What is your study/project about?

Head and neck cancer is the eighth most common cancer in the UK, with nearly 13,000 new cases a year. For many patients radiotherapy is their best chance of a cure, but the treatment often leads to changes in the structure and function of the muscles of speech, chewing and swallowing.  These changes lead to patients experiencing difficulties communicating, eating and drinking which have a negative impact on their quality of life. This project aims to see if ultrasound will be helpful to assess the size, structure and changes in key muscles before and after radiotherapy to guide assessment and therapy.

Why is your study important?

Speech and Language Therapists (SLTs) work with patients who are having radiotherapy for head and neck cancer to assess and manage their speech and swallowing difficulties. These difficulties are often because of the changes to the muscles caused by radiotherapy (scarring, stiffening) and become worse over time. We do not understand exactly when or how these changes happen or how to treat them, but we patients tell us that these side effects are very difficult to live with. This study will give us some initial information about whether ultrasound might be a useful method to learn more about muscle changes and help us to start to be more targeted with the therapy we offer. This will hopefully mean better outcomes for the patients we see in terms of their speech and swallowing.

How was the intervention developed?

SLTs are already using quantitative muscle ultrasound of speech and swallowing muscles (QMUS) with children and adults who have progressive neurological disorders both as an outcome measure and in some cases for biofeedback. In a head and neck cancer population, ultrasound is often used by radiologists and surgeons to help diagnose the condition but is not routinely used by SLTs. We have adapted the QMUS protocol from studies focused on an adult population with progressive neurological disease and are using it for this study.

Who is the research team?

The research team is led by Dr Gemma Clunie (a clinical academic SLT). At the NHS Trust there is another  clinical academic SLT  Dr Margaret Coffey, an oncologist Dr Dorothy Gujral and a head and neck surgeon Mr Jonathan Bernstein. At the university there is an academic expert in biomechanics, Professor Alison McGregor. Finally there is soon-to-be Dr Jodi Allen an SLT colleague and researcher at a different institution who is an expert in QMUS within the adult progressive neurological disease population.

What will happen during the study?

We are completing QMUS on 20 patients, pre-radiotherapy and at least 3 months post-radiotherapy. This involves assessment of the following muscles involved in speech and swallowing: submental muscles (left and right anterior belly digastric and geniohyoid), masticatory muscles (masseter and temporalis), and tongue muscles (longitudinal, transverse and genioglossus). We will use the ultrasound images to identify if we can a) identify the key muscles, b) measure the size of the muscles c) measure the structure and echogenicity (grayscale) of the muscles. We will also describe any differences between the two timepoints.

At both time points the participants also complete two patient reported outcome measures, one about swallowing and one about their speech, and we are completing 3 clinician reported outcome measures as well. At some point during the study the participants also complete a survey on the acceptability of the ultrasound procedure. We will describe any patterns in these outcome measures and compare them descriptively to the QMUS data.

What will happen after the study?

This is a small pilot project to determine the feasibility and acceptability of using QMUS for assessment of key speech and swallowing muscles pre- and post-radiotherapy. If we show that it is both feasible and acceptable to use QMUS in this way, the next steps will be to seek funding for a bigger grant to be able to complete a larger trial to explore the potential for this technique in more details with this population.

What is the future of your research?

Radiotherapy treatment for head and neck cancer is a known area of significant morbidity in relation to speech and swallowing function. We would hope that the development of QMUS as an assessment and monitoring technique for SLTs will help us to be more specific and timelier with our interventions.   We also have links with a team at the Institute of Cancer Research to consider involving elastography, an ultrasound technique that measures stiffness in the muscles in future studies, and there is huge potential to use QMUS as a biofeedback tool as part of therapy programmes.