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Starmer HM, Patterson J, Young B, Fleming J, Cherry MG. Development of a head and neck lymphoedema specific quality of life tool: The Comprehensive Assessment of Lymphoedema Impact in the Head and Neck. Head Neck 2024; 46:1103-1111. [PMID: 38380786 DOI: 10.1002/hed.27704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/04/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024] Open
Abstract
PURPOSE To develop a head and neck lymphoedema (HNL) specific quality of life (QoL) instrument to assess physical, functional, and social/emotional impacts of HNL. METHODS Instrument candidate items were reviewed by patients with HNL and clinicians and rated for importance, clarity, and invasiveness. The Content Validity Ratio was applied for item reduction. Three-step cognitive interviews were conducted with HNL patients to validate the items, survey format, and instructions. RESULTS Initially, 130 candidate questions were developed. Following item reduction, 52 items progressed to three-step cognitive interviews. Following cognitive interviews, the Comprehensive Assessment of Lymphoedema Impact in Head and Neck (CALI-HaN) included 33 items; 1 global, 10 physical, 7 functional, and 15 emotional. CONCLUSIONS Physical, functional, and socioemotional effects need to be considered when measuring QoL in patients with HNL. This study describes initial development of the CALI-HaN, an instrument that shows promise for clinical and research applications following future validation.
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Affiliation(s)
- Heather M Starmer
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
- Department of Otolaryngology - Head & Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Joanne Patterson
- School of Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Bridget Young
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Jason Fleming
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Mary Gemma Cherry
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
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Keskin Kavak S, Duran A, Ünsal Delialioğlu S, Aktekin L. Effect of Complex Decongestive Therapy on Quality of Life and Physical Parameters in Head and Neck Lymphedema. Laryngoscope 2024. [PMID: 38308440 DOI: 10.1002/lary.31318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/12/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To assess the effect of complex decongestive therapy treatment (CDT) on quality of life, neck disability, cervical range of motion, and facial and neck lymphedema size using specific anatomical landmark points. METHODS This prospective study was conducted in a tertiary cancer center in Turkey. Thirty patients included in the study were treated with CDT for 21 days. The patients were evaluated before and after CDT with MD Anderson Cancer Center Head and Neck Lymphedema (MDACC HNC) staging system, The Neck Disability Index, European Organization for Research and Treatment of Cancer Quality of Life 30 (EORTC-QLOC30), Facial Composite score and Neck Circumferences, cervical range of motion. RESULTS Median follow-up was 7.2 months. After treatment of 30 patients significant cognitive function, emotional function, and social function (p < 0.001). After CDT treatment, the quality of life sub-parameters of EORTC QLQ-C30 showed significant improvement (p < 0.001). The facial composite score and neck circumferences indices showed significant improvement (p < 0.001). A decrease of 2% or more in the facial composite score and neck circumferences was observed in all patients participating in the study. CONCLUSION There have been few studies on the effectiveness of CDT on the EORTC QLQ-C30, facial composite score, and neck circumferences in head and neck lymphedema. In patients with head and neck lymphedema following head and neck cancer, our study demonstrated the positive effects of complex decongestive therapy (CDT) on neck disability, range of motion, quality of life, and facial and neck lymphedema tissue size. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Songul Keskin Kavak
- Department of Physical Therapy and Rehabilitation, Ankara Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Arzubetül Duran
- Department of Ear Nose Throat, Ankara Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | | | - Lale Aktekin
- Physical Medicine and Rehabilitation Department, Ankara Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey, Ankara, Turkey
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
The article is a review of the latest literature data on lymphedema of the head and neck, its etiology, pathogenesis, classification and main clinical manifestations. The main methods of diagnosis and treatment of this pathology are indicated.
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Affiliation(s)
- V A Semkin
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A G Nadtochiy
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - O V Vozgoment
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - A A Ivanova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Gutiérrez C, Mayrovitz HN, Naqvi SHS, Karni RJ. Longitudinal effects of a novel advanced pneumatic compression device on patient-reported outcomes in the management of cancer-related head and neck lymphedema: A preliminary report. Head Neck 2020; 42:1791-1799. [PMID: 32187788 PMCID: PMC7496342 DOI: 10.1002/hed.26110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 01/11/2020] [Accepted: 01/28/2020] [Indexed: 11/16/2022] Open
Abstract
Background Head and neck cancer (HNC) survivors experience head and neck lymphedema (HNL), which requires treatment to prevent morbidity. We explore the self‐reported outcomes and satisfaction of patients with HNC receiving treatment for HNL with an advanced pneumatic compression device (APCD). Methods HNC survivors (n = 205) prescribed with an at‐home Flexitouch head and neck APCD completed pretreatment and posttreatment self‐reported assessments addressing efficacy, function, and symptoms. Participant average age was 60 years with 74% male. Pre‐post responses for ≥25 days of use were assessed via the non‐parametric Wilcoxon Signed Rank test. Results Analysis revealed statistically significant improvement in all symptoms and all function items (P < 0.00001). Compliance with prescribed therapy (at least 30 minutes daily) was high with 71% of participants reporting daily use and 87% reporting overall satisfaction. Conclusions The reported improvements in function and symptoms, and high compliance rate, provide a rationale for a subsequent randomized controlled trial.
