DOI:10.31557/APJCP.2024.25.2.

453
Surveying Practice Patterns of the Speech–Language Pathologist in the Care of Head and Neck Cancer Patients in India

RESEARCH ARTICLE Editorial Process: Submission:07/07/2023 Acceptance:02/11/2024

Speech-Language Pathologist’s Pattern of Practice in the

Rehabilitation of Head and Neck Cancer patients across
Hospitals in India
Janet Jaison Varghese1, Venkataraja U. Aithal2*, Krishna Sharan3, Bellur
Rajashekar2
Abstract
Objective: India has a significant burden of Head and Neck cancer (HNC) patients. Patients afflicted with HNC often
encounter difficulties in speech, voice, and swallowing, either due to the disease itself or the treatment they receive.
The rehabilitation of HNC patients is crucial, and Speech and Language Pathologists (SLPs) have a significant role in
it. The current study aimed to understand the practices followed by SLPs in India while rehabilitating HNC patients.
Methods: A questionnaire was developed and validated by five Speech-language pathologists, before circulation as an
E-survey. The target participants were SLPs working in hospitals across India. The final online version of the questionnaire
remained open for eight weeks. Result: A total of 75 Hospital-based SLPs working in India participated in the survey.
The responses depict notable trends and differences in the assessment and management approaches. HNC patients
who had undergone surgery were more likely to be referred for rehabilitation than those who received non-surgical
treatments. Only 36% of the SLPs reported getting pre-operative referrals for HNC patients. The time point for initial
assessment and intervention, as well as the protocols used, varied across different hospitals. About 50% of participants
had instrumental swallow evaluation facilities in their hospitals, and the majority of hospitals only used instrumental
swallow evaluation for 1-3 assessments per week. Conclusion: Variability exists in several aspects of SLP practice
for HNC patients offered across Hospitals in India. All HNC patients do not get access to speech-language pathology
services. Developing standardized protocols towards early evaluation, intervention and enhancing compliance could
improve SLP-led rehabilitation of HNC patients in India.

Keywords: Head and Neck Cancer- rehabilitation- dysphagia- voice problems- speech and swallow

Asian Pac J Cancer Prev, 25 (2), 453-460

Introduction States of America [6] have specified guidelines on the

role of SLPs in managing HNC. There have been efforts
In India, one in nine individuals are at risk of to evaluate the standards of SLP rehabilitation for HNC
developing cancer during their lifetime [1]. Head and patients in Australia [7], especially in rural areas [8], after
neck cancer (HNC) accounts for 26% of cancer cases in which there have been collective efforts to improve the
males and 8% in females [2]. Patients may experience service delivery [9, 10].
speech, voice, and swallowing difficulties as a symptom Though recent studies from India have surveyed
of the disease or resultant effect of treatment. Cancer Speech-language pathologists, they have been restricted
management options are surgery, radiation therapy, to the assessment and management patterns of dysphagia
and chemotherapy [3]. However, surgery of the oral, in general and not specially HNC patients [11, 12]. As
pharyngeal, and laryngeal regions can affect speech and there are no national guidelines in place, institutions and
swallowing, while radiation therapy can cause xerostomia, clinicians have to rely on creating their own protocols.
mucositis, trismus, and pain [4]. Due to these reasons, With this study, we aimed to gain insight into the practice
speech-language pathologists (SLPs) play an essential patterns of SLPs working with HNC patients and to
role in the patient care pathway of HNC management. understand the trends in service delivery nationwide.
Countries such as the United Kingdom [5] and the United
1
Research Scholar, Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher
Education, Manipal, India. 2Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of
Higher Education, Manipal, India. 3Department of Radiation Oncology, Justice KS Hegde Medical College, Nitte (Deemed to be
University); Former Professor & Head, Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy
of Higher Education, Manipal, India. *For Correspondence: vrajaithal@manipal.edu
Asian Pacific Journal of Cancer Prevention, Vol 25 453
Janet Jaison Varghese et al

