Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Purpose: Head and neck lymphedema (HNL) is a potential complication following treatment for head and neck cancer (HNC), arising from surgical or tumor obstruction of lymphatic drainage. The prevalence of HNL is unknown, with estimates ranging from 12% to 90% in post-treatment patients. Symptoms including pain, persistent edema, disfigurement, dysphagia and dysphonia can negatively impact a patient’s quality of life. A lack of consensus on a standard diagnostic algorithm makes clinical diagnosis challenging. This study aims to identify which symptoms are most debilitating for patients diagnosed with HNL and to assess the impact on quality of life using the Head and Neck Lymphedema and Fibrosis Symptom Inventory (HN-LEF SI), a previously validated tool. The findings may help clinicians diagnose and manage HNL more effectively in affected patients.
Methods: Patients who underwent neck dissection and/or parotidectomy at our institution were surveyed using the HN-LEF SI during clinic follow-ups. A retrospective chart review was conducted to gather data on demographics, medical history, cancer staging, surgical details and postoperative recovery. A clinical diagnosis of lymphedema was defined as a referral to Lymphedema Physical Therapy (LPT). Statistical analysis including Fisher’s Exact Test, Pearson Correlation, Shapiro-Wilk’s Normality Test and Mann-Whitney U Tests was performed using R Software.
Results: A total of 78 patients participated, with 35.9% (28 patients) receiving a clinical diagnosis of HNL. The cohort was predominantly White, non-Hispanic males who underwent neck dissections for cancer. Patients referred to LPT had significantly higher overall HN-LEF SI scores compared to those not referred (1.43 vs 0.99, p<0.05). Subdomains related to swallowing (p<0.05), body image (p<0.05) and communication (p=0.01) showed strong correlations with lymphedema referrals. While advanced cancer stage and neck dissection were associated with higher HN-LEF SI scores, they were not predictive of receiving a clinical lymphedema diagnosis or referral for LPT.
Conclusion: The preliminary findings suggest that higher HN-LEF SI scores, particularly in the domains of swallowing, body image, and communication, are useful in screening for HNL. Patients with advanced cancer stage and neck dissection scored higher on the inventory but were not more likely to be referred to LPT, indicating the need for more proactive screening in this population. Future studies will expand the sample size and scope to further assess the utility of the HN-LEF SI in aiding diagnosis and identifying patients who may benefit from treatment for HNL.