By Charles Bankhead, Staff Writer, MedPage Today
Published: March 02, 2010
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
PHOENIX -- Treatment of head and neck cancer causes potentially severe
lymphedema, which responds to complete decongestive therapy in most
retrospective chart review showed.
The most severe lymphedema occurred in patients treated with surgery
radiation therapy, followed by definitive surgery alone. Complete
therapy led to clinical improvement in a majority of the patients,
of those treated with surgery alone.
"Lymphedema is vastly under-recognized and under-reported in patients
and neck cancer," Jan S. Lewin, PhD, of M.D. Anderson Cancer Center in
said in an interview at the Multidisciplinary Head and Neck Cancer
"The lymphedema can be just as severe as what's seen after treatment
and other types of cancer. Lymphedema in patients with head and neck
be terribly disfiguring and cause severe functional problems."
"Complete decongestive therapy leads to clinically significant
most patients, whether it's performed in a clinic or at home," she
Available evidence suggests that fewer than half of patients with head
cancer develop lymphedema after treatment. However, cosmetic and
sequelae can be severe, including problems with speaking, eating,
obstruction, and drooling, as well as self-image.
As compared with lymphedema in other cancers, a paucity of information
about the presentation and treatment of the condition in patients with
neck cancer, said Lewin.
In an effort to add to the information base, she and her colleagues
retrospectively reviewed records of patients referred for evaluation
lymphedema following treatment of head and neck cancer.
Data collection included patient and disease characteristics, site and
of lymphedema, and the type of complete decongestive therapy each
received (outpatient or at home).
Investigators stratified patients by type of cancer treatment and
therapy regimen. Outcomes were assessed by clinical examination, and
was defined as a reduction in lymphedema stage, resolution of the
site, or ≥2% decrease in total surface area affected.
Complete decongestive therapy conformed to recognized standards and
manual lymphatic drainage massage, use of compression bandages,
exercise, and a skin-care regimen.
Outpatient therapy was performed by a certified therapist and
consisted of an
intensive phase of three to five sessions weekly for two to four
by maintenance home therapy. Patients who were unwilling or unable to
the outpatient regimen were assigned to a self-administered home-based
The study population consisted of 270 patients, 30% of whom were
definitive external beam radiation therapy, 9% with surgery alone, and
surgery and radiation therapy.
The neck was the most common site of lymphedema (89%), followed by the
(84%), facial (32%), and intraoral (6%) areas. Some patients had more
Lewin reported that 53% of the patients had moderately severe
defined as M.D. Anderson stage 1b (reversible, pitting edema).
resulted in significantly worse lymphedema (P=0.001).
Overall, 161 (60%) patients reported functional problems related to
including difficulty swallowing in 80 patients (30%) and speech
problems in 31
Outcome data were available for 152 patients who received complete
therapy and returned for follow-up evaluation (an average of 10.7
Lewin and colleagues found that 54% (82 of 152) of patients had
clinically at follow-up (15 of 20 who had outpatient therapy and 67 of
had home-based therapy).
Improvement was observed in 83% of patients treated by surgery alone,
patients treated with definitive radiation therapy, and 49% of
with surgery and radiation.
Primary source: Multidisciplinary Head and Neck Cancer Symposium
Source reference: Lewin JS, et al "Early experience with head and neck
lymphedema after treatment
for head and neck cancer" MHNCS 2010; Abstract 45.