A pre-treatment speech and swallowing evaluation is best practice and standard for patients diagnosed with oral, pharyngeal and or laryngeal cancer. National Cancer Center Network guidelines support early and continued speech therapy intervention for patients diagnosed with oral, pharyngeal, and laryngeal cancer.

 The goal in the initial visit is to identify how the patient can maintain the safest and most efficient swallow function going into radiation therapy in an effort to prevent disuse atrophy and maintain oral and pharyngeal function as best as possible.  Deconditioning and disuse atrophy of musculature specific to swallow function can result from reduced or no oral intake (Hutcheson et al., 2013). Continued eating by mouth and completion of a swallowing home exercise program while undergoing radiation treatment is beneficial for swallow function, diet level, and quality of life, with reduced need for feeding tube placement (Starmer, 2014).

There are several normal tissue changes in the first weeks and months (edema) of radiation therapy. Swelling in the laryngeal apparatus and pharynx contributes to sensory change and mobility.  Head and neck lymphedema is swelling that most often occurs following surgery and or radiation. It occurs when fluid, normally drained by the lymph vessels, does not flow out of the head and neck properly. It can occur before, during, or after cancer treatment. Lymphedema can cause discomfort and if not treated, it can become permanently edematous and fibrotic.  There is a high prevalence of internal and external lymphedema leading to dysphagia, communication deficits, and or dyspnea symptoms in head and neck cancer patients both pre- and post-treatment (Ridner et al., 2016).  Early intervention is critical for lymphedema treatment to minimize potential adverse outcomes and prevent further disability related to speech and swallow function (Sleigh & Manna, 2021).  Lymphedema is a chronic and progressive condition. NCCN Survivorship Guidelines support early-stage intervention and home management for symptom management to prevent progression.

 Pre-habilitation interventions including Pharyngocize and The Mcneil Dysphagia Therapy Program can help to reduce the incidence and severity of current and future swallowing impairments related to radiation (Silver& Baima, 2013).

 SLP evaluation pre-treatment, week 1, and mid radiation therapy visit, is recommended for patients diagnosed with oral, pharyngeal, and laryngeal cancer. Follow up re-evaluations at one month, three months, six months,12 months, and 24 months is also recommended (Messing et.al,2018).