1st ed. 2019 Edition
by Philip C. Doyle (Editor)
Malignancies involving structures of the head and neck frequently
impact the most fundamental aspects of human existence, namely, those
functions related to voice and speech production, eating, and
swallowing. Abnormalities in voice production, and in some instances its
complete loss, are common following treatment for laryngeal (voice box)
cancer. Similarly, speech, eating, and swallowing may be dramatically
disrupted in those where oral structures (e.g., the tongue, jaw, hard
palate, pharynx, etc.) are surgically ablated to eliminate the cancer.
Consequently, the range and degree of deficits that may be experienced
secondary to the treatment of head and neck cancer (HNCa) are often
substantial. This need is further reinforced by the Centers for Disease
Control and Prevention who have estimated that the number of individuals
who will be newly diagnosed with HNCa will now double every 10 years.
This estimate becomes even more critical given that an increasing number
of those who are newly diagnosed will be younger and will experience
the possibility of long-term survival post-treatment.
Contemporary
rehabilitation efforts for those treated for HNCa increasingly demand
that clinicians actively consider and address multiple issues. Beyond
the obvious concerns specific to any type of cancer (i.e., the desire
for curative treatment), clinical efforts that address physical,
psychological, communicative, and social consequences secondary to HNCa
treatment are essential components of all effective rehabilitation
programs. Comprehensive HNCa rehabilitation ultimately seeks to restore
multiple areas of functioning in the context of the disabling effects of
treatment. In this regard, rehabilitation often focuses on restoration
of function while reducing the impact of residual treatment-related
deficits on the individual’s overall functioning, well-being, quality of
life (QOL), and ultimately, optimize survivorship.
Regardless of
the treatment method(s) pursued for HNCa (e.g., surgery, radiotherapy,
chemoradiation, or combined methods), additional problems beyond those
associated with voice, speech, eating and swallowing frequently exist.
For example, post-treatment changes in areas such as breathing,
maintaining nutrition, limitations in physical capacity because surgical
reconstruction such as deficits in shoulder functioning, concerns
specific to cosmetic alterations and associated disfigurement, and
deficits in body image are common. Those treated for HNCa also may
experience significant pain, depression, stigma and subsequent social
isolation. Concerns of this type have led clinicians and researchers to
describe HNCa as the most emotionally traumatic form of cancer. It is,
therefore, essential that clinicians charged with the care and
rehabilitation of those treated for HNCa actively seek to identify,
acknowledge, and systematically address a range of physical,
psychological, social, and communication problems. Efforts that
systematically consider this range of post-treatment sequelae are seen
as critical to any effort directed toward enhanced rehabilitation
outcomes. Actively and purposefully addressing post-treatment challenges
may increase the likelihood of both short- and long-term rehabilitation
success in this challenging clinical population.
Current
information suggests that successful clinical outcomes for those with
HNCa are more likely to be realized when highly structured, yet flexible
interdisciplinary programs of care are pursued. Yet contemporary
educational resources that focus not only on management of voice,
speech, eating, and swallowing disorders, but also address issues such
as shoulder dysfunction due to neck dissection, the significant
potential for cosmetic alterations can offer a much broader perspective
on rehabilitation. Contemporary surgical treatment frequently involves
reconstruction with extensive procedures that require donor sites that
include both soft tissue from a variety of locations (e.g., forearm,
thigh, etc.), as well as bone (e.g., the scapula). Collectively,
resources that address these issues and many other concerns and the
resultant social implications of HNCa and its treatment can serve to
establish a comprehensive framework for clinical care. Consequently,
providing a highly specialized and comprehensive educational resource
specific to HNCa rehabilitation is currently needed. The proposed edited
book is designed to address this void in a single authoritative
resource that is also accessible to the clinical readership. Integral to
this proposed book is information that guides clinical approaches to
HNCa rehabilitation, in addition to offering emphasis on the direct
impact of changes in voice, speech, and swallowing and the impact of
such losses on outcomes.
Finally, while several other published
sources currently exist (see attached list), the emphasis of these books
is directed either toward the identification and diagnosis of malignant
disease, clinical and surgical pathology, associated efforts directed
toward biomedical aspects of cancer and its treatment, or those with a
focus on a single clinical problem or approach to rehabilitation.
Therefore, the content of the proposed multi-chapter text centers on
delivering a systematically structured, comprehensive, and
clinically-oriented presentation on a range of topics that will provide
readers at a variety of levels with a strong, well-integrated, and
empirically driven foundation to optimize the clinical care of those
with HNCa.
The primary audience for this textbook is undergraduate
and graduate-level students in Speech-Language Pathology, as well as
practitioners, especially hospital-based practitioners, in
Speech-Language Pathology; other key audiences include junior and
senior level otolaryngology residents and fellows, translational
researchers in head and neck cancer, related medical specialists (e.g.,
radiation oncology), oncology nurses, and potentially other
rehabilitation professionals such as occupational therapists, counseling
psychologists, social workers, and rehabilitation counselors.
