Head And Neck Cancer Across The Continuum Of Care: Addressing Swallowing Challenges




Course Type


This comprehensive online course will provide the participant an in-depth examination of head and neck cancer, its presentation, functional sequelae, evaluation approaches, treatment options, and provide an evidence-based approach of optimal patterns of care for head and neck patients with swallowing dysfunction. Types of treatment for head and neck cancer and their impact on swallowing and communication function will be described, including both surgical and organ preservation.

Assessment and evidence-based practice relevant to the head and neck cancer population will provide support for the practitioner in developing a holistic approach to rehabilitation which will optimize functional outcomes and, most importantly, quality-of-life. Video presentation will be an integral part of this course. By the completion of this course, the participant will possess a comprehensive understanding of dysphagia management in this challenging and rewarding population. Offered for 0.9 ASHA CEUs – 9 contact hours.

Course Run Time: 9:00:00

Course Overview:

  • Management of Head and Neck Cancer (HNC) Throughout the Continuum of Care
  • The Pathophysiology of Swallowing Dysfunction in HNC
  • The Role of the Speech-Language Pathologist in the Patient's Journey: Timelines and Interventions
  • Aspiration in Head and Neck Cancer: What Do We Know and how Concerned Should We Be?
  • Predicting Swallowing Function
  • Diagnostic Considerations
  • Treatment of Swallowing
  • The Feeding Tube Controversy

The content of this online CE course does not focus exclusively on any specific proprietary product or service. Presenter financial and non-financial disclosures may be found in the Presenter & Disclosures area.

Course Format:

Video PowerPoint presentation with author narration & downloadable handout.

Course Objectives

  1. List the types of swallowing disorders seen in the surgically treated and organ preservation treated head and neck cancer patient.
  2. Explain the acute and chronic effects of radiation therapy on structure and function of the swallow mechanism.
  3. Identify key factors that predispose individuals to dysphagia after organ preservation treatment.
  4. Explain the impact of tumor location, stage of disease, and extent and type of treatment on post-treatment dysphagia severity.
  5. Discuss assessment tools and outcomes measures to evaluate health-related quality-of-life and functional outcomes of swallowing.
  6. Discuss patient, tumor, and treatment considerations to help identify patients that would benefit from prophylactic feeding tube placement.
  7. Discuss prophylactic intervention techniques to limit swallowing dysfunction.
  8. Explain the specific components of swallowing intervention before, during, and after cancer treatment.
  9. Discuss the physiotherapeutic, device driven, and prosthetic management strategies for swallowing dysfunction after cancer treatment.
  10. Discuss current best practice and new directions in the care of the individual with dysphagia after head and neck cancer and its treatment.  

Presenter & Disclosures

Paula A. Sullivan, MS, CCC-SLP, BCS-S, currently is a Senior Speech-Language Pathologist in the Department of Neurology/Speech Section, North Florida/South Georgia Veterans Health System in Gainesville, FL. Paula's clinical expertise and research are focused on swallowing disorders in head and neck cancer and at end-of-life. She has been affiliated with numerous comprehensive cancer centers, including H. Lee Moffitt Cancer Center, Tampa, FL, Sylvester Cancer Center, Miami, FL, and the University of Wisconsin, Madison, WI. Paula also has participated as part of numerous clinical research trials in swallowing.

Paula served as a co-regional primary investigator for the largest controlled, randomized research trial in oropharyngeal dysphagia funded by the National Institutes of Health (Protocol 201). Protocol 201 examined the effectiveness of chin down and thickened liquids in individuals with dementia and Parkinson's disease both with and without dementia. Other research activities include collaborating with Dr. Jeri Logemann on numerous National Cancer Institute clinical swallowing protocols in head and neck cancer. Additionally, Paula has published numerous articles, book chapters, and co-authored books, including Swallowing Intervention in Oncology and the Easy-To-Swallow, Easy-To-Chew Cookbook. She also has co-authored multiple national guidelines, directives, and policies relating to oropharyngeal swallowing disorders for both the Veterans Health Administration and the American Speech-Language-Hearing Association (ASHA). She is a board recognized specialist in swallowing and swallowing disorders. Paula is an ASHA Fellow and former coordinator of ASHA's Division 13, Swallowing and Swallowing Disorders. She was named "2013 Clinician of the Year" by the Association of Veterans Affairs Speech-Language Pathologists. 

