Helping cancer patients find their voice

Speech language pathologists are part of a multidisciplinary team

Not only do they help with speech, but with swallowing and oral health, too

They can be the first line of assistance during cancer screenings

Cancer can take a toll on the body, and it can be an especially intense challenge for patients with oral, head or neck cancer, which can impair their speech or rob them of it altogether. That’s why speech language pathologists are an integral part of the care team at Providence Oral, Head and Neck Cancer Clinic in Portland, Oregon.

“We are involved from the very beginning,” says speech language pathologist Kelli Harrington-Bollenbaugh. “After patients are told their diagnosis they have a lot of questions about what it means, about surgery and rehabilitation, about whether they will need a feeding tube and for how long, and also what life after surgery looks like. And that’s where we come in.”

“We do a lot of the pre-surgical screenings and education on what surgery entails, how long a patient will have to use a feeding tube, and if they will lose their voice permanently or not,” she explains “We also see patients right after surgery in the hospital and follow up with them in our outpatient clinic, or sometimes even through radiation and chemotherapy. I think it is a pretty incredible thing that our clinic offers, that we are there from start to finish.”

Adds fellow speech language pathologist Megan Hyers, “We follow them wherever they are on the continuum of care.”

Hyers and Harrington-Bollenbaugh are among the roughly 25 speech therapists working at the cancer clinic and other Providence clinics throughout the city. They concentrate on helping patients in the areas of speech, language, cognition and swallowing.

“With speech, that can be broken down to articulation issues, helping patients to be more precise with their speech, because cancer of the head and neck can affect that,” Hyers says. “We help with exercises to improve the range of motion and the strength of their articulators. With language or cognition, if they are having any problems with ‘chemo brain,’ which can happen with chemo drugs, we can help them with that.”

Hyers adds that swallowing is a major focus of their work because it can be affected by surgery, chemotherapy and radiation. Harrington-Bollenbaugh agrees.

“Depending on what problems the patient is having, we have wonderful objective studies at our fingertips to filter down the appropriate exercises to address their specific swallowing difficulties,” she says. “We can also do diet texture adjustments. Say a patient is aspirating thin liquids, which means they’re going down the wrong pipe - we have the ability to change the diet to safely accommodate a patient’s swallowing needs at that time and we reassess that every time we see a patient.”

There are also patients who undergo a laryngectomy, in which the voice box is removed. The speech language pathologists have to then help those patients regain a communication system of some kind.

“It can be nonverbal, like carrying around a little white board and writing on it, or using a communications board with pictures of things they need that they can point to,” Harrington-Bollenbaugh says. “There is also text to talk; we do a lot of augmentative and alternative communication. Those are apps on a phone that patients can use that tell the phone what to say. But the most common route we see patients take is either an electrolarynx or a tracheoesophageal prosthesis, like on the stop-smoking commercials, using the artificial hole placed by the surgeon in the patient’s neck.”

In addition to developing communication systems to replace lost speech, exercises for articulation and swallowing strategies, Hyers and Harrington-Bollenbaugh also stress the importance of oral health for patients dealing with oral, head or neck cancers. For instance, patients undergoing radiation can develop painful mouth sores and it’s necessary to keep up with brushing their teeth - even if the process hurts - in order to eliminate bacteria from the mouth. It's also important for patients to drink a substantial amount of water to keep the inside of the mouth moist. To that end, the speech language pathologists work closely with the team’s oncology dentist, Dr. Amber Watters - just one of many health care professionals in the oral, head and neck cancer program who play highly specialized roles in patient care.

“One of the best things about the head and neck program is how multidisciplinary it is, and it’s a very strong team where we talk a lot with each other - everyone from the surgeons to the medical oncologists to the nurse navigators to the dentists, to the techs - to meet the needs of the patients,” Hyers says, while Harrington-Bollenbaugh adds that there are also chaplains and support groups. “What makes our team work like a well-oiled machine is that all disciplines are equally respected and listened to; they all have an equal place at the table. We are all advocating for our patients.”

Several of the team members also work together during the cancer clinic’s community screenings, with the next one scheduled for April 18. “There will be dentists, physicians and speech pathologists there,” Hyers says. “We screen patients to assess for any overt signs of any cancer. If there’s a question on anything or something we’re not sure about, one of the physicians can come in and take a look right then, or the patient can come into the clinic for a more thorough evaluation.” During last year’s screening, the team was able to catch a handful of cases, Harrington-Bollenbaugh adds.

Because everyone works together in caring for each patient, they get to share the success stories as a team. “One of my favorite things is when we are able to give people their voice back or help them communicate in some way,” Hyers says. “I also love to help someone resume eating when they haven’t been able to eat comfortably for a while; it’s very heartwarming to give somebody something so tangible and life changing.”

Adds Harrington-Bollenbaugh, “I’ve been fortunate enough to be there when patients says their first words after being unable to communicate verbally. When they look at their loved ones to say ‘I love you’ or ‘hello,’ and everyone in the room breaks into tears, it’s an incredible moment for the entire team.”

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.