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Deng J, Dietrich MS, Aulino JM, Sinard RJ, Mannion K, Murphy BA. Longitudinal Pattern of Lymphedema and Fibrosis in Patients With Oral Cavity or Oropharyngeal Cancer: A Prospective Study. Int J Radiat Oncol Biol Phys 2024; 118:1029-1040. [PMID: 37939731 DOI: 10.1016/j.ijrobp.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 09/27/2023] [Accepted: 10/14/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE The study aimed to describe the prevalence, severity, and trajectory of internal lymphedema, external lymphedema, and fibrosis in patients with oral cavity or oropharyngeal (OCOP) cancer. METHODS AND MATERIALS One hundred twenty patients with newly diagnosed OCOP cancer were enrolled in a prospective longitudinal study. Recruitment was conducted at a comprehensive medical center. Participants were assessed pretreatment; at end of treatment; and at 3, 6, 9, and 12 months post-cancer treatment. Validated clinician-reported measures and computed tomography were used to assess the study outcomes. RESULTS Seventy-six patients who completed the 9- or 12-month assessments were included in this report. Examination of the external lymphedema and fibrosis trajectories revealed that the total severity score peaked between the end of treatment and 3 months posttreatment and then decreased gradually over time but did not return to baseline by 12 months posttreatment (P < .001). The longitudinal patterns of severity scores for patients treated with surgery only or with multimodality therapy were similar. Examination of the internal swelling trajectories revealed that all patients experienced a significant increase in sites with swelling immediately posttreatment. For patients treated with surgery only, swelling was minimal and returned to baseline by 9 to 12 months posttreatment. Patients receiving multimodal treatment experienced a gradual decrease in number of sites with swelling during the 12-month posttreatment period that remained significantly above baseline (P < .05). Computed tomography revealed different patterns of changes in prevertebral soft tissue and epiglottic thickness in the surgery-only and multimodality treatment groups during the 12-month posttreatment period. There were minimal changes in thickness in both regions in the surgery-only group. Patients with multimodal treatment had significant increases in thickness in both regions 3 months posttreatment that remained thicker at 12 months than at baseline (P < .001). CONCLUSIONS Lymphedema and fibrosis are the common complications of OCOP cancer therapy. Routine assessment, monitoring, and timely treatment of lymphedema and fibrosis are critical.
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Affiliation(s)
- Jie Deng
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania; Vanderbilt-Ingram Cancer Center, Vanderbilt Medical Center, Nashville, Tennessee.
| | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Vanderbilt Medical Center, Nashville, Tennessee
| | - Joseph M Aulino
- Vanderbilt-Ingram Cancer Center, Vanderbilt Medical Center, Nashville, Tennessee
| | - Robert J Sinard
- Vanderbilt-Ingram Cancer Center, Vanderbilt Medical Center, Nashville, Tennessee
| | - Kyle Mannion
- Vanderbilt-Ingram Cancer Center, Vanderbilt Medical Center, Nashville, Tennessee
| | - Barbara A Murphy
- Vanderbilt-Ingram Cancer Center, Vanderbilt Medical Center, Nashville, Tennessee
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2
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Arends CR, van der Molen L, van den Brekel MWM, Stuiver MM. Test-Retest Reliability of a Protocol for Assessment of Local Tissue Water in the Head and Neck Area. Lymphat Res Biol 2024; 22:12-19. [PMID: 37815799 DOI: 10.1089/lrb.2022.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
Background: Lymphedema measurement is vital to select appropriate treatment and monitor its progress. Quantifying lymphedema in the head and neck area is challenging. The use of tissue dielectric constant (TDC) measurements has shown promising results in other body areas. This study aims to determine the test-retest reliability of a TDC measurement protocol developed for the head and neck area. Methods and Results: A detailed measurement protocol, including eight measurement points per side, was developed. Subsequently, the reliability of the protocol was tested in a sample of healthy participants (n = 50, 28 males). Using the LymphScanner (Delfin, Finland), participants were subjected to two measurement sessions. Each measurement point was measured three times per session. Test-retest reliability for each point was evaluated using intraclass correlation coefficients (ICCs) and standard errors of measurement (SEMs). Using the average of three measurements, reliability was good to excellent for all points (ICCs 0.81-0.95), with small measurement errors (SEMs 1.51-2.86). The reliability of a single measurement was moderate to excellent for all measurement points (ICCs 0.58-0.87), with larger, but still small, measurement errors (SEMs 1.65-3.39). When using single measurements, the lowest ICCs were found for the temporal (left 0.73 and right 0.67) and submandibular (left 0.58 and right 0.77) locations. Conclusion: Measurements with the LymphScanner, taken according to the developed protocol, are reliable in healthy participants. We recommend using the average of three measurements to optimize reliability. The protocol is fit for further testing in patient populations and for determining normal values in a larger scale study with healthy subjects.