Materials and Methods Demographic details and clinician-related questions

As shown in Table 1, most of the respondents had
Development of Survey Instrument post-graduate qualifications in their specialty and had “one
For the study, a questionnaire was created with to four years” of experience working with HNC patients.
multiple domains that included both closed-ended and
open-ended questions, utilizing skip logic. The questions Table 1. Demographic and SLP Related Details of
on swallowing were based on the research done by Roe Practice among the Participants (n=75)
et al., [13] and Krisciunas et al., [14] after receiving
Demographic Details % (n)
prior permission from both authors. The questionnaire
Gender
was initially content validated by five speech-language
Female 78.7% (59)
pathologists (SLPs) who had over five years of experience
in HNC rehabilitation. The questions were then revised Male 21.3% (16)

based on expert feedback, and the final version was pilot Educational Qualification
tested on three SLPs who worked with HNC patients. Undergraduate 14.7% (11)
Since no further adjustments were proposed, this Postgraduate 81.3% (61)
version of the questionnaire was approved for the study. Ph.D. 4% (3)
(Supplementary-Material.1). Years of experience working with HNC patients
Less than a year 24% (18)
Participants and Data Collection
1 to 4 years 54.7% (41)
The participants in this study were SLPs working in
5 to 10 years 12% (9)
hospitals across India. The survey was made available
More than 10 years 9.3% (7)
online through Google forms and distributed via email
with information about the study’s purpose, inclusion Type of Hospital

criteria, and contact information for any questions. Academic Teaching Hospital 48% (36)
The first page of the electronic survey provided written Stand-alone specialized cancer center 10.7% (8)
consent options and the choice to decline participation. Urban or suburban Non-teaching Hospital 40% (30)
Only those who gave consent were able to access and Rural Hospital 1.3% (1)
complete the subsequent pages. The link for participation New referrals per annum
was also shared on social networking groups of Indian 0-25 33.3% (25)
SLPs. Persons who were contacted by email were sent a
25-50 28% (21)
reminder after two weeks. Snowball sampling was also
50-75 5.3% (4)
done by contacting the SLPs who had already participated
75-100 8% (6)
in the survey.
100-125 5.3% (4)

Statistical Analysis 125-150 2.7% (2)

Descriptive statistics were used to analyze the closed- Above 150 17.3% (13)
ended questions. Graphical and tabular presentations Location of workplace (State)
were used to summarize the data. Open-ended questions Karnataka 41.3% (31)
were analyzed using content analysis. Responses about Maharashtra 14.7 % (11)
intervention approaches were analyzed using deductive Kerala 10.6% (8)
content analysis. The structure of the analysis was
Tamil Nadu 9.3% (7)
operationalized, coded, and allocated [15]. Other free-text
Delhi 5.3% (4)
answers were deduced using inductive content analysis to
West Bengal 4% (3)
incept themes from the data [15].
Telangana 4% (3)

Results Punjab 2.7% (2)

Uttar Pradesh 1.3% (1)
The contact information of Speech-Language Rajasthan 1.3% (1)
Pathologists was collected from the websites of various Odisha 1.3% (1)
teaching and non-teaching hospitals located in different Haryana 1.3% (1)
states of India. The survey link was then personally shared Gujarat 1.3% (1)
via email (n=211) and WhatsApp (n=89). Additionally,
Assam 1.3% (1)
profiles of hospital based SLPs employed in India were
Additional certification or training 38.67% (29)
searched on LinkedIn, and the survey link was messaged to
Fiberoptic endoscopic evaluation of swallowing (FEES) 48.2% (14)
them (n=198). The survey remained open for participation
for eight weeks, from mid-April 2021 to mid-June 2021. Modified Barium Swallow Impairment Profile (MB- 10.3% (3)
SImP)
A total of 76 Speech-language pathologists participated in
Laryngectomy rehabilitation 13.8% (4)
the study with informed consent. Seventy-five responses
Fellowship program in speech and swallowing disorders 10.3% (3)
were considered for analysis after excluding the responses
of an SLP practicing outside India. Observer program in a cancer center 10.3% (3)
Post-graduate program in Deglutology 6.9% (2)

