Dysphagia Therapy Following Radiation Therapy for Head and Neck Cancer: Speech-Language Pathologists' Practice and Preferences

Purpose: This study investigated the perspectives of speech-language pathologists (SLPs) providing dysphagia therapy for head and neck cancer (HNC) patients receiving radiation therapy (RT). It explored current practices versus perceived optimal practice, therapy preferences, and factors influencing these preferences. Method: A total of 152 SLPs completed a 32-question survey. Response numbers varied per question due to the skip logic design. Descriptive analysis was conducted. Results: Most SLPs provided one to three total sessions pre-RT (96%) and one session per week during RT (across 7 weeks), and they reported that 3.5 total sessions pre-RT ( SD = 4.3) and 6.9 total sessions across the RT period ( SD = 5.8) would be optimal. Post-RT, 24% reported providing more than 10 total sessions, while the perceived optimal number was 13 total sessions post-RT. The most frequently selected interventions were effortful swallow, tongue base retraction exercises, and proactive swallowing therapy, while neuromuscular electrical stimulation and thermal tactile stimulation were the least preferred. Factors influencing intervention choices included evidence supporting its use (98.6%), compatibility with SLP's skills (98.5%), and the patient's quality of life (97.2%). Less influence was attributed to caseload limitations (58.3%), financial-related factors, the need for preparation time prior to therapy sessions (38.9%), and the ability to deliver by teletherapy (33.3%). Conclusions: A mismatch remains between current practices and perceived optimal practice, particularly pre- and post-RT. SLPs applied various therapeutic interventions and programs. Participants prioritized evidence, patient quality of life, swallowing deficits, comorbidities, and their own skills and ability to implement a given therapy.