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What is the impact of HNC treatments on swallowing function?

Barbara Messing, PhD, CCC-SLP, BCS-S, FASHA

July 17, 2023



HNC patients may present with mild to severe swallowing difficulties. What is the impact of HNC treatments on swallowing function?


Although HNC treatments target malignancies, they trigger a multitude of treatment-related toxicities that transiently or permanently alter anatomical structures and function essential for swallowing safety, oral intake, and quality of life. Treatments for HNC contribute to the disruption of critical functions, such as feeding, eating, and swallowing, resulting in life-altering changes and potentially death (Chera et al., 2014; Nguyen et al., 2005). Critical anatomical and physiological swallowing structures or dysphagia/aspiration-related structures (DARS) (Eisbruch et al., 2004) are at high risk of mucosal and structural damage from intensive treatment likely contributing to late and ongoing dysphagia and aspiration (Eisbruch et al., 2004). Surgery, radiation, and/or chemotherapy are selected with the intent to cure HNC. However, the tumor and treatment(s) disrupt normal function. Disuse quickly results in muscle atrophy from reduced muscle use, movement, and motion. Muscle atrophy results in reduced frequency of swallow, edema, and lymphedema (King et al., 2016). Muscle fibrosis, tissue scarring, anatomical changes from excision of structures, muscle atrophy from neuromuscular changes, cranial nerve denervation, stricture, trismus, xerostomia, and taste loss all increase the risk and severity of dysphagia and malnutrition post-treatment. Long-term effects of muscle atrophy from disuse result in tissue and muscle fiber changes resulting in fibrosis and functional abnormalities contributing to moderate or severe oropharyngeal dysphagia (King et al., 2016).

This Ask the Expert is an excerpt from the course, 20Q: Head and Neck Cancer for the Speech-Language Pathologist, by Barbara Messing, PhD CCC-SLP, BCS-S, FASHA.

barbara messing

Barbara Messing, PhD, CCC-SLP, BCS-S, FASHA

Barbara Pisano Messing, PhD, CCC-SLP, BCS-S, FASHA, is a medical speech pathologist with over 36 years of clinical and leadership experience. She is a Clinical Specialist in Head and Neck Rehabilitation and a Board-Certified Specialist in Swallowing and Swallowing Disorders. She has lectured nationally and internationally on dysphagia and published in peer-reviewed journals on managing patients with head and neck cancer and voice disorders. Her clinical and research interests are in the area of head and neck cancer rehabilitation, dysphagia, and voice disorders.

Related Courses

20Q: Head and Neck Cancer for the Speech-Language Pathologist
Presented by Barbara Messing, PhD, CCC-SLP, BCS-S, FASHA


Barbara Messing, PhD, CCC-SLP, BCS-S, FASHA
Course: #10591Level: Advanced1 Hour
  'The course presented information that was so very characteristic of what I experienced in working with HNC patients'   Read Reviews
Aspects of head and neck cancer (HNC) management relevant to the speech-language pathologist considering working with this population are described in this course. Specifically, HNC diagnosis and treatment, surgical and reconstructive options, communication and swallowing issues, treatment-related toxicities, and the impact on quality of life are addressed.

20Q: Beyond the Swallow - Tracheostomy Tube and Ventilator Management
Presented by George Barnes, MS, CCC-SLP


George Barnes, MS, CCC-SLP
Course: #10056Level: Intermediate1 Hour
  'Good, succinct information about trach/vent patients and the risks/benefits of intervention'   Read Reviews
This course addresses the various questions that may arise for the medical SLP involved in the care of patients with tracheostomy and/or mechanical ventilation. Topics include causes of respiratory failure, consequences of tracheostomy/ventilation, risk management related to intervention, and considerations for assessment and treatment of swallowing and communication, including the use of speaking valves.

20Q: Velo-Cardio-Facial Syndrome (VCFS)
Presented by Karen J. Golding-Kushner, PhD, CCC-SLP, ASHA Fellow


Karen J. Golding-Kushner, PhD, CCC-SLP, ASHA Fellow
Course: #8700Level: Intermediate1 Hour
  'I liked the information on the correct order to teach sounds and the impact of the anatomy'   Read Reviews
This course describes the characteristics of Velo-cardio-facial syndrome that are of the greatest relevance to SLPs: those that affect feeding, speech and language. Best practice for intervention is also explained.

20Q: Pediatric Voice Disorders: Diagnostic and Treatment Approaches
Presented by Susan Baker Brehm, PhD, CCC-SLP, Barbara (Derickson) Weinrich, PhD, CCC-SLP, Lisa Nelson Kelchner, PhD, CCC-SLP, BCS-S


Susan Baker Brehm, PhD, CCC-SLPBarbara (Derickson) Weinrich, PhD, CCC-SLPLisa Nelson Kelchner, PhD, CCC-SLP, BCS-S
Course: #8972Level: Introductory1 Hour
  'Easy to read'   Read Reviews
This course provides the practicing speech-language pathologist with information on special considerations in the treatment of children with voice disorders. The various causes of voice disorders are discussed as well as the treatment of specific types of disorders.

20Q: Becoming a Medical SLP: From NICUs to SNFs and Everything in Between
Presented by Kristie A. Spencer, PhD, CCC-SLP, Jacqueline Daniels, MA, CCC-SLP, Tamar Nir, MA, CCC-SLP


Kristie A. Spencer, PhD, CCC-SLPJacqueline Daniels, MA, CCC-SLPTamar Nir, MA, CCC-SLP
Course: #10005Level: Intermediate1 Hour
  'Good overview'   Read Reviews
This course provides an introduction to the career of a Medical Speech-Language Pathologist, including the wide range of possible employment settings, interdisciplinary colleagues, and clinical caseload considerations. It discusses the recommended initial foundational coursework and preparatory training for beginner to advanced certifications, and clinical specializations for current, practicing SLPs.

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