Common Residuals of Throat Cancer After Treatment
Dysphagia (swallowing difficulties) and voice/speech impairment are the most common and significant residual problems after throat cancer treatment, affecting up to 75% of patients and significantly impacting quality of life. 1
Swallowing Dysfunction
Dysphagia is a prevalent and debilitating residual after throat cancer treatment:
Up to 50% of survivors of advanced head and neck cancer experience dysphagia, with aspiration rates between 47-84% among symptomatic patients after radiation therapy (RT) or chemoradiation therapy (CRT) 1
Swallowing problems affect social life in 75.6% of patients, with 80% reporting difficulties eating in public 2
Dysphagia is most common in patients with oral cavity and/or oropharyngeal cancer (57.6%) and those treated less than 2 years ago 2
Dysphagia after RT or CRT typically results from:
- Edema
- Fibrosis
- Sensory alterations associated with acute and chronic soft tissue changes 1
Risk factors for persistent dysphagia include:
- Pre-treatment swallowing difficulties
- Prolonged periods without oral intake during treatment
- Higher radiation doses and larger radiation fields
- Combined chemoradiation therapy 1
Voice and Speech Impairment
Voice and speech problems are significant residuals that affect communication and quality of life:
Speech problems are reported by 63.8% of patients after treatment for oral and oropharyngeal cancer 3
Risk factors for moderate to severe voice and speech symptoms include:
- Increasing survival time
- Higher total radiation dose
- Black race and Hispanic ethnicity
- Current cigarette smoking
- Treatment with induction and concurrent chemotherapy
- Lower cranial neuropathy 4
Specific voice issues include:
- Weak, breathy vocal quality
- Problems with pitch variation (especially with anterior commissure involvement)
- Complete loss of natural voice after total laryngectomy 1
Alaryngeal Speech After Total Laryngectomy
For patients who undergo total laryngectomy, alternative speech methods are necessary:
Options include electrolarynx (artificial larynx), esophageal speech, or tracheoesophageal voice restoration 1
Selection of the optimal alternative depends on:
- Patient selection
- Patient motivation
- Clinician expertise with the chosen alaryngeal speech alternative 1
Successful rehabilitation is associated with good quality of life, but requires specialized expertise 1
Other Common Residuals
Additional residuals that significantly impact quality of life include:
- Xerostomia (dry mouth) 1
- Trismus (limited mouth opening) 1
- Hearing impairment 1
- Cognitive impairment 1
- Cranial nerve injuries 1
- Persistent cough 2
- Hoarseness 2
- Sticky saliva 2
- Loss of smell and taste 2
- Oral and throat pain 2
- Risk of second primary tumors related to radiation therapy 1
Temporal Patterns of Residual Effects
The timeline of residual symptoms is important to understand:
Voice quality and swallowing function may not stabilize until at least 6 months post-treatment 1
Risk of recurrence shows a bimodal pattern:
- First peak around 1.5 years after treatment (mainly in T3, T4 and N2, N3 diseases)
- Second peak around 3.5 years (for all T stages and N2, N3 diseases) 1
Long-term survivors after Intensity-Modulated Radiation Therapy (IMRT) may experience a decline in cognitive function and quality of life 1
Monitoring and Management
Regular monitoring is essential to detect and manage residual problems:
Instrumental, performance status, and quality-of-life measures should be used to evaluate post-treatment function 1
Assessment tools include:
- Self-recorded and/or expert-rated voice quality measures
- Voice-related quality-of-life tools
- Video-stroboscopy
- Radiographic (videofluoroscopic) or fiber-optic laryngoscopic evaluation of swallowing
- Dietary assessment 1
Thyroid function should be evaluated annually in patients who received RT to the neck 1
Pituitary function should be evaluated periodically or if symptoms develop 1