454 Asian Pacific Journal of Cancer Prevention, Vol 25

 DOI:10.31557/APJCP.2024.25.2.453
Surveying Practice Patterns of the Speech–Language Pathologist in the Care of Head and Neck Cancer Patients in India
Table 2. Swallowing Interventions that were Usually Table 3. Reasons for Poor Compliance to Speech and
Given by the SLPs Derived from the Free-Text Responses Swallow Therapy Derived from Free Text Responses
Themes Respondents mentioning Themes Respondents mentioning
this theme n (%) this theme n (%)

Swallow Maneuvers 48 (64%) Low Patient motivation 29 (38.6%)

Postural Modifications 42 (56%) Treatment side effects-Pain, Mucositis 26 (34.6%)
Airway protection Maneuvers 27 (36%) Poor follow up 10 (13.3%)

Range of Motion exercises 19 (25.3%) Lack of awareness 10 (13.3%)

Consistency Modifications 15 (20%) Travel distance 7 (9.3%)

Lack of family support 6 (8%)
Oral Stimulation 4 (5.3%)
Financial issues 4 (5.3%)
Pitch Glides 1 (1.3%)

A multi-answer question asked which professionals

Twenty- nine SLPs indicated that they had completed a refer head and neck cancer patients to the SLP. The results
certificate course or additional training. indicated that surgeons, particularly onco-surgeons and
Ear, Nose, and Throat (ENT) surgeons, made the most
Hospital services and referral policy referrals among all specialties, with a percentage of 78.7%
The data reveals that the largest proportion of (n=59) for each. Medical oncologists followed with a
respondents (48%, n=36) were employed in Academic percentage of 60% (n=45), radiation oncologists with
Teaching Hospitals. Furthermore, the survey reports that 54.7% (n=41), and general physicians with 40% (n=30).
17.3% (n=13) of the SLPs had a referral rate of over 150 Sixty out of the seventy-five participants stated that
new HNC patients per year, while the majority (33.3%; most of their HNC patients were those who underwent
n=25) indicated a yearly caseload of 0-25 patients. The surgery as their main treatment. Referrals were mainly
detailed responses are reported in Table 1. given after the surgery, with only 27 participants (36%)
It was found that there were not many speech-language reporting receiving pre-operative referrals. The time for
pathologists (SLPs) working in hospitals with a consistent the initial access to the SLP after surgery varied greatly
policy for referring head and neck cancer patients to SLPs. across different clinical settings. Thirty-two speech
The majority of cases (72%; n=54) were referred on a language pathologists received patient referrals within the
case-by-case basis at the discretion of the referring doctor first week following surgery, while 10 received referrals
for speech, voice, or swallowing issues. Only 11% (n=8) of two weeks after surgery, and 3 received referrals one-
SLPs reported routinely referring all HNC patients, while month post-surgery. Forty percent of the SLPs received
13 SLPs were part of a multidisciplinary oncology team. referrals during follow-up visits with the surgeon.

Figure 1. Components of assessment Battery and SLPs Usage Percentages

Asian Pacific Journal of Cancer Prevention, Vol 25 455
Janet Jaison Varghese et al

