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What is Lymphedema?
Lymphedema is a term used to describe swelling in an area of the body caused by an accumulation of lymphatic fluid. The lymphatic system is a complex network of tissues, glands, and organs that filters out toxins and viruses, helping our bodies heal and maintain homeostasis.
Why is lymphedema a concern for cancer patients and survivors?
Head and neck lymphedema is a frequent complication of radiation or surgery for head and neck cancer. It can cause difficulties in swallowing, chewing, voice changes, trouble speaking clearly, breathing difficulties, and issues simply turning the head.
If physical therapy (PT) and occupational therapy (OT) are traditionally the therapies that address lymphedema, why are speech therapists beginning to treat this condition as well?
Lymphedema treatment can be expensive. Patients require not only hands-on manual therapy but also compression garments, tape, bandages, foam, and gauze. It wasn't until January 2024 that insurance companies were required to cover some of the costs related to lymphedema therapy.
Due to the personal financial burden and time commitment required for clinicians to become certified lymphedema therapists, as well as low insurance reimbursement rates, many physical therapists and occupational therapists have chosen not to specialize in this area. As a result, many regions of the country (including the Florida Panhandle) struggle with staffing to meet the true need. The PTs and OTs who treat lymphedema are highly skilled and necessary, and we wish there were more of them.
But why are speech therapists addressing this? I know someone with lymphedema who can talk just fine!
Speech therapists (or speech-language pathologists) treat conditions "from the neck up." We are the experts in swallowing, speech, and voice. Internal pharyngeal lymphedema, silent aspiration, and dysphonia caused by vocal abuse are conditions that PTs and OTs are not trained to address. Patients were losing function in speech, swallowing, and voice unnecessarily because we had to wait for them to complete a round of lymphedema treatment before we could target weak swallowing muscles.
Think about this objectively: If a patient has a rock-hard neck or is too swollen internally to adequately feel food and liquid as they try to swallow, there isn't much we can do to help them restore a safe swallow. Patients have historically gone weeks, months, or even years before appropriate referrals for speech therapy are sent. By then, it can be a long, disheartening road to restore function and/or find compensatory strategies to safely swallow and communicate their needs verbally.
Some speech therapists who specialize in treatment for head and neck cancer petitioned to become certified lymphedema therapists. Their advocacy on behalf of their patients paid off, and now more speech therapists are learning how they can help as well.
This is a game changer.
Lymphedema does not heal on its own. Our patients need to understand that this is a lifelong condition, but it can be managed through Complete Decongestive Therapy (CDT), which includes manual lymph drainage, compression therapy, appropriate exercises, skin care, and environmental modifications. By proactively teaching speech, voice, and swallowing exercises while adding an additional clinician who can perform and teach CDT, our patients have better outcomes.
Where can I learn more?
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