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Affiliation(s)
- Coralie R Arends
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Amsterdam Center for Language and Communication, ACLC-Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Amsterdam Center for Language and Communication, ACLC-Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Department of oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Martijn M Stuiver
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department for Quality of Life, Division of Psychosocial Oncology and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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3
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Sher DJ, Moon DH, Vo D, Wang J, Chen L, Dohopolski M, Hughes R, Sumer BD, Ahn C, Avkshtol V. Efficacy and Quality-of-Life Following Involved Nodal Radiotherapy for Head and Neck Squamous Cell Carcinoma: The INRT-AIR Phase II Clinical Trial. Clin Cancer Res 2023; 29:3284-3291. [PMID: 37363993 DOI: 10.1158/1078-0432.ccr-23-0334] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/03/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE Elective neck irradiation (ENI) has long been considered mandatory when treating head and neck squamous cell carcinoma (HNSCC) with definitive radiotherapy, but it is associated with significant dose to normal organs-at-risk (OAR). In this prospective phase II study, we investigated the efficacy and tolerability of eliminating ENI and strictly treating involved and suspicious lymph nodes (LN) with intensity-modulated radiotherapy. PATIENTS AND METHODS Patients with newly diagnosed HNSCC of the oropharynx, larynx, and hypopharynx were eligible for enrollment. Each LN was characterized as involved or suspicious based on radiologic criteria and an in-house artificial intelligence (AI)-based classification model. Gross disease received 70 Gray (Gy) in 35 fractions and suspicious LNs were treated with 66.5 Gy, without ENI. The primary endpoint was solitary elective volume recurrence, with secondary endpoints including patterns-of-failure and patient-reported outcomes. RESULTS Sixty-seven patients were enrolled, with 18 larynx/hypopharynx and 49 oropharynx cancer. With a median follow-up of 33.4 months, the 2-year risk of solitary elective nodal recurrence was 0%. Gastrostomy tubes were placed in 14 (21%), with median removal after 2.9 months for disease-free patients; no disease-free patient is chronically dependent. Grade I/II dermatitis was seen in 90%/10%. There was no significant decline in composite MD Anderson Dysphagia Index scores after treatment, with means of 89.1 and 92.6 at 12 and 24 months, respectively. CONCLUSIONS These results suggest that eliminating ENI is oncologically sound for HNSCC, with highly favorable quality-of-life outcomes. Additional prospective studies are needed to support this promising paradigm before implementation in any nontrial setting.
