Communication after Cancer

Communication after Head and Neck Cancer

How we talk

To understand the impact of your surgery/ treatment, it is useful to see how we speak, (once we have the opportunity and the message). We breathe in and the out breath can then be used to voice – the vocal folds close and get in the way of the airstream – creating the Bernoulli effect. The tone of our voice depends on – the amount of air, the tension in our throat and the physical condition of our voice-box.
The sound is then further shaped by the shape of our throats and mouths, tension or swelling can change the sound a great deal. There are just two sounds made by our voice box alone these are ‘h’ and the glottal stop.
Other sounds are made with our lips closing together- m, p, and b or with our lips and teeth – f,v, or teeth and tongue -th as in Thursday. Other sounds are made with the tongue touching the palate / roof of the mouth, at the front – t,d and at the back -k,g,ng and other sounds are made by extra pressure in the mouth causing longer sounds, e.g. s. Our cheeks and lip rounding are used for the sounds w and sh.
Sounds are also nasal or oral and the back part of the palate known as the uvula is responsible for making the difference -when it is up the air is stopped from going down the nose as in p and when it is down air is routed through the nose as in m.

How your ability to communicate is affected

It is sometimes difficult to predict exactly how your ability to communicate will be after surgery or chemo/radiotherapy as it will depend on several factors, some of which are:

  1. How much tissue or muscle that has had to be removed to take away the cancer,
  2. what nerves or muscles are working after the surgery,
  3. the size and shape of the flap of skin and muscle that has been put into your mouth to fill the gap,
  4. which part of the mouth has had surgery, whether you have had previous surgery or illnesses affecting your ability to talk,
  5. whether any salivary glands have had to be removed thus making your mouth drier,
  6. whether you have teeth or dentures,
  7. how your mouth heals, e.g. the amount of pain or swelling there is,
  8. your relationship with the person you are talking to (stranger/friend) and how tired you are feeling.

What may help

Voice – changes through surgery can be dramatic and if you have your voice-box removed you will receive support and therapy to guide you through this. – changes from scarring, dryness and swelling after radiotherapy (and previous biopsies being taken); drink plenty of non-caffeinated, non- alcoholic drinks, try to rest your voice – try to avoid long telephone conversations.
Palate – you may find it hard to make a difference between oral and nasal sounds you may need to wear a special clip or plate to improve things.
Tongue – certain sounds may be very difficult for you so try to remember which ones are easiest.

For everyone try to:

  1. Keep background noise to a minimum
  2. Speak slowly and deliberately
  3. Try to keep eye contact with the person
  4. Avoid talking through the house – that is try to stay in the same room to chat
  5. Tell people that you prefer if they ask you to repeat rather than pretend
  6. Use writing with difficult names.

Be kind to yourself:

You may FEEL This may make you BEHAVE
Self-conscious S Shy S
Conspicuous C Cowardly C
Angry, anxious A Aggressive A
Rejected R Retreating R
Embarrassed E Evasive E
‘Different’ D Defensive D


The other person you talk to may FEEL and BEHAVE
Sorry, shocked S Staring/speechless S
Curious, confused C Clumsy C
Anxious A Asking/ awkward A
Repelled R Recoiling/rude R
Embarrassed E Evasive E
Distressed D Distracted D

So try to be patient and

R Reassurance O Over there!
E Enthusiasm U Understanding
A Assertiveness T Try again
C Courage
H Humour

When you are feeling able to.