Challenges and Opportunities for Speech-Language Pathology Services in Comprehensive Head and Neck Cancer Care: Insights From a Mixed Methods Study

Ben B Levy; Jade Goodman; Andrea Gomes; Rosemary Martino; Christopher W Noel; Pabiththa Kamalraj; Frances C Wright; Jonathan C Irish; Lesley Gotlib Conn; Antoine Eskander

doi:10.1002/hed.28234

Challenges and Opportunities for Speech-Language Pathology Services in Comprehensive Head and Neck Cancer Care: Insights From a Mixed Methods Study

Head Neck. 2025 Jul 3. doi: 10.1002/hed.28234. Online ahead of print.

Authors

Ben B Levy^{1

2}, Jade Goodman³, Andrea Gomes^{4

5}, Rosemary Martino^{1

5

6}, Christopher W Noel¹, Pabiththa Kamalraj⁷, Frances C Wright^{7

8

9}, Jonathan C Irish^{1

4

9}, Lesley Gotlib Conn¹⁰, Antoine Eskander^{1

2

7

10}

Affiliations

¹ Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
³ Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
⁴ Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada.
⁵ Department of Speech-Language Pathology, University of Toronto, Toronto, Canada.
⁶ Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.
⁷ Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁸ Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
⁹ Cancer Care Ontario, Toronto, Ontario, Canada.
¹⁰ Sunnybrook Research Institute, Toronto, Ontario, Canada.

PMID: 40611542
DOI: 10.1002/hed.28234

Abstract

Background: Speech-language pathologists serve a critical role within multidisciplinary head and neck cancer care teams. Provision of speech-language pathology services for head and neck cancer patients varies by region and is not well characterized.

Methods: A mixed methods scoping assessment was conducted with a purposive sample of speech-language pathologists from designated comprehensive head and neck cancer centers. Each speech-language pathologist completed a 31-item survey and 60-min semi-structured interview.

Results: Analysis of survey responses and qualitative interviews identified three major themes: unsuitable infrastructure; multilevel barriers; and the need to champion speech-language pathology services. Speech-language pathologists consistently reported inadequate resources, inequitable services, and increasing job responsibilities associated with growing patient complexity and caseloads.

Conclusions: Significant systemic barriers impede the effective delivery of speech-language pathology services in head and neck cancer care. Our findings and recommendations create an important foundation for healthcare agency decisions on the allocation and funding of speech-language pathology services.

Keywords: cancer care continuum; mixed methods; models of care; multidisciplinary care; speech‐language pathology.