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Affiliation(s)
- David J Sher
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dominic H Moon
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dat Vo
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jing Wang
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Liyuan Chen
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Dohopolski
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Randall Hughes
- Department of Medical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Baran D Sumer
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chul Ahn
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vladimir Avkshtol
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
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Deng J, Lukens JN, Zhu J, Cohn JC, Andersen LP, Spinelli BA, Quinn RJ, Chittams J, McMenamin E, Lin A. Patient Experience of Photobiomodulation Therapy in Head and Neck Chronic Lymphedema. J Palliat Med 2023; 26:1225-1233. [PMID: 37116057 DOI: 10.1089/jpm.2021.0419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Purpose: Lymphedema is a common late effect of head and neck cancer treatment that causes various symptoms, functional impairment, and poor quality of life. We completed a pilot, prospective, single-arm clinical trial to determine the feasibility and potential efficacy of the use of photobiomodulation (PBM) therapy for head and neck lymphedema. In this study, we report patients' perceived treatment experience of PBM therapy and provide suggestions to better understand head and neck cancer survivors' experience of PBM therapy. Methods: Head and neck cancer patients who underwent PBM therapy completed face-to-face semi-structured interviews. Interviews were audio-recorded and then transcribed verbatim. Qualitative content analysis was used to analyze the transcriptions from the interviews. Results: Among 12 participants who consented for the study, 11 (91.7%) completed the PBM therapy. Participants described positive experiences and unique benefits about the PBM therapy, for example, decreased swelling, reduced tightness, increased range of motion, increased saliva production, and improved ability to swallow. Some participants (n = 5, 45.5%) delineated challenges related to traffic, travel time, and distance from study location. Many participants proposed suggestions for future research on PBM therapy, for example, research on internal edema and its relationship with swallowing, and indicated patients with severe lymphedema and fibrosis may be more likely to benefit. Conclusions: Findings from this study suggested the potential benefits of PBM therapy in treatment of chronic head and neck lymphedema. Rigorously designed clinical trials are needed to evaluate the effect of PBM therapy for head and neck cancer-related lymphedema. Trial Registration Number and Date of Registration: ClinicalTrials.gov Identifier: NCT03738332; date of registration: November 13, 2018.
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Affiliation(s)
- Jie Deng
- University of Pennsylvania, School of Nursing, Biobehavioral Health Sciences, Philadelphia, PA, USA
| | - John N Lukens
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA, USA
| | - Jonathan Zhu
- University of Pennsylvania, School of Nursing, Biobehavioral Health Sciences, Philadelphia, PA, USA
| | - Joy C Cohn
- Good Shepherd Penn Partners, Philadelphia, PA, USA
| | - Lucy P Andersen
- University of Pennsylvania, School of Nursing, Biobehavioral Health Sciences, Philadelphia, PA, USA
| | - Bryan A Spinelli
- Thomas Jefferson University, Jefferson College of Rehabilitation Sciences, Department of Physical Therapy, Philadelphia, PA, USA
| | - Ryan J Quinn
- University of Pennsylvania, School of Nursing, Biobehavioral Health Sciences, Philadelphia, PA, USA
| | - Jesse Chittams
- University of Pennsylvania, School of Nursing, Biobehavioral Health Sciences, Philadelphia, PA, USA
| | - Erin McMenamin
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA, USA
| | - Alexander Lin
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA, USA
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Saleem A, Noel CW, Hueniken K, Grewal R, Kwinter A, Peralta G, de Almeida JR, Goldstein DP. Quantifying Neck Fibrosis: Establishing the Domain Structure of the Neck Fibrosis Scale. Laryngoscope 2023; 133:2198-2202. [PMID: 36479707 DOI: 10.1002/lary.30497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/25/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We recently described the development of the Neck Fibrosis Scale (NFS). In this submission, we confirm domain structure and validate a scoring system for the NFS. STUDY DESIGN Prospective cross-sectional study. METHODS Between January 2020 and December 2021, 127 head and neck cancer patients with varying degrees of cutaneous neck fibrosis completed the original 15 item NFS. Exploratory factor analysis was used to identify optimal groupings with similar underlying factors. The association between the domains of the NFS and various measures of neck morbidity (i.e., construct validity) were assessed using gamma regression. RESULTS Exploratory factor analysis confirmed 13 of the 15 items from the NFS mapped onto two factors, which were labelled 'physical' and 'emotional' domains. Of the remaining two items, 'energy' did not load uniquely onto one factor and was removed. 'Neck-swelling' did not load on either factor (loadings <0.3) but was retained within the physical domain based on clinical importance. This resulted in a revised 14-item questionnaire. Internal consistency for these two domains was high (>0.8, p < 0.01). Both the physical and emotional domains of the revised NFS show strong correlation with the neck dissection impairment index and neck range of motion. The physical domain strongly correlated with neck elasticity (0.902 [95%CI 0.839-0.972], p < 0.01). Patients receiving multimodal therapy had physical domain scores that were 31.6% [95% 13.9-51.8] higher (worse) than unimodal therapy patients. CONCLUSIONS A domain structure and scoring strategy have been developed for the NFS. Future efforts should be directed toward an evaluation of responsiveness. LEVEL OF EVIDENCE NA Laryngoscope, 133:2198-2202, 2023.
