Speech and swallowing intervention following oral cancer treatment: A survey of speech-language pathologists in Australia and New Zealand

Figures & data

Table I. Clinician demographic and caseload information.

Primary work setting (n = 43)	n (%)	Years working (n = 43)
Academic/tertiary teaching hospital	17 (39.5)	SLP	n (%)	HNC	n (%)
Specialist cancer centre	14 (32.6)	>10 years	28 (65.1)	>10 years	17 (39.5)
Regional or rural non-teaching hospital	6 (14)	5–10 years	11 (25.6)	5–10 years	11 (25.6)
Metropolitan smaller hospital	5 (11.6)	<4 years	4 (9.3)	<4 years	15 (34.9)
Private practice	1 (2.3)
Proportion of patient caseload
HNC (n = 43)	M 66.8, SD 29.54	Oral cancer (n = 42)			M 43.4, SD 20.76
More than half	29 (67.4)	More than half			13 (31)
Less than half	14 (32.6)	Less than half			29 (69)
Cancer treatments (n = 141)	n (%)	Oral cancers most frequently seen (n = 103)			n (%)
Surgery and chemoradiotherapy	38 (27)	Oral tongue			36 (35)
Surgery and radiotherapy	32 (22.7)	Floor of mouth			33 (32)
Surgery alone	29 (20.6)	Cheek			14 (13.6)
Radiotherapy and chemotherapy	24 (17)	Soft palate			10 (9.7)
Radiotherapy alone	17 (12.1)	Hard palate			8 (7.8)
Other (C0^2 laser)	1 (0.7)	Gums			2 (1.9)

Figure 1. When speech-language pathologists initiate speech (n = 74) and swallowing (n = 90) intervention across the cancer treatment pathway.

Table II. Speech and swallowing interventions.

	Speech	Swallowing
Compensation	Writing/gesture to replace verbal speech Communication board Text-speech device or apps Slowed speech rate Gesture Use of repetition with breakdown when not understood	Single sips at a time Straw drinking Slurp and swallow Head tilt (back or side) Alternate food with fluids Multiple swallows Swallowing saliva (if nil by mouth)
Active rehabilitation	Practice problem sounds Practice commonly used words and phrases Biofeedback (e.g. ultrasound, PRAAT) during speech	Supraglottic or super supraglottic Masako Effortful Mendelssohn Biofeedback (ultrasound, sEMG) on swallow
Range of motion (ROM) or stretches	Tongue or lip ROM exercises +/− resistance, stretches of the jaw, lips, tongue, or neck
Other	E-Stim, massage and lymphedema treatment	N/A

Figure 2. Type and frequency of speech and swallowing interventions recommended. ROM = Range of motion.

Table III. Frequency and intensity of speech and swallowing active rehabilitation.

	Swallowing		Speech
	Total (n)	Frequency (%)	Total (n)	Frequency (%)
Number of days of patient practice per week (n = 34)
7 days per week	26	76	24	71
4–6 days per week	6	18	8	24
2–3 days per week	1	3	2	6
1 day per week	0	0	0	0
I only recommend compensatory strategies	1	3	0	0
Average number of practice blocks per day for swallowing and speech (n = 29)
≤3	19	66	25	86
>3	10	34	4	14
Average number of repetitions per block (swallowing n = 30, speech n = 26)
<10	15	50	9	35
≥10	15	50	17	65

Figure 3. Speech (n = 67) and swallowing (n = 75) outcome measures used by speech-language pathologists. QoL = Quality of Life.

Figure 4. Main reasons for speech (n = 34) and swallowing (n = 39) service delivery.

Figure 5. Sources of influence on choice of intervention (n = 212).

Figure 6. Perceived barriers to speech-language pathology service delivery (n = 101).

Data availability statement

The data that support the findings of this study are available on request from the corresponding author (KMB).