The Swallows Australian Edition Magazine

Swallowing and
Speaking Problems
- Pauline Dooley
Swallowing Problems
You may have trouble with eating and drinking
during or after your cancer treatment. Difficulty
with swallowing (dysphagia) will depend
primarily on the location of your cancer and
your treatment regime including surgery,
radiation and chemotherapy. A rehabilitation
team including speech pathologists, doctors,
nurses, dieticians, and physiotherapists will
help you throughout your treatment, aiming to
create minimal changes to your daily routine
and lifestyle.
At the time of your surgery a tracheostomy
tube may be inserted in your neck to assist
your breathing. In the main this is a temporary
procedure but impacts on the normal
swallowing pattern. The presence of a
tracheostomy tube may irritate your throat and
cause coughing and discomfort, so the aim is
to have the tube removed as soon as you can
manage.
To assist your mouth or throat to heal nutrition
may be given via a NG (nasogastric) tube
through the nose. Should you need alternative
feeding the surgeon may discuss the option of
having a PEG (gastrostomy) tube inserted in
your stomach. These alternate methods of
nutrition take the pressure from eating but do
not mean you will be unable to eat and drink
normally before going home or in the future.
You may be able to drink fluids from day 1,
others require several weeks for mouth and
throat swelling to settle. Surgery can impact on
the muscles of swallowing, create discomfort
or dryness in the throat and be helped by
medication or advice. Protection of your airway
when eating and drinking is a priority. You may
be given techniques to prevent any aspiration
or need to modify the consistency of food,
including vitamised (pureed) foods or
thickened drinks.
Radiation treatment may lead to specific
swallowing difficulties especially dry mouth,
reduced chewing ability and food being
caught in your throat when swallowing. The
speech pathologist will work with the dietician
to ensure you have a manageable consistency
of foods with good nutrition during and after
radiation. Moist, soft foods may be advised.
Exercises for the muscles of the mouth, jaw
and throat may be given to reduce the time
taken to eat and drink, and to protect your
lungs and avoid chest infections. Advice for
oral care to keep your mouth clean will be
given. It is essential to continue these when
home. In general, difficulty with eating and
drinking increases in the later stages of
treatment.
A MBS (modified barium swallow) test may be
advised to identify any swallowing problem. No
anaesthetic or fasting is required. You will
swallow food/drink containing a small amount
of radio-active dye of barium. This locates any
swallow difficulty arising from the mouth, throat
or particularly any spillage into the larynx
(aspiration) on or after swallowing. Modifying
the consistency of food may be advised from
the results.
Speech Difficulty
Speech difficulties may result from surgery or
radiotherapy to the muscles of the mouth
(oropharynx) especially the tongue, and the
voice box (larynx). Your speech pathologist will
assist with methods of improving functional
communication either by exercises to the
muscles of speech or, in the case of surgery to
remove vocal folds (a laryngectomy), trialling
options of alternative communication.
Quality of life
This is a priority in all cancer care and your
speech pathologist is focused on maintaining
your general well-being with advice and
support of your speech and swallowing
rehabilitation. Individualized care is a priority
and no two patients face the same journey to
recovery.
Pauline Dooley, Speech Pathologist
St Vincent's Private Hospital and St Vincent's Clinic,
Sydney
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