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Affiliation(s)
- Ahmed Saleem
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Christopher W Noel
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Katrina Hueniken
- Department of Biostatistics, Princess Margaret hospital, Toronto, Ontario, Canada
| | - Rajan Grewal
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Adam Kwinter
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Giselle Peralta
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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6
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Cheng JT, Leite VF, Tennison JM, Gutierrez C, Kline-Quiroz C, Capozzi LC, Yu S, Krause KJ, Langelier D, Parke SC. Rehabilitation Interventions for Head and Neck Cancer-Associated Lymphedema: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2023; 149:743-753. [PMID: 37382963 DOI: 10.1001/jamaoto.2023.1473] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Importance Head and neck cancer-associated lymphedema (HNCaL) affects up to 90% of survivors of head and neck cancer and is a substantial contributor to disability following head and neck cancer treatment. Despite the prevalence and morbidity associated with HNCaL, rehabilitation interventions are not well studied. Objective To identify and appraise the current evidence for rehabilitation interventions in HNCaL. Evidence Review Five electronic databases were searched systematically from inception to January 3, 2023, for studies on HNCaL rehabilitation interventions. Study screening, data extraction, quality rating, and risk of bias assessment were performed by 2 independent reviewers. Findings Of 1642 citations identified, 23 studies (1.4%; n = 2147 patients) were eligible for inclusion. Six studies (26.1%) were randomized clinical trials (RCTs) and 17 (73.9%) were observational studies. Five of the 6 RCTs were published during 2020 to 2022. Most studies had fewer than 50 participants (5 of 6 RCTs; 13 of 17 observational studies). Studies were categorized by intervention type, including standard lymphedema therapy (11 studies [47.8%]) and adjunct therapy (12 studies [52.2%]). Lymphedema therapy interventions included standard complete decongestive therapy (CDT) (2 RCTs, 5 observational studies), modified CDT (3 observational studies), therapy setting (1 RCT, 2 observational studies), adherence (2 observational studies), early manual lymphatic drainage (1 RCT), and inclusion of focused exercise (1 RCT). Adjunct therapy interventions included advanced pneumatic compression devices (APCDs) (1 RCT, 5 observational studies), kinesio taping (1 RCT), photobiomodulation (1 observational study), acupuncture/moxibustion (1 observational study), and sodium selenite (1 RCT, 2 observational studies). Serious adverse events were either not found (9 [39.1%]) or not reported (14 [60.9%]). Low-quality evidence suggested the benefit of standard lymphedema therapy, particularly in the outpatient setting and with at least partial adherence. High-quality evidence was found for adjunct therapy with kinesio taping. Low-quality evidence also suggested that APCDs may be beneficial. Conclusions and Relevance The results of this systematic review suggest that rehabilitation interventions for HNCaL, including standard lymphedema therapy with kinesio taping and APCDs, appear to be safe and beneficial. However, more prospective, controlled, and adequately powered studies are needed to clarify the ideal type, timing, duration, and intensity of lymphedema therapy components before treatment guidelines can be established.