According to the responses of the SLPs, their HNC assessment kit (n=1), a patient-reported checklist (n=1),
caseload comprised mainly of patients who had undergone the EORTC QLQ H&N35 (n=1), and the Nair Hospital
glossectomy (n=29) and laryngectomy (n=22). Swallowing Assessment Scale (n=1). Additionally,
Additionally, 34.7% (n=26) of SLPs revealed that one participant evaluated smell using a self-developed
they did not receive any referrals for patients undergoing olfactory assessment kit.
organ preservation protocols. Moreover, out of the 49
individuals who received referrals, the timing of referrals Usual Practices of Intervention
was inconsistent. Only thirteen SLPs indicated that In the survey, free text options were provided to
patients are referred to them before or during radiation describe the intervention approaches employed by the
therapy, regardless of the presence of dysphagia. SLPs to improve speech, voice and swallowing skills. The
Conversely, 17 participants reported that only patients approaches and the proportion of survey respondents that
with swallowing difficulties are referred to them. Most mentioned each approach are listed below.
responses (32.7%, n=16) suggested that patients are To improve speech, Oromotor exercises were the most
referred on a “case-to-case referral basis,” depending on favored method (n=26). Additionally, other techniques
the judgement of the referring physician. Only one speech such as articulatory drills (n=9), open mouth approach
language pathologist (SLP) reported routinely assessing (n=6), exaggerated articulation (n=2), rate reduction (n=2),
all HNC patients who underwent radiation therapy after sensory stimulation (n=2), compensatory articulation
the completion of treatment, while two SLPs mentioned (n=2), and reading aloud (n=1) were reportedly used to
conducting assessments during follow-up visits post- a lesser extent.
completion of radiation therapy. The following voice therapy techniques were
recommended: Relaxation exercises (n=30); Vocal
Assessment procedures followed in different centers Function exercises (n=14); Resonant voice therapy
The survey participants were asked about the (n=17); Semi Occluded Vocal Tract (n=2); Pitch Gliding
components of their patient assessment. Figure 1 (n=3); Speech breathing (n=1); Vocal hygiene program
illustrates the assessment domains and proportion (n=3); Chewing (n=2); Yawn sigh (n=2); Push-pull
of SLPs who incorporate them into their assessment exercises (n=8); Digital Manipulation (n=4); Laryngeal
protocol. The following instruments were reportedly manipulation (n=2); Half-swallow Boom (n=2) and
used for evaluation: Fiberoptic endoscopic evaluation of Humming (n=1).
swallowing (FEES) (n=43); Videofluoroscopic Swallow Swallowing therapy techniques that the participants
Study (VFSS) (n=37); Stroboscopy (n=39); Computerized reported are depicted in Table 2. Postural techniques
Speech Lab (CSL™) (n=24); VAGHMI (n=27); Dr such as head rotation, head tilt, chin tuck, side-lying,
Speech (n=24); Nasometer (n=18); sEMG (n=13); Digital etc., have been mentioned under the theme of “postural
swallow station (n=4). modifications;” Effortful swallow, Mendelson Maneuver
It is noteworthy that, only Forty-three SLPs had and Masako technique under “swallow maneuvers;”
access to Fiberoptic endoscopic evaluation of swallowing supraglottic swallow and super supra-glottic swallow
(FEES), and 37 SLPs reported having a Videofluoroscopic under “airway protection maneuvers;” finally, “Range-of-
Swallow Study (VFSS) facility. According to the results, motion exercises” were inclusive of exercises for tongue,
29 SLPs carried out FEES and VFSS assessments on “1 to lip, mouth opening and neck stretches.
3 patients weekly”. Additionally, 5 and 9 SLPs reported According to a survey, 38 participants used strategies
weekly assessments on “4 to 6” patients for VFSS and to enhance their patient’s ability to recognize taste.
FEES, respectively. Two SLPs carried out “7 to 10 The most frequently mentioned recommendations