Speaker Disclosures:

Financial — Paula Sullivan is a coauthor of the text, "Easy-To-Swallow; Easy-To-Chew Cookbook"; receives royalty payments.

Financial — Paula Sullivan is a presenter of online CE courses sponsored by Northern Speech Services; receives royalties.

Nonfinancial — Paula Sullivan has no relevant nonfinancial relationships to disclose.

Intended Audience/Accreditation

This program is offered for 0.9 ASHA CEUs (Intermediate Level; Professional Area).

Intended Audience

  • SLP

ASHA CEUs: NSS online courses are registered with ASHA and are offered for ASHA CEUs. The number of ASHA CEUs is noted above. Note that 0.1 ASHA CEU = 1 contact hour = equals 1 CEE.

ASHA CE Registry: During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.

ASHA CEUs: Attendees must meet at least one of the following conditions in order to be eligible to earn ASHA CEUs:

  • Current ASHA Member
  • ASHA Certificate of Clinical Competence (CCC) Holder
  • Licensed by a state or provincial regulatory agency to practice speech-language pathology (SLP) or audiology
  • Credentialed by a state regulatory agency to practice SLP or audiology
  • Credentialed by a national regulatory agency to practice SLP or audiology
  • Engaged in a Clinical Fellowship under the supervision of an individual with their ASHA CCC
  • Currently enrolled in a masters or doctoral program in SLP or audiology

If an attendee is not an ASHA member or CCC holder but meets any of the above criteria, they may inform the ASHA CE Registry of their eligibility by visiting this site.

Licensing Boards: Most state licensing boards DO accept CEUs earned online (usually classified as home-study credits). Some state boards do, however, place a limit to the number of credits that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any credit limits related to home-study courses prior to registering for this course.

Additional accrediting agencies by which Northern Speech is an approved CE provider:

  • California: NSS is approved as a provider of continuing education by the California Speech-Language Pathology & Audiology Board. Provider #PDP4. Online CEU limits may apply; please contact SLPAHADB for current online CEU acceptance policies.
  • Iowa: NSS is approved as a provider of continuing education by the Iowa Board of Speech Pathology and Audiology Examiners. Provider #169.
  • Kansas: NSS is approved as a provider of continuing education by the Kansas Department of Health and Environment. Provider #LTS-S0005.

Frequently Asked Questions

Customer Support: Please phone 888.337.3866 or email info@northernspeech.com.

Course Completion Timeframe:

You have unlimited time to complete our online courses. You may log off and log on as often as you’d like to in order to complete all sections of a course.

However, completion dates are based on Eastern Standard Time. Therefore, if you need your CEUs by a certain date, be sure to complete the course test before 11:59pm EST on that date. For example, if you need CEUs before January 1st, you will need to complete the course test before 11:59pm EST on December 31st.

Content Access:

Access to course materials and content does not expire, even after completing the post test. You may continue to review course material by logging into your NSS account, clicking the My Online Courses tab, and then viewing your desired course.

Certificate of Completion:

On successful completion of the post test (80%), a certificate will be immediately available for download and/or printing. This certificate will include your name, date of completion (based on Eastern Time Zone, USA/Canada), and number of contact hours (CEUs / CEEs). Please note that CEUs are awarded on the date of successful test completion, not the date of course enrollment. Please ensure that you successfully complete the post test prior to any licensure renewal dates.

ASHA CE Registry Submission:

During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.

Purchase Orders:

Purchase orders are NOT accepted when registering for online courses. Payment must be made online in the form of a credit or debit card payment.

What is an Online Course?

Our Online Courses consist of video, audio, and/or text content and are offered for ASHA CEUs. Unlike a webinar, which requires participants to be logged on and at a computer at specific times, our Online Courses are available to you at any time, from any device, via your NorthernSpeech.com online account. You may work at your own pace and start and stop your course as you wish. Your course will conclude with a short post test. On successful completion of the post test (>80%), a printable certificate of completion is presented to you.

Receiving CEUs:

Northern Speech is an ASHA CE Provider and our online courses are registered with ASHA and offered for ASHA CEUs. Please note that successful completion of the online post test is required prior to the awarding of CEUs. Please contact your state licensing board for acceptance policies related to CEUs earned online.