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Affiliation(s)
- Jessica T Cheng
- Department of Supportive Care Medicine, City of Hope Orange County, Irvine, California
| | - Victor F Leite
- Rehabilitation Department, Instituto do Cancer, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jegy M Tennison
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Carolina Gutierrez
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, Houston, Texas
| | - Cristina Kline-Quiroz
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lauren C Capozzi
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Shui Yu
- Department of Rehabilitation Services, City of Hope Orange County, Irvine, California
| | - Kate J Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston
| | - David Langelier
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Sara C Parke
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Arizona, Phoenix
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Ebersole BM, McMillan H, Hutcheson K. Evaluation and Management of Speech and Swallowing Issues in RFS. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
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8
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Arends CR, Lindhout JE, van der Molen L, Wilthagen EA, van den Brekel MWM, Stuiver MM. A systematic review of validated assessments methods for head and neck lymphedema. Eur Arch Otorhinolaryngol 2023; 280:2653-2661. [PMID: 36763153 PMCID: PMC10175329 DOI: 10.1007/s00405-023-07841-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/15/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE This systematic review aimed to provide a comprehensive overview of the validity and reliability of existing measurement instruments for quantifying head and neck lymphedema. METHODS Four databases were searched on January 31st, 2022. The COnsensus-based Standards for selecting health Measurement INstruments (COSMIN) checklists were used for the risk of bias (ROB) assessment. RESULTS Out of 3362 unique records, eight studies examined the reliability and validity of five measurement instruments of which one patient reported outcome. The Patterson scale for internal lymphedema and the patient reported head and neck external lymphedema and fibrosis (LIDS-H&N) demonstrated validity and reliability. For external lymphedema, none of the instruments had good reliability for all measuring points. CONCLUSION There is a lack of sufficiently reliable and valid measurement instruments for external head and neck lymphedema. The Patterson scale and the patient reported LIDS-H&N seem reliable for clinical practice and research.
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Affiliation(s)
- Coralie R Arends
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Josephine E Lindhout
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Amsterdam Center for Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
| | - Erica A Wilthagen
- Scientific Information Service, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Amsterdam Center for Language and Communication, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands.
| | - Martijn M Stuiver
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Center for Quality of Life and Division of Psychosocial Oncology and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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9
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Starmer H, Cherry MG, Patterson J, Young B, Fleming J. Assessment of Measures of Head and Neck Lymphedema Following Head and Neck Cancer Treatment: A Systematic Review. Lymphat Res Biol 2023; 21:42-51. [PMID: 35679595 DOI: 10.1089/lrb.2021.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Head and neck lymphedema is a common condition following head and neck cancer (HNC) treatment, with substantial functional morbidity. This systematic review aimed to (1) identify tools used to assess head and neck lymphedema in HNC patients and (2) determine their validity and reliability. Methods: Electronic and hand searches of Prospero, MEDLINE, Cochrane Library, and Embase were searched from their inception until April 2021, and hand searches were independently screened by two reviewers. Studies were included if they were available in English and measured lymphedema in adult HNC patients (aged ≥18 years). Data including psychometric characteristics were extracted and synthesized narratively, with the Quality Assessment of Diagnostic Accuracy Studies-2 and the COnsensus-based Standards for the selection of health Measurement INstruments checklists used to assess risk of bias. Results: Thirty-three studies, reporting 38 assessment tools, were included. Assessments included clinician rating scales, symptom inventories, size measures, measures of internal edema, radiographic and ultrasonographic measures, and quality-of-life measures. Of the 38 measures cited, only 11 had any degree of validation and reliability testing. Risk of bias varied among the different assessment tools. Conclusion: While many tools are used in the assessment of head and neck lymphedema, the majority of these tools lack validation and reliability data. Only one tool, the Head and Neck Lymphedema and Fibrosis Symptom Inventory, met criteria for strong quality assessment. Further efforts to establish a core set of metrics for this complex condition are warranted.