assessments per week” for FEES, while one SLP did the were experimenting with various textures and flavours
same for VFSS. Higher usage of instrumental swallow (mentioned 37 times) and trying thermal stimulation
assessment of more than 10 cases a week was reported (mentioned 7 times). Additionally, nineteen SLPs
by 2 SLPs for VFSS and 3 SLPS for FEES. suggested informal techniques to improve smell
Twenty-six SLPs routinely assessed olfactory skills, recognition through “olfactory stimulation,” with items
while thirty-four SLPs reportedly performed gustatory such as lavender and jasmine essential oils, coffee beans,
assessment. The results showed that most SLPs used and Indian spices used for stimulation.
informal methods to assess their patients. These
methods often involved asking patients to describe their Prophylactic dysphagia intervention during radiation
self-perception of taste (11 responses) and smell (17 therapy
responses). Other SLPs used different stimuli to evaluate Fifty participants (66.7%) recommended swallowing
patients, such as asking them to rate the intensity of taste exercises to patients undergoing radiation therapy, while
(19 responses) and smell (8 responses). According to the remaining did not. Among those who recommended
free-text responses, the items utilized to informally assess exercises, most (50%, n=25/50) advised “Range of
taste included citrus fruits like lemon and orange, as well Motion exercises”, while 16 out of 50 suggested “Effortful
as honey, sugar, salt, sour candy, and biscuits. Similarly, swallows”. “Airway protection maneuvers” were
the items used to informally assess smell reportedly mentioned by seven participants, and five suggested the
included coffee, oranges, perfumes, and sanitizer. “Mendelson maneuver”. The “Masako technique” was
According to responses, four SLPs used different mentioned by three clinicians, and two suggested the
tools for assessing taste, including a self-developed taste “Shaker exercise”.
456 Asian Pacific Journal of Cancer Prevention, Vol 25
 DOI:10.31557/APJCP.2024.25.2.453
Surveying Practice Patterns of the Speech–Language Pathologist in the Care of Head and Neck Cancer Patients in India
Forty SLPs (80%) felt that fewer than 50% of their
patients on radiation therapy were compliant with Additional themes
prophylactic swallowing exercises, and compliance A free-text box was provided at the end of the survey
of more than 50% was reported by only 10 SLPs. for additional information. Among those who responded,
The following themes were mainly derived from the 18 mentions were of the theme that medical professionals
responses for reasons for poor adherence to therapy- “Low in their workplaces are “unaware of the range of SLP
motivation”, “Pain”, “Fatigue”, “Financial issues”, and services” that can be offered for rehabilitating HNC
“Low prioritization of swallowing skills”. patients, which leads to inadequate referrals. Another
common theme mentioned 11 times is the “need for a team
Laryngectomy Rehabilitation by SLP approach” to patient care. By having a multidisciplinary
Two-thirds of the participants (n=50) reported carrying team, patients can be better managed and have improved
out laryngectomy rehabilitation. Tracheoesophageal access to care. Nine of the respondents also emphasized
speech (n=28/50) was the most preferred mode of the “need for facilities”, particularly instrumentation for
alaryngeal voice rehabilitation, followed by oesophageal swallow assessment.
speech (n=10/50) and artificial larynx (n=9/50).
Three SLPs carried out insertion, removal and Discussion
troubleshooting of voice prosthesis independently. Eleven
SLPs reported that the ENT surgeon handled it, while The findings from this study highlight the significant
another 11 indicated that both the SLP and ENT surgeon variability in SLP-led service delivery for HNC patients
handled it equally. Three reported handing by HNC in India. The initial time point of referral of HNC patients
surgeon. Out of all the devices, Provox voice prosthesis depends entirely on institutional practices. However,
was the most preferred by 16 participants, followed by in the absence of a standard operating procedure, the