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Affiliation(s)
- Carolina Gutiérrez
- Department of Physical Medicine & Rehabilitation, The University of Texas Health Science Center / McGovern Medical School, Houston, Texas.,Department of Otorhinolaryngology - Head & Neck Surgery, The University of Texas Health Science Center / McGovern Medical School, Houston, Texas
| | - Harvey N Mayrovitz
- Division of Physiology, Department of Medical Education, Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Syed Hassan Shiraz Naqvi
- Department of Otorhinolaryngology - Head & Neck Surgery, The University of Texas Health Science Center / McGovern Medical School, Houston, Texas
| | - Ron J Karni
- Division of Head & Neck Surgical Oncology, Department of Otorhinolaryngology - Head & Neck Surgery Division of Medical Oncology, The University of Texas Health Science Center / McGovern Medical School, Houston, Texas
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Anand A, Balasubramanian D, Subramanian N, Murthy S, Limbachiya S, Iyer S, Thankappan K, Sharma M. Secondary lymphedema after head and neck cancer therapy: A review. Lymphology 2018; 51:109-118. [PMID: 30422433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Secondary head and neck lymphedema (SHNL) is a chronic condition affecting patients who have undergone treatment for head and neck cancers. It results from the disruption of normal lymphatic flow by surgery and/or radiation. The incidence of secondary head and neck lymphedema varies anywhere between 12 and 54% of all patients treated for head and neck cancer, but it is still commonly under-diagnosed in routine clinical practice. In spite of awareness of this condition, treatment has been difficult as definitive staging, diagnostic, and assessment tools are still under development. This review article is aimed at looking at the evidence, standards of management, and deficiencies in current literature related to SHNL to optimize management of these patients and improve their quality of life.
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Affiliation(s)
- A Anand
- Department of Head and Neck Oncology, Amrita Hospital, Kochi, India
| | | | - N Subramanian
- Department of Head and Neck Oncology, Amrita Hospital, Kochi, India
| | - S Murthy
- Department of Head and Neck Oncology, Amrita Hospital, Kochi, India
| | - S Limbachiya
- Department of Head and Neck Oncology, Amrita Hospital, Kochi, India
| | - S Iyer
- Department of Plastic and Reconstructive Surgery, Amrita Hospital, Kochi, India
- Department of Head and Neck Oncology, Amrita Hospital, Kochi, India
| | - K Thankappan
- Department of Head and Neck Oncology, Amrita Hospital, Kochi, India
| | - M Sharma
- Department of Plastic and Reconstructive Surgery, Amrita Hospital, Kochi, India
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Mayrovitz HN, Ryan S, Hartman JM. Usability of advanced pneumatic compression to treat cancer-related head and neck lymphedema: A feasibility study. Head Neck 2017; 40:137-143. [PMID: 29131439 PMCID: PMC5765451 DOI: 10.1002/hed.24995] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/07/2017] [Accepted: 09/15/2017] [Indexed: 11/12/2022] Open
Abstract
Background This functional usability study assessed ease of use, fit, comfort, and potential clinical benefits of advanced pneumatic compression treatment of cancer‐related head and neck lymphedema. Methods Patient‐reported comfort and other treatment aspects were evaluated and multiple face and neck measurements were obtained on 44 patients with head and neck lymphedema before and after 1 treatment session to assess usability and treatment‐related lymphedema changes. Results A majority of the patients (82%) reported the treatment was comfortable; most patients (61%) reported feeling better after treatment, and 93% reported that they would be likely to use this therapy at home. One treatment produced overall small but highly statistically significant reductions in composite metrics (mean ± SD) of the face (82.5 ± 4.3 cm vs 80.9 ± 4.1 cm; P < .001) and neck (120.4 ± 12.2 cm vs 119.2 ± 12.1 cm; P < .001) with no adverse events. Conclusion Results found the treatment to be safe, easy to use, and well tolerated while demonstrating edema reduction after a single initial treatment.
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Affiliation(s)
- Harvey N Mayrovitz
- Department of Physiology, College of Medical Sciences, Nova Southeastern University, Fort Lauderdale, Florida
| | - Shelly Ryan
- Department of Lymphedema, Mercy Hospital St. Louis, St. Louis, Missouri
| | - James M Hartman
- Department of Otolaryngology, Sound Health Services, St. Louis, Missouri
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