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Affiliation(s)
- Heather Starmer
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA.,Institution of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Mary Gemma Cherry
- Institution of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Joanne Patterson
- Institution of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Bridget Young
- Institution of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Jason Fleming
- Liverpool Head and Neck Centre, University of Liverpool, Liverpool, United Kingdom
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10
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Deng J, Murphy BA, Niermann KJ, Sinard RJ, Cmelak AJ, Rohde SL, Ridner SH, Dietrich MS. Validity Testing of the Head and Neck Lymphedema and Fibrosis Symptom Inventory. Lymphat Res Biol 2022; 20:629-639. [PMID: 35483066 PMCID: PMC9810345 DOI: 10.1089/lrb.2021.0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Lack of reliable and valid tools significantly impacts early identification and timely treatment of lymphedema and fibrosis (LEF) in the head and neck cancer population. To address this need, we developed and reported a patient-reported outcome measure (Head and Neck Lymphedema and Fibrosis Symptom Inventory [HN-LEF SI]). This article reports the construct validity (convergent and divergent validity) testing of the tool. Materials and Methods: A prospective, longitudinal, instrument validation study was conducted in patients with a newly diagnosed oral cavity or oropharyngeal cancer. Participants completed the HN-LEF SI and six carefully selected self-report measures at pretreatment, end-of-treatment, and every 3 months up to 12 months after treatment. Spearman correlations were used. Results: A total of 117 patients completed the study. Patterns of correlations of the HN-LEF SI scores with the established self-report measure scores were consistent with expected convergent and divergent validity. Conclusion: Evidence from this work supports the construct validity of the HN-LEF SI.
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Affiliation(s)
- Jie Deng
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | - Sarah L. Rohde
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Sheila H. Ridner
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Mary S. Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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11
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Fadhil M, Singh R, Havas T, Jacobson I. Systematic review of head and neck lymphedema assessment. Head Neck 2022; 44:2301-2315. [PMID: 35818729 DOI: 10.1002/hed.27136] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/25/2022] [Accepted: 06/16/2022] [Indexed: 11/08/2022] Open
Abstract
Head and neck lymphedema (HNL) is an increasingly recognized complication of head and neck cancer and its treatment. However, no consensus exists on the "gold-standard" assessment tool for the purposes of diagnosis, classification, or monitoring of HNL. We conducted a systematic review of the literature regarding HNL assessment to determine the optimal method/s of assessment for patients with HNL. A review of publications between January 2000 and September 2021 was undertaken on four electronic databases. Studies were excluded if no clear assessment method of HNL was documented. Sixty-seven articles were included in the study. A wide range of assessment methods for HNL have been reported in the literature. For the purposes of diagnosis and classification of physical findings, computed tomography (CT) appears the most promising tool available for both external and internal HNL. In terms of monitoring, ultrasound appears optimal for external HNL, while a clinician-reported rating scale on laryngoscopy is the gold standard for internal HNL. Patient-reported assessment must be considered alongside objective methods to classify symptom burden and monitor improvement with treatment.
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Affiliation(s)
- Matthew Fadhil
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ravjit Singh
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group, Sydney, New South Wales, Australia.,Department of Otolaryngology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Thomas Havas
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group, Sydney, New South Wales, Australia.,Department of Otolaryngology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Ian Jacobson
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group, Sydney, New South Wales, Australia.,Department of Otolaryngology, Prince of Wales Hospital, Sydney, New South Wales, Australia
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Parke SC, Langelier DM, Cheng JT, Kline-Quiroz C, Stubblefield MD. State of Rehabilitation Research in the Head and Neck Cancer Population: Functional Impact vs. Impairment-Focused Outcomes. Curr Oncol Rep 2022; 24:517-532. [PMID: 35182293 DOI: 10.1007/s11912-022-01227-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Management of head and neck cancer (HNC) typically involves a morbid combination of surgery, radiation, and systemic therapy. As the number of HNC survivors grows, there is growing interest in rehabilitation strategies to manage HNC-related comorbidity. In this review, we summarize the current state of HNC rehabilitation research. RECENT FINDINGS We have organized our review using the World Health Organization's International Classification of Function (ICF) model of impairment, activity, and participation. Specifically, we describe the current research on rehabilitation strategies to prevent and treat impairments including dysphagia, xerostomia, dysgeusia, dysosmia, odynophagia, trismus, first bite syndrome, dysarthria, dysphonia, lymphedema, shoulder syndrome, cervicalgia, cervical dystonia and dropped head syndrome, deconditioning, and fatigue. We also discuss the broader impact of HNC-related impairment by exploring the state of rehabilitation literature on activity, participation, psychosocial distress, and suicidality in HNC survivors. We demonstrate that research in HNC rehabilitation continues to focus primarily on impairment-driven interventions. There remains a dearth of HNC rehabilitation studies directly examining the impact of rehabilitation interventions on outcomes related to activity and participation. More high-quality interventional studies and reviews are needed to guide prevention and treatment of functional loss in HNC survivors.