Blom-Singer by eight respondents. Interestingly, two judgment of “when to refer” for rehabilitation is often at
respondents preferred indigenous voice prostheses over the discretion of the treating physician/surgeon.
the other options. From the additional comments of the survey
respondents, it is evident that many SLPs vouch for the
Feeding tube-related questions need for heightening awareness about speech and swallow
The recommendations from SLPs concerning oral rehabilitation among medical professionals to facilitate
intake while utilizing a feeding tube were varied. Out of more referrals and prevent patients from missing the
the 75 participants, 43 SLPs suggested taking a “small, potential benefit of SLP services. The HNC caseload
controlled amount of oral intake” along with using the of the respondents comprised majorly of patients who
feeding tube as the primary source of nutrition. Ten underwent surgical resections than patients treated with
recommended refraining from any oral intake while using organ preservation regimens. A similar preference was
a feeding tube, and 11 advised taking in “as much oral reported in the study by Roe rt al., [13]. Only a third of
intake as possible”. In addition, 11 SLPs indicated that the respondents carried out a pre-operative evaluation,
the decision to permit oral intake while using a feeding and the time point to initiation of speech and swallow
tube was dependent on the patient’s evaluation. rehabilitation after surgery was highly variable across
different facilities. This is contrary to the recommendation
Treatment compliance, Reasons for poor adherence, and by the National Comprehensive Cancer Network (NCCN)
Duration of follow up [16], which mandates pretreatment speech and swallow
Twenty-four SLPs reported that less than a quarter of assessment for patients with baseline issues and those
their patients were following the prescribed swallowing whose treatment is likely to affect speech and swallow
intervention. About 33 % of the patients of 14 participants problems. Therefore, all patients with head and neck
and 50 % of 24 participants were committed to speech cancer must undergo a speech and swallow evaluation
and swallowing intervention. Only thirteen participants pre-operatively.
reported that over 50% of their patients were adhering to The UK guidelines for speech and swallow
the intervention. Possible causes of low adherence were rehabilitation in head and neck cancer patients [5] and
identified in Table 3 based on the free-text responses. the American Head and Neck Society recommends
Fifty-four SLPs reported conducting follow-ups as baseline evaluation of HNC patients [6], as it may help
required on a “case-to-case” basis. Nine SLPs mentioned identify patients who may require additional support
following up their patients until “three months post-cancer such as enteral nutrition during cancer treatment,
until treatment, while others stated following up “until voice rehabilitation etc. In addition, early teaching of
one year”. Five participants claimed to conduct long-term swallowing strategies is advised to maximize function
follow-up of “more than a year”. However, patient and reduce the time required for removing tube feeding.
compliance with follow-up was not consistent. Thirty-six The group of HNC patients most frequently referred
participants informed that only 25% or fewer patients to the SLP were those who underwent glossectomy, with
adhered to follow-up, while 17 SLPs mentioned that 50% laryngectomy patients following closely behind. This is
of their patients followed up. nine SLPs mentioned that likely due to the overt communication and swallowing
33 % of their patients followed up. Only thirteen SLPs difficulties experienced by patients after the procedure,
reported a higher follow-up rate of more than 50% of which necessitates a referral for speech and swallowing
the caseload. rehabilitation. Moreover, it is worth noting that India has
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Janet Jaison Varghese et al

