The surgical management and speech and swallowing rehabilitation of patients with advanced tongue cancer in South Africa

Abstract

Advanced tongue cancer may have a devastating effect on a person’s ability to speak and to swallow. Very little is known about the surgical management and speech and swallowing rehabilitation of persons with advanced tongue cancer in South Africa. The aim of this study was to obtain information regarding clinical practices in treatment and rehabilitation. Questionnaires were distributed to 450 surgeons and 150 speech-language pathologists in South Africa. The response rate was 16% for the surgeons and 33% for the speech-language pathologists. Results showed that only a small number of surgeons and speech-language pathologists in South Africa are involved in the treatment of persons with advanced tongue cancer. Surgeons prefer combined modality treatment (surgery and post-operative radiotherapy) in the primary treatment of patients with advanced tongue cancer, but the use of radiochemotherapy is growing. Total glossectomy is a very radical procedure, but it is sometimes used by surgeons to treat patients with advanced disease. Total glossectomy with laryngeal preservation is preferred to total glossolaryngectomy by surgeons, in order to preserve laryngeal voice. Patients with total glossectomy form only a small part of the caseload of speech-language pathologists. Swallowing rehabilitation includes aspects such as dietary changes, compensatory swallowing techniques and airway protection mechanisms. Speech intelligibility is targeted in speech rehabilitation, but alternative communication is sometimes recommended for patients who have undergone total glosso-laryngectomy.