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Affiliation(s)
- Sara C Parke
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Arizona, Phoenix, USA.
| | - David Michael Langelier
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre Toronto, Ontario, Canada
| | - Jessica Tse Cheng
- Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, TX, Houston, USA
| | - Cristina Kline-Quiroz
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, TN, Nashville, USA
| | - Michael Dean Stubblefield
- Department of Physical Medicine and Rehabilitation - Rutgers New Jersey Medical School, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, NJ, 07052, West Orange, USA
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13
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Noel CW, Kwinter A, Mifsud M, Ringash J, Waldron J, Chepeha DB, Irish JC, Martino R, Gomes A, Aziza E, de Almeida JR, Goldstein DP. Quantifying Neck Fibrosis and Its Functional Implications: Development of the Neck Fibrosis Scale. Laryngoscope 2021; 132:1015-1021. [PMID: 34652823 DOI: 10.1002/lary.29897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/21/2021] [Accepted: 09/29/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Despite increasing recognition of the importance of functional outcomes for patients with head and neck cancer, post-treatment neck fibrosis remains poorly understood. We sought to develop and validate a patient reported outcome measure for head and neck cancer patients with neck fibrosis. STUDY DESIGN Prospective multiphase cross-sectional study. METHODS To guide instrument development, we employed the World Health Organization International Classification of Functioning, Disability and Health as our conceptual framework. Items were generated using a composite strategy consisting of patient focus groups, literature review, and expert opinion from a multidisciplinary group. Candidate items were reduced through the item impact method. Preliminary psychometric properties of the finalized instrument were evaluated through measures of internal consistency, test-retest reliability, and construct validity. RESULTS Four in person focus groups were held with 13 head and neck cancer patients. The process of item generation led to 221 relevant citations and 68 unique items. An additional 17 items were identified from review of existing neck disability questionnaires and expert opinion. A draft instrument with 25 candidate items was generated and reduced to its final 15-item scale using item impact method. Early psychometric testing revealed excellent internal consistency (Cronbach's alpha = 0.95) and test-retest reliability [ICC = 0.95]. Internal consistency at the item level was good (>0.7) for 11/15 individual items. Four separate constructs were evaluated. Three of the four constructs matched our a priori hypotheses. CONCLUSION The Neck Fibrosis Scale demonstrates preliminary reliability and validity for discriminate use. Further research is needed to confirm dimensionality and assess responsiveness. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Adam Kwinter
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Mifsud
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, U.S.A
| | - Jolie Ringash
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Douglas B Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Rosemary Martino
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Speech Language Pathology, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Gomes
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Elana Aziza
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Lou DI, Dietrich MS, Deng J, Murphy BA. Mechanisms of pain and their manifestations in head and neck cancer: Importance of classifying pain subtypes. Head Neck 2021; 43:3720-3729. [PMID: 34617646 PMCID: PMC9292513 DOI: 10.1002/hed.26859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/07/2021] [Accepted: 08/12/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pain is an under-recognized complaint among head and neck cancer (HNC) survivors. Treatment is hindered by inadequate characterization of pain. METHODS A secondary analysis from a prospective, longitudinal study was conducted to characterize pain prevalence, quality, and functional consequences in 77 HNC patients. Pain and pain-related outcomes were captured before treatment, at end-of-treatment, and 3, 6, 9 and 12 months post-treatment. RESULTS Pain was most prevalent at end-of-treatment and declined over time. Chronicity of pain was established by 6 months post-treatment. Oral mucosal neuropathic pain was the most common chronic pain subtype at 12 months post-treatment. Widespread joint and muscle pain was also present at lower numbers. 40.2% of patients continued to require analgesics at 12 months. CONCLUSION Peripheral and central pain subtypes contribute significantly to chronic pain in HNC survivors. Preventive and treatment regimens should be tailored to specific pain subtypes for optimal symptom control.