the highest incidence of tongue cancer worldwide [17], frequently express concern about these domains [26],
and surgical intervention is the most favored approach to as they synergistically impact food consumption and
treating this form of cancer [18, 19]. This could explain dysphagia. As a result, clinicians often resort to explore
the increased number of patients with glossectomy. various approaches to rehabilitate taste and smell.
Fifty SLPs reported carrying out laryngectomy According to reports, the level of adherence to
rehabilitation. Even though tracheoesophageal speech intervention regimens and follow-ups was suboptimal.
was the preferred rehabilitation mode for 28 SLPs, The reasons for this were attributed to poor patient
it is noteworthy that only 14 SLPs reported handling motivation, lack of awareness regarding the potential
voice prostheses independently or with ENT specialist’s benefits of the intervention, and financial constraints that
assistance. It has been reported in other studies that there hindered patients from attending follow-up hospital visits.
are only few centers in India that possess the necessary Overall, the rehabilitation of HNC in India led by SLPs is
expertise to implement post-laryngectomy voice making progress, and the approach to practice is changing
rehabilitation effectively [20]. It would be beneficial for to align with the trends observed in Western countries.
future studies to investigate why there are fewer SLPs SLPs in India are transitioning to a proactive approach to
involved in laryngectomy rehabilitation. minimize the expected decline in speech and swallowing
Although there were some similarities in the during cancer treatment and initiate rehabilitation as early
assessment protocols used, there were also variations as possible instead of waiting until after cancer treatment.
across different settings. While clinical swallow A recent survey [27] compared the usual care practices for
assessments were performed regularly, not all hospitals dysphagia management of HNC patients in the USA with
had access to Fiberoptic Endoscopic Evaluation of an earlier survey [14] and reported that the practice pattern
Swallowing (FEES) and Videofluoroscopic Swallow had improved significantly, with increased early referrals
Study (VFSS). Furthermore, even when these instruments and implementation of intervention during the period of
were available, their utilization was limited. HNC treatment. This positive change can be attributed
Access to instrumental swallow assessments in to the implementation of evidence-based practice in the
India is restricted due to a range of factors, including a assessment and management of swallowing disorders.
dearth of clinical proficiency, limited experience, high The clinical arena of speech-language pathology in India
expenses, and inadequate support from physicians, as is also influenced by clinical and scientific e-resources
reported by Rangarathnam and Desai [12]. However, such as journal articles, webinars, and seminars from
these assessments are essential in comprehending the Western countries, which shape and modify the practice
biomechanics of swallowing and ensuring its safety, patterns [23].
which cannot be determined by a clinical examination One of the limitations of this study is the low
alone [21]. Given the importance of instrumental swallow representation of participants from states in the Northeast-
assessments in patient care, it is imperative for healthcare which has the highest HNC incidence as per National
professionals to address these obstacles and work towards Cancer Registry Programme Report, 2020 [28]. Moreover,
more widespread availability of instrumental assessments. it should be noted that this survey only covers care patterns
According to the responses received from participants, provided by hospital based SLPs. Thus, it does not account
it appears that patient-reported outcome measures for the care provided by SLPs in private practice or non-
(PROMs) have not been widely utilized. One possible hospital work settings who may also work with this patient
explanation for this is the absence of tools that are population. Additionally, we have yet to capture care
customized for specific cultures and languages in various patterns in hospitals without an in-house SLP.
regions. This is compounded by the existence of different There is an estimated 12% rise in cancer cases in India
dietary habits in different regions. As Dang et al. [22] have over the next five years [28]. Improving early identification
noted, PROMs developed in Western countries may not be and treatment of cancer is undoubtedly essential. However,
appropriate due to differences in culture and region [22]. we should also prioritize rehabilitation and survivorship
Speech issues were usually assessed using articulation to ensure that patients receive the best possible care.
tests and intelligibility rating scales. There was a consensus To achieve this, we need to sensitize oncologists and
preference toward “Oromotor exercises” and “articulatory surgeons regarding rehabilitation and enhance referral
drills” in improving speech precision. The use of Oromotor pathways for patients with HNC cancer. Early referrals and
exercises among Indian SLPs has been reported in another interventions can improve patient functionality and overall
survey [23]. However, research over the past two decades quality of life [29]. A multidisciplinary team approach is
has criticized the efficacy of Oromotor exercises in speech needed for effective assessment and management [5].
disorders [24]. Despite this, the popularity of this approach Additionally, the capacity building in the SLP community
among clinicians depicts an equivocal perspective on this can be improved by leveraging the benefits of special
topic. The use of this approach may be due to the benefits interest groups.
of range of motion exercises and resistance training in Advocating for the needs of head and neck cancer
reducing trismus and improving articulatory precision in patients is crucial for SLPs in India. It is also important
patients with head and neck cancer [25]. to conduct vanguard studies that can identify barriers
Clinicians often find themselves relying on informal to accessing SLP services and come up with potential
methods to assess and intervene in patients’ taste and solutions. These solutions should be tested, evaluated,
smell, likely due to a lack of established best practices and implemented to overcome the barriers.
for managing these sensory skills. However, patients In conclusion, the current study shows that few
458 Asian Pacific Journal of Cancer Prevention, Vol 25
 DOI:10.31557/APJCP.2024.25.2.453
Surveying Practice Patterns of the Speech–Language Pathologist in the Care of Head and Neck Cancer Patients in India
observable trends exist, along with a lack of consensus on et al. Head and neck cancer survivorship consensus statement
the rehabilitation of HNC patients in India. Formulations from the american head and neck society. Laryngoscope
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to align the current clinical practice in India with that in org/10.1002/lio2.702.
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developed countries. SLPs are a crucial component of the
K, Sokoloff W, Hayatbakhsh R. Comparing dysphagia
medical team and must be involved in all aspects of patient therapy in head and neck cancer patients in australia with
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All authors participated in conceptualizing the idea speech pathology service delivery. Aust J Rural Health.
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and designed the study. JJV carried out the data collection,
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analysis and prepared the draft manuscript. VA,BR and et al. Speech pathology service enhancement for people with
KS revised the draft for intellectual content. All authors head and neck cancer living in rural areas: Using a concept
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Ethical Declaration 11. Krishnamurthy R, Bhat B, Nayak PS, Balasubramanium
The current study is a preliminary part of an RK. Videofluoroscopy practice in india: A survey of speech-
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