Registering for an online course:

You may browse all online courses by clicking the Continuing Education tab above, then Online Courses. Once you find a course, click Enroll Now, and you will be asked to either log into your existing Northern Speech account or create a new online account. Once you’ve entered your account information and provided your credit card payment, your course will be immediately available to you.

Accessing your purchased course or returning to a purchased course:

You will be able to access your online course by logging into your Northern Speech account and then clicking the My Online Courses tab on your profile screen. Click the course you would like to start or to resume. From there, proceed through the course sections until you are ready to complete the post test. You do not have to complete your course all at once. You may log on and off as you wish.

Testing requirements:

Each online course concludes with a post test consisting of multiple choice or true & false questions. Scores of 80% or greater are required for successful course completion and awarding of CEUs. You may revisit course materials and retest as needed to achieve a passing score.

Number of CEUs offered:

We offer courses from 1 to 21 contact hours. Each course will note the number of CEUs offered. Please note that 0.1 CEU = 1 contact hour = 1 CEE.

State licensing boards and online CEUs:

NSS is an ASHA CE Provider and most state licensing boards DO accept ASHA CEUs earned online (usually classified as home-study credits). Some boards do, however, place a limit to the number of CEUs that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any CEU limits related to home-study courses prior to enrolling in an online course.

Course formats:

Our course formats include: text, audio, video, and PowerPoint with author narration. Each course will note the format on the course description page.

Course handouts:

Most of our online courses provide a link to download the accompanying handout as a PDF file. 

Group discounts:

Groups of 3 or more are eligible for a 20% discount on each registration on most of our online courses. To receive this discount, registrations need to be processed together via the "Group Rates" tab on the Online Course of your choice.

Computer requirements:

For our online courses to function best, we recommend that you update your computer to include the newest version of your Internet browser (Safari, Chrome, Firefox, Edge, Internet Explorer, etc.) and newest version of your computer's operating system. Also a high-speed Internet connection is recommended (cable or DSL). Speakers or headphones will be required for many of our courses as many contain audio components.

Course Cancellation Policy:

A purchased online course can be exchanged, refunded, or transferred to another individual if contact is made with NSS (via phone or email) within 30 days of purchase and the course materials have not been viewed or downloaded. 

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"I volunteer with Mercy Ships in Africa and with orphanages in Bolivia--and all have severe cases, so this information is relevant." – J.E. (Apr. 2020)

"I liked how the course widened my knowledge into this population group and prepared me better for my new job." – Y.K. (Mar. 2020)

“I appreciated the discussion of chemo and radiation treatment and how / when to begin skilled ST treatment for PO intake. I liked the visual details presented.” – R.M. (Feb. 2020)

“I liked how comprehensive the course was. The discussion of applicable swallowing exercises was especially helpful.” – A.G. (Jan. 2020)

“All of it was beneficial. The cancer treatment information and going over how to predict outcomes for therapy as well as modalities of tx.” – R.K. (Dec. 2019)

“Fantastic presentation. I found the entire course to be very helpful. Paula is a wealth of information.” – E.L. (Dec. 2019)

"All topics were relevant and beneficial. The information was relevant to my current practice and increased my knowledge considerably." – P.S. (Nov. 2019)

"I work in a rehab setting and come across HNC often. I liked the way it was presented. The speaker broke down topics that made it easy for me to understand." – N.S. (Nov. 2019)

"I appreciated the specific treatment techniques and studies to support the recommendations given on treatment timing." – E.J. (Oct. 2019)

"The discussion of prognostic indicators, recommended timelines for instrumental assessment and for intervention as well as specific exercises which are evidence-based. Very thorough and well-organized with enough pictures to enhance understanding." – L.M. (Sept. 2019)

"Excellent course. Very complete. I can take the information and apply it immediately to my patients and tx plan." – P.B. (Aug. 2019)

"Going over the many side affects of radiation and chemo radiation therapy were most helpful. Very thorough. I enjoyed the FEES videos." – J.D. (July 2019)

"I appreciated her going over the predictors for success, case studies, treatment approaches, and considerations. The presenter was incredibly knowledgable." – C.Z. (July 2019)

"I liked that the course was systematically organized. The best discussions were on diagnostic QOL assessments and therapy." – S.W. (June 2019)

"The treatment and information about multi-disciplinary teams were most helpful." – M.Y. (May 2019)

"I enjoyed learning about the strengthening tx activities to implement. I enjoyed the class! It was thorough, and I learned a lot." – K.K. (Apr. 2019)

