Did you know that each year, amost 13,000 people in the UK will be given the news that they have head and neck cancer? Unfortunately, these numbers continue to rise. To mark World Head and Neck Cancer Day, we hear from Grainne Brady, PhD Student at Imperial’s Department of Surgery and Cancer, NIHR Clinical Doctoral Research Fellow and Speech Language Therapist at the Royal Marsden NHS Foundation Trust London. She shares her expertise on the link between head and neck cancer and changes to swallowing, communication and the potential impact on quality of life.
Treatments for HNC include surgery, radiation and chemotherapy(1). Traditional risk factors for HNC include a history of tobacco and alcohol use (2). More recently, human papilloma virus (HPV) has been recognised as a risk factor for the development of oropharyngeal cancer which is a subtype of cancer affecting the back of the throat, tonsils, back of the tongue and soft palate (2). The discovery that a virus can cause this condition has led to the development of a UK-wide HPV vaccination programme available for both boys and girls aged 12-13 years (3).
There have been huge advances in the treatment of HNC over the past two to – three decades. These include advanced radiation techniques like intensity-modulated radiation therapy and minimally invasive surgeries such as transoral robotic surgery, which are now standard of care techniques (4).
HNC and the anti-cancer treatments administered can result in significant changes to an individual’s ability to eat, drink and swallow safely and comfortably and to be able to produce clear voice and speech. Difficulties with swallowing (dysphagia) has been highlighted as a key priority concern at 12 months following treatment for HNC (5). Dysphagia can lead to significant health complications including malnutrition, dehydration, pneumonia, feeding tube dependency, and significant healthcare costs. Both changes to swallowing and/or a person’s ability to communicate can have a significant impact on their overall quality of life (QoL). Given the potential impact of HNC on swallowing and communication and subsequent QoL, there has been a paradigm shift in HNC research to not only focus on survival outcomes, but to place equal importance on function and QoL outcomes for our patients.
As a speech and language therapist working in the area of HNC, my role is to assess, diagnose and treat any communication or swallowing difficulties which arise as a result of the HNC and/or the anti-cancer treatment(s) administered. I have always had a keen interest in clinically based research aiming to optimise the function, QoL and patient experience outcomes for the patients I treat clinically. I was delighted to be accepted as a PhD candidate within the Department of Surgery and Cancer at Imperial College London. Working alongside my supervisors at Imperial – Professor Mary Wells, Professor Justin Roe and Professor Pernilla Lagergren – in collaboration with Professor Vinidh Paleri at the Royal Marsden NHS Foundation Trust, I am currently completing my PhD research which is investigating function and QoL outcomes and patient and carer experience in recurrent HNC. It has been a privilege to work with my patients to hear their experience of HNC treatment and rehabilitation, and to contribute to the growing evidence base to optimise function, QoL and patient experience for patients with head and neck cancers.
References:
- Cancer Research UK. Head and neck cancer statistics [Available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/head-and-neck-cancers] Accessed 25th July 2024.
- Schache AG, Powell NG, Cuschieri KS, Robinson M, Leary S, Mehanna H, et al. HPV-related oropharynx cancer in the United Kingdom: an evolution in the understanding of disease etiology. Cancer research. 2016;76(22):6598-606.
- Jopson R, Callender J. Are UK healthcare professionals equipped to provide information and support on Human Papillomavirus to patients diagnosed with cancer of the head and neck? Journal of Radiotherapy in Practice. 2022;21(2):165-70.
- Homer JJ, Winter SC. Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines, Sixth Edition. J Laryngol Otol. 2024;138(S1):S1-s224.
- Roe JW, Drinnan MJ, Carding PN, Harrington KJ, Nutting CM. Patient-reported outcomes following parotid-sparing intensity-modulated radiotherapy for head and neck cancer. How important is dysphagia? Oral oncology. 2014;50(12):1182-7.