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Affiliation(s)
- Dianne I Lou
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mary S Dietrich
- Department of Biostatistics, Schools of Nursing and Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Jie Deng
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Barbara A Murphy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Head and Neck Lymphedema Assessment Methods. REHABILITATION ONCOLOGY 2021. [DOI: 10.1097/01.reo.0000000000000273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Deng J, Lukens JN, Swisher-McClure S, Cohn JC, Spinelli BA, Quinn RJ, Chittams J, McMenamin E, Lin A. Photobiomodulation Therapy in Head and Neck Cancer-Related Lymphedema: A Pilot Feasibility Study. Integr Cancer Ther 2021; 20:15347354211037938. [PMID: 34387119 PMCID: PMC8366198 DOI: 10.1177/15347354211037938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: Lymphedema is a common debilitating late effect among patients post-head and neck cancer (HNC) treatment. Head and neck lymphedema was associated with symptom burden, functional impairment, and decreased quality of life. The objective of this study was to determine the feasibility and potential efficacy of the use of photobiomodulation (PBM) therapy for head and neck lymphedema, symptom burden, and neck range of motion among HNC survivors. Methods: This was a single-arm, pre- and post-design clinical trial. Eligible patients included those with lymphedema after completion of complete decongestive therapy (CDT) and 3 to 18 months after completion of cancer therapy. The intervention included PBM therapy 2 times a week for 6 weeks for a total of 12 treatments. Lymphedema, symptom burden, and neck range of motion were measured at baseline, end-of-intervention, and 4-week post-intervention. Results: Of the 12 patients enrolled in the study, 91.7% (n = 11) completed the study intervention and assessment visits, and no adverse events were reported. When comparing the baseline to 4-week post-intervention, we found statistically significant improvements in the severity of external lymphedema, symptom burden, and neck range of motion (all P < .05). Conclusion: PBM therapy was feasible and potentially effective for the treatment of head and neck lymphedema. Future randomized controlled trials are warranted to examine the efficacy of PBM therapy for HNC-related lymphedema. Trial Registration Number and Date of Registration: ClinicalTrials.gov Identifier: NCT03738332; date of registration: November 13, 2018.
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Affiliation(s)
- Jie Deng
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Joy C Cohn
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ryan J Quinn
- University of Pennsylvania, Philadelphia, PA, USA
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Jeans C, Brown B, Ward EC, Vertigan AE. Lymphoedema after head and neck cancer treatment: an overview for clinical practice. Br J Community Nurs 2021; 26:S24-S29. [PMID: 33797943 DOI: 10.12968/bjcn.2021.26.sup4.s24] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lymphoedema is a disorder of the lymphatic system that presents as an atypical swelling and accumulation of protein-rich fluid within the interstitial spaces. Head and neck lymphoedema (HNL) is highly prevalent in patients who have been treated for head and neck cancer (HNC) and may manifest externally on the face and neck; internally within the oral cavity, pharynx or larynx; or as a combination of both. HNL is known to contribute to a wide range of physical, functional and psychological issues, and presents several unique challenges in terms of its management. This review article provides an overview of HNL for clinicians and aims to improve awareness of this condition and the impact it has on patients.
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Affiliation(s)
- Claire Jeans
- Speech Pathologist, Speech Pathology Department, Calvary Mater Hospital Newcastle, New South Wales Australia; PhD candidate, School of Health and Rehabilitation Sciences, University of Queensland, Queensland, Australia
| | - Bena Brown
- Senior Research Fellow, School of Health and Rehabilitation Sciences, University of Queensland, Queensland, Australia; Centre for Functioning and Health Research, Metro South Health Services District, Queensland Health, Queensland, Australia
| | - Elizabeth C Ward
- Professor, School of Health and Rehabilitation Sciences, University of Queensland, Queensland, Australia; Centre for Functioning and Health Research, Metro South Health Services District, Queensland Health, Queensland, Australia
| | - Anne E Vertigan
- Speech Pathology Manager, Speech Pathology Department, John Hunter Hospital and Belmont Hospital, New South Wales, Australia; Conjoint Associate Professor School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia; Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, New South Wales, Australia
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