"I appreciated going over the pathophysiology of swallowing dysfunction in HNC. The course was very clear, great outline/handout for future reference - thank you!" – S.M. (Feb. 2019)

"I liked the video of a couple post treatment. The discussions on PEG tube placement, quality of life measures, and evidence for exercises were most helpful." – S.M. (Jan. 2019)

"I liked the specific timelines for when to see patients with head and neck cancer across their course of cancer treatment. I thought there might be more on HPV, but it was fine that there wasn't." – K.W. (Dec. 2018)

"Very thorough information. Going over the results of chemo radiation on swallowing mechanisms was most beneficial. I think the course was fabulous!" – C.F. (Dec. 2018)

"The entire course was beneficial as I'm treating more patients in home health setting. Very detailed discussions of the different anatomical changes, the importance of types of medical treatment, prosthesis, etc. Overall, an excellent course." – V.F. (Dec. 2018)

"The specific treatments for dysphagia are always the most beneficial. I liked the ease of listening and the corresponding visuals. Excellent and easy to use." – S.T. (Nov. 2018)

"I enjoyed the specific information about treatment intervention techniques. Many courses I've had in the past were not specific about treatment. I liked that there was information that was directly applicable and useable in my practice." – K.O. (Nov. 2018)

"The entire course information was useful because I've never had a HNC client. I liked the swallowing study videos and actual patient videos/pictures." – M.B. (Oct. 2018)

"I appreciated the discussion on different types of CA interventions with symptoms r/t each, EBP related to SLP intervention, predicting swallow function." – R.N. (Sept. 2018)

"The entire course provided thorough information to allow me to better assist my clients with assessment and treatment. Going over the details regarding after effects after radiation & chemotherapy were most beneficial." – G.J.J. (Aug. 2018)

"I liked understanding how radiation and chemo affect the swallow. The entire course was helpful in treating my CA patients." – S.M. (June 2018)

"I liked the amount of detail provided in the course.  I was specifically interested in the treatment of patients with HNC. Working in an SNF, the majority of my patients are referred after surgery and CRT." – A.S. (May 2018)

"The course provided great information on how to be more thorough when performing MBSS, to include an A-P view on all HNC patients.  It was helpful to learn how many repetitions of each exercise should be recommended to the patients." – D.A. (May 2018)

"I did not know how much aspiration played a role in pneumonia with these patients, the course was very helpful.  I really liked the ability to make prognostic decisions." – J.R. (May 2018)

"I found the discussion on treatment of HNC patients most beneficial. I liked the attachments provided." – M.V.N. (Apr. 2018)

"Very practical information for a practicing clinician - guided by EBP where possible. Going over how radiotherapy is administered, conventional RT and IMRT, effects of CCRT, and rehab were all especially helpful." – M.B. (Mar. 2018)

"All the sections were valuable as I am new to this population. I liked how the course was organized." – D.T. (Mar. 2018)

"The sections on exercise timing and preventative care were excellent." – J.S. (Jan. 2018)

"The information on swallow studies was very helpful. I liked the useful data she presented. It was clear in the way it was presented. The course was very well done." – A.G. (Dec. 2017)

"Everything was beneficial!! This entire course is useful to my daily practice and will assist with treatments, assessments, patient education, interdisciplinary interactions, etc." – K.J. (Dec. 2017)

"This is a very difficult subject to consume, and I am happy with the practical experience of the presenter and in expectations of tx and why." – J.J. (Nov. 2017)

"Going over when to perform VFSS and what type of therapy to do at each stage of treatment was most valuable. I really liked that the course information was great evidence-based and can be applied to my caseload tomorrow." – M.R. (Oct. 2017)

"The discussions on prophylactic feeding tube considerations and QOL inventories were especially useful. I liked the convenience of completing the course at home in my own time/schedule." – J.O. (Sept. 2017)

"The treatment section was very helpful for me. I appreciate that the course helped to further develop my passion with this population." – Z.K. (July 2017)

"I enjoyed the section on HPV as well as the treatment section and radiation dose section." – J.C. (June 2017)

"The side effects of radiation/chemotherapy on swallow function and what treatments are beneficial were the most helpful. I like that there were a lot of statistics to support the importance of prophylactic swallowing therapy." – A.Z. (May 2017)

