Head and Neck cancers can involve a wide variety of sites, including the lips, oral cavity, pharynx, larynx, nasal cavity, paranasal sinuses, major salivary glands and thyroid glands. Tumours affecting these sites require multimodality treatment including surgery, radiotherapy and chemotherapy. Treatment-related side effects may leave the patient with psychological, physical and nutritional issues that can directly impact their treatment. Thus, a multidisciplinary team is paramount in a patient’s treatment process.
A pre-treatment assessment is done in order to develop an individualised care plan for the patient. Most patients scheduled for major head and neck surgery will be referred to the Allied Health Professionals (AHP) clinic. In this clinic, patients are assessed on their pre- and post-surgery needs. Our AHPs are introduced and speak to patients and their loved ones to adequately prepare and support them in their rehabilitation, nutritional and emotional needs.
1. Most of the patients scheduled for major head and neck surgery will be referred to the Allied Health Professional clinic for education on pre, during and post- surgery care & management and assessment by the group.
2. This will prepare the patient and their caregivers on pre & postsurgery rehabilitation, nutritional and psychosocial needs.
Speech and language therapists (SLTs) are allied health professionals who assess, treat, and manage communication and swallowing difficulties.
Head and neck cancers and their treatment can cause changes in a patient’s voice, speech and swallowing abilities.
Our SLTs help in the compensation and rehabilitation of these difficulties. They work closely in the multidisciplinary team, and are involved in a patient’s care from diagnosis through to supporting them back to work and life long after treatment is complete.
Before your treatment, the SLT will speak with you about your communication habits and needs. She will explain to you the possible changes in voice and speech that may occur during and after your treatment. If necessary, the SLT will work with you to establish an alternative method of communication in the time when you may find speaking difficult.
After your treatment, the SLT will work with you to improve the precision and clarity of your speech. Close collaboration with your surgeons and prosthodontists allow for customised rehabilitation.
If your surgery involves removal of your voice box, the SLT will work with you and your surgeon to find a method of rehabilitating your voice that is most suitable for you.
These methods may include:
The SLT can also work with you on using external communication aids, such as electronic tablets and communication charts to help you communicate.
Before your treatment, the SLT may assess the way you swallow, so as to identify and help you with any difficulties you may have. She will explain to you the changes in swallowing that may happen during and after your treatment.
The SLT will work with you to develop strategies to compensate for your swallowing difficulties, and exercises to rehabilitate your swallowing function.
These may include:
After surgery, you may need to undergo a videofluoroscopic swallow (VFS) study or a fibre-optic endoscopic evaluation of swallowing (FEES). A VFS is a video X-ray study that allows the SLT to review the oral and pharyngeal phases of swallowing. A FEES is where an SLT passes a small flexible endoscope through the nose to the throat to look at how the swallowing muscles move. In both studies, you will be given a range of food consistencies to try.
Malnutrition is highly prevalent in patients with cancer and it is well recognised that patients with head and neck cancer are among those at highest nutritional risk, even before treatment starts.
This is because symptoms associated with cancer e.g. ulceration/difficulty in swallowing can directly affect the patient’s intake. Malnutrition is found to be associated with increased risk for infections, decreased response to treatment and poorer quality of life.
Nutritional status can further be compromised when treatment starts due to their adverse effects. Common side effects of surgery include difficulty in swallowing or pain during swallowing, while those of radiotherapy and chemotherapy include difficulty in swallowing, mucositis, stomatitis, nausea, anorexia and altered taste sensation.
These adverse effects experienced by the patient lead to a reduction in nutritional intake, and thus causing unintentional weight loss and malnutrition.
Nutrition screening and assessment At the Head and Neck Centre, a quick and simple questionnaire that can be administered by the patient, nursing staff or doctor, is used to help identify patients at high risk of malnutrition before the surgery. These patients are then referred to the Dietitian for a detailed nutritional assessment and intervention.
Early nutrition interventionThe intervention includes medical nutrition therapy recommended by the Dietitian to help optimise the nutritional status and thus minimise the risk of malnutrition-related complications.
Individualised nutrition care plan may include food texture modification if there are chewing or swallowing difficulties, food choices, food fortification, use of oral nutritional supplements and devising tube feeding regimen.
Physiotherapists (PT) are professionals who provide services that develop, maintain and restore people’s maximum movement and functional ability. All patients who are seen by a PT will be assessed on the domains of fitness, respiratory health and functional limitation. The PT will then prescribe and guide patients through specific exercises to help them regain functional mobility and joint movement and maintenance of pulmonary hygiene.
During the early post-operative period, the assistance and guidance by the PT for patients post head and neck surgery is critical as they may experience pain, stiffness, swelling and weakness in the affected and surrounding areas.
Limitation in mobility may worsen after surgery due to immobility associated with the post-operative discomfort. PTs will gradually introduce patients and carers to various exercises to optimise posture, strengthen neck and shoulders muscles and prevent limb swelling.
Additionally, PTs can perform procedures and teach patients techniques to assist in clearing secretions.
Occupational Therapists (OT) are professionals who help to improve your ability to perform activities in your daily living and working environment to a desired level of functioning. They assess patients and carry out treatment interventions that help improve patient basic motor function and reasoning ability.
Activities of daily living such as eating, dressing and showering are incorporated into treatment interventions to maximize patient’s independence in self-care. OTs also advise on assistive devices and educate patients on compensatory techniques when there is impaired function e.g. blindness/loss of a limb.
Home visits and caregiver trainings are provided for patients and their caregivers who may require modifications to their home environment post-surgery. Assessments on physical and work demands would be conducted by OTs to facilitate early return to work and resumption of roles in the family.
The OT trained in the management of lymphoedema uses specialised massage techniques to manage swelling post-operatively or as a result of cancer treatment. Customised pressure garments are also provided to patients to manage swelling and/or scarring.
In SGH, the OTs conduct a weekly group therapy session to educate patients and their caregivers on the importance of exercises post-surgery, and to facilitate discussion on issues related to activities of daily living. It is also a channel for patients to overcome their fears through the support and sharing during the group session.
Our team of occupational therapists, with their skills and knowledge of health management, ensure that there is a high standard of service provision to people with diverse needs. We hope that the provision of these quality services would help our clients reduce the cost of injuries and disabilities and lead a better quality of life.
Head and Neck Cancers and its treatment bring extraordinary challenges for patients and their families. You and your family may experience significant emotional challenges from dealing with the shock of the diagnosis and the implications of treatment to an acceptance of the illness. Psychosocial and emotional support can ease the strain of a challenging illness and enhance coping during your cancer journey.
Clinical psychologists aim to enhance and promote well-being and manage emotional distress. They will work closely with you and your loved ones to help strengthen the way you cope and manage your illness concerns. Treatment effects from surgery, chemotherapy and radiotherapy often bring about concerns about body image, implication on lifestyle and other practical matters.
Our clinical psychologist will assist to develop an individualised plan to help you be more prepared for the upcoming treatment journey ahead and support you as you come to terms with the illness and the treatment required. You may speak to your doctor for a referral to our service.
Subscribe to our mailing list to get the updates to your inbox