American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

Royal College of Speech & Language Therapists; Department of Health (UK); National Institute for Clinical Excellence (NICE)
RCSLT Clinical Guidelines: 5.13 Head & Neck Cancer

Taylor-Goh, S., ed. (2005).
RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd.

AGREE Rating: Highly Recommended

Description:

This guideline provides recommendations for the assessment and management of voice, speech, and swallowing in adults with head and neck cancer. The target audience of this guideline is speech and language therapists. Levels of evidence are provided and defined as follows: Grade A evidence includes “at least one randomised controlled trial as part of the body of literature, of overall good quality and consistency” (p. 387), that addresses the specific recommendation. Grade B evidence includes “well-conducted clinical studies but no randomised clinical trials on the topic of recommendation” (p. 387). Grade C evidence indicates the absence of “directly applicable studies of good quality” and is from expert committee reports on opinions and/or clinical experience.

Recommendations:

  • Assessment/Diagnosis
    • Assessment Areas
      • Hearing, Speech/Voice & Swallowing
        • “Patients will ideally be seen for assessment as soon as possible after diagnosis and before treatment commences, where communication and/or swallowing problems are a foreseeable consequence” (Grade B Evidence) (p. 112).
        • "Pre- and post-treatment assessment/management will incorporate the following areas:
          • An evaluation of the patient’s ability to adapt to their expected prognosis,
          • Patient and carer concerns and expectations,
          • Preferred communication/language,
          • Family support,
          • Psychosocial status,
          • Physical status and well-being,
          • Quality of life,
          • Hearing,
          • Manual dexterity,
          • Visual acuity,
          • Current medications,
          • General health and associated conditions,
          • Cognitive status,
          • Oromotor examination,
          • Vocal function,
          • Speech intelligibility,
          • Literacy skills,
          • General communication skills and need, and
          • Swallowing function” (Grade B Evidence) (p. 112).
  • Treatment
    • Speech/Voice
      • General Findings
        • “All patients will be offered the opportunity to discuss with the Speech & Language Therapist the probable effects of the proposed treatment on their voice, speech, and swallowing and the options for post-treatment rehabilitation” (Level B Evidence) (p. 112).
        • “Before treatment commences, anticipated loss of voice, speech and oromotor skills should be identified and alternative and supplementary methods of communication provided at the appropriate time according to patient need. These could include writing, gesture, mouthing or electronic aids, eg, artificial larynx and Lightwriter” (Level B Evidence) (p. 113).
        • “The Speech & Language Therapist will select and teach the most appropriate method of laryngeal voice in consultation with the patient to achieve optimum functional voice. Detailed counseling will enable appropriate choice of communication method(s)” (Grade B Evidence) (p. 114).
      • Tracheoesophageal Prothesis - “It is recognized that surgical voice restoration offers the best opportunity for achieving the closest quality to laryngeal voice in the shortest time. It also offers the least communicative dysfunction. The Speech & Language Therapist will be involved in decision-making regarding the choice of prosthesis, sizing, fitting and ongoing management” (Grade B Evidence) (p. 114).
    • Swallowing
      • General Findings - “All patients will be offered the opportunity to discuss with the Speech & Language Therapist the probable effects of the proposed treatment on their voice, speech, and swallowing and the options for post-treatment rehabilitation” (Level B Evidence) (p. 112).

Keywords: Head and Neck Cancer; Laryngectomy; Alaryngeal Speech Treatment

Access the Guideline

Added to Compendium: November 2010

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