowledge in Head and Neck Cancer Rehabilitation (Philip C. Doyle)....Pages 433-444 Well-Being and Quality of Life in Head and Neck Cancer (Philip C. Doyle, Chelsea MacDonald)....Pages 445-461 The Impact of Postlaryngectomy Audiovisual Changes on Verbal Communication (Paul M. Evitts)....Pages 463-481 Communicative Participation After Head and Neck Cancer (Tanya L. Eadie)....Pages 483-497 Back Matter ....Pages 499-513 This expansive text provides a comprehensive grounding in the contemporary rehabilitation, management, and clinical care of patients following treatment of head and neck cancer (HNCa). It provides the diagnostic and clinical information necessary to successfully manage patients with HNCa, and aids clinical health trainees and professionals in identifying, acknowledging, and addressing a wide range of problems that may occur post treatment, such as abnormalities in voice and speech production, eating, and swallowing. In addition, the book explores the physical, psychological, communicative, and social aspects that form essential components of cancer rehabilitation programs that seek to restore multiple areas of functioning which are disrupted secondary to treatment. Post-treatment changes in breathing, nutrition, physical capabilities, disfigurement, mood, and body image are also covered. Written by exerts is the fields of speech-language pathology, otolaryngology, and multidisciplinary care, Clinical Care and Rehabilitation in Head and Neck Cancer will be a valuable reference for students, residents and fellows, speech-language pathologists, oncology nurses, and other healthcare professionals dedicated to cancer rehabilitative care