Swallowing therapy during radiation to the head and neck

This page is for people having radiation to the head and neck who want to protect their swallowing. It explains why exercises should come from a speech therapist, and what to ask.

People search for a list of swallowing exercises to do at home during head and neck radiation. They hope it will protect their swallowing for later.

NCI's summary on oral complications does not publish such a list. Instead, it points to a person: a speech therapist can check how well the patient is swallowing and give the patient swallowing therapy and information to understand the problem better.

That is not a dodge. Swallowing is a coordinated act that uses many muscles. A routine found online was not built around your cancer or your treatment, so it may not fit your case. NCI does not publish one, which is why the therapist matters.

The exercises should come from someone who has actually watched you swallow.

Two things are named here. Assessment: working out how well swallowing is happening right now. And therapy: treatment for the problem found, plus information so you understand what is going on and why.

That second part is easy to undervalue. Knowing why swallowing has changed can make the exercises easier to understand and keep doing.

NCI also describes the wider team: a team that includes a speech and swallowing therapist can help patients get back to normal eating.

NCI adds that tube feedings are decreased as eating by mouth increases, and stopped when you can get enough nutrients by mouth. NCI also says trouble swallowing raises the risk of other complications, including pneumonia, so involve your team early.

NCI lists jaw stiffness as its own concern in head and neck cancer care. It lists these treatments for jaw stiffness:

• medical devices for the mouth
• pain treatments
• medicine to relax muscles
• jaw exercises
• medicine to treat depression

Jaw exercises are on that list, but no technique is described for them. That again points back to getting them from a professional, not copying a video you found online.

The practical takeaway: ask your care team about seeing a speech and swallowing therapist early in your care, before eating has become hard.

Useful things to raise at that first appointment:

• what your swallowing is like right now, including any coughing during meals
• what you can still eat and drink comfortably
• how your jaw opening compares with before treatment started
• what exercises you should do, how often, and for how long each time

Also ask who follows up with you after radiation ends. Knowing who to contact after treatment means you are not starting over from scratch if swallowing changes later.

If swallowing gets harder partway through treatment, say so at your next daily visit. Do not wait for a scheduled review to bring it up. Coughing or choking during meals especially is something your team will want to hear about right away, since it affects whether eating is safe as well as whether it is comfortable.

A therapist who sees you before symptoms appear has a starting point to compare against later. That can make it easier to spot small changes.

None of this replaces the medical team treating your cancer. It sits alongside that care, aimed at one specific function that treatment can affect. Bringing it up is not a distraction from the main treatment plan. It is part of the plan.

• Call your care team right away if food or drink makes you cough, choke or go breathless while you are swallowing it, or if pain in your mouth, lips or throat has reached the point where eating, drinking or sleeping is difficult.
• Call your care team within a day or two if your mouth opens less far than it did, or you are quietly dropping foods and drinks from your diet because swallowing them has become work.