"I think just generally having research behind various components of dysphagia within this population was the most impactful. The treatment section was very helpful for guiding my team and I on how to structure our POC. Also, the information provided related to prophylactic feeding tube is helpful as we approach the medical team. I liked the examples, VFSS's, and general layout." – C.E. (Apr. 2017)

"Reviewing the swallowing exercises - sometimes even I get caught in a rut with doing the same exercises and this reminds me to mix up the exercises. I love that the swallowing exercises were taught in depth. I have attended a LOT of CEU courses on swallowing; however, since graduate school, this is by far the best review of swallowing exercises that I have seen yet! This is great!" – C.H. (Mar. 2017)

"I found it very interesting. I'm a novice to the field of ST and I feel that this was a great class to take for a new therapist. The portions on rating scales, Trismus exercises, and QoL surveys were most valuable to me." – B.M. (Feb. 2017)

"The role of the SLP throughout the cancer journey was so well explained that I am inspired to reach out to our oncology department to develop a better process for caring for these patients. The case studies and patient examples were terrific in bringing the discussion to life. This was a very comprehensive course and my expectations were exceeded." – B.C. (Jan. 2017)

"I especially appreciated the discussion re: PEG placement and the treatment information. I liked the fact that information was presented along the continuum and linked the need for SLP involvement from diagnosis through post care." – L.R. (Dec. 2016)

"All of it was beneficial! I am working with predominately HNC patients at this time in the Outpatient setting." – A.B. (Dec. 2016)

"The course addressed each phase; from diagnosis, to treatment, to what's expected once treatment is complete. I think everything was thoroughly explained." – N.T. (Dec. 2016)

"It was all very interesting as I had very little education about this topic during graduate school. I like that the course was so thorough and gave you actual goals and ideas." – N.B. (Dec. 2016)

"I liked the information on exercises for head and neck cancer patients. It verified what I was already doing and helped give me more ideas. Good information throughout the continuum of care and not just after the patient has had treatment." – T.B. (Dec. 2016)

"Treatment was the most beneficial portion -- BUT all very informative / beneficial. I'm not very disciplined, but I found myself glued to every work and every minute of this course." – J.E. (Nov. 2016)

"I enjoyed the treatment strategies / exercises; examples of ways to add resistive load to oral pharyngeal exercises; information on prosthetics; information on different QoL and dysphagia assessments; examples of different symptoms / side effects of C/RT and ways to compensate for them. Very thorough information." – K.O. (Nov. 2016)

"The discussion of the treatment of HNC patients and how to improve their QoL was most valuable for me. I liked the videos and pictures." – A.P. (Oct. 2016)

"I appreciated learning about all the different phases to treatment and when it is appropriate to intervene plus the intervention practices." – S.V. (Oct. 2016)

"Great course, both content and speaker. Very comprehensive." – T.S. (Sept. 2016)

"Paula's genuine and palpable compassion for the cases presented are a tremendous highlight to the excellence in therapy provided." – D.H. (Sept. 2016)

"Information was organized and easy to follow. Food information re: therapy goals, treatment strategies, POC, and expectations." – R.L. (Sept. 2016)

"Overall, the content was excellent-it is difficult to find higher level dysphagia courses, so the elevated content was appreciated." – C.B. (Aug. 2016)

"Thorough notes, clear examples, and multiple pictures/MBSS videos to illustrate discussion points. I especially appreciated the various exercise types and ways to adapt them to patients' needs." – K.S. (Aug. 2016)

"The information about the effects of radiation and chemotherapy as well as treating strategies was most beneficial." – T.D. (July 2016)

"I especially enjoyed the specific exercises and frequencies, info on treating/handling complications of mucositis and xerostomia. Good overall coverage of Head & Neck Cancer including diagnosis, treatment, SLP role, various components (tube feeding, tracheostomy, outcomes...)." – G.C. (June 2016)

"I liked the ideas of how to begin helping my patients immediately. This will help me develop a better protocol of how to work with my patients." – N.G. (Apr. 2016)

"It was great! Very functional information about the HNC patient as a whole (nutrition, medical issues, QoL, diet). I appreciated the treatment recommendations for before/during/after, as well as the frequency of seeing patients at each stage of recovery." – K.N. (Feb. 2016)

"The discussions on exercises and counseling were most beneficial." – L.D. (Jan. 2016)

"The coverage on treatment planning and rehabilitation was very helpful. I liked the comprehensive nature of the course." – E.F. (Jan. 2016)