Side Effect: Trouble Speaking

What is Trouble Speaking?

Trouble with speaking is a speech disorder characterized by poor voice quality. Patients can experience changes in voice pitch, volume, or vocal effort known as dysphonia. Patients with cancer can also experience difficulty in articulating speech sounds or producing speech due to impaired movement of the lips, tongue and mouth known as dysarthria (muscles used to produce speech are weak).

Who has Trouble Speaking?

Cancers of the head and neck region can directly affect the speech muscles and nerves. Additionally, cancer treatments such as surgery and radiation therapy can also cause dysarthria by damaging the speech muscles and nerves.

Chemotherapy-related trouble speaking examples:

• Although extremely rare, chemotherapy treatment with irinotecan has been reported to cause dysarthria and typically occurs within 90 minutes of treatment.
• Vincristine, an IV chemotherapy medication, has also been rarely associated with vocal cord paralysis.

How to prevent Trouble Speaking

Preventing speaking trouble in patients with cancer receiving radiation involves careful planning and coordination of treatment. Radiation to the head and neck may be delivered with techniques that minimize the dose to the vocal cords.

Speech and language therapy can be helpful in teaching patients strategies to preserve their voice and maintain good vocal hygiene during cancer treatment. Other preventive measures, such as adequate hydration, avoidance of irritants, voice training, and amplification, may reduce the risk of developing dysphonia. Behaviors to avoid include yelling or shouting, consumption of alcoholic products, and smoking.

How to treat Trouble Speaking

Treatment for dysarthria in patients with cancer may involve a combination of medical and rehabilitative approaches. Medical treatments may include medications to reduce inflammation or surgery to remove tumors that are pressing on speech muscles or nerves.

Voice therapy rehabilitation methods such as speech therapy, physical therapy, and occupational therapy can help patients improve their speech and regain functional communication skills.

• Dysarthria from irinotecan is typically reversible within 24 hours with most symptoms resolving within 2 to 7 hours. Although not routinely recommended, some cases of dysarthria due to irinotecan can respond to treatment with atropine.
• Dysarthria from vincristine may or may not improve with time.