MHNCS: Lymphedema Common in Head and Neck Cancer
lymphedemapeople
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
cases, a
retrospective chart review showed.
The most severe lymphedema occurred in patients treated with surgery
and
radiation therapy, followed by definitive surgery alone. Complete
decongestive
therapy led to clinical improvement in a majority of the patients,
including 83%
of those treated with surgery alone.
"Lymphedema is vastly under-recognized and under-reported in patients
with head
and neck cancer," Jan S. Lewin, PhD, of M.D. Anderson Cancer Center in
Houston,
said in an interview at the Multidisciplinary Head and Neck Cancer
Symposium.
"The lymphedema can be just as severe as what's seen after treatment
of breast
and other types of cancer. Lymphedema in patients with head and neck
cancer can
be terribly disfiguring and cause severe functional problems."
"Complete decongestive therapy leads to clinically significant
improvement in
most patients, whether it's performed in a clinic or at home," she
added.
Available evidence suggests that fewer than half of patients with head
and neck
cancer develop lymphedema after treatment. However, cosmetic and
functional
sequelae can be severe, including problems with speaking, eating,
airway
obstruction, and drooling, as well as self-image.
As compared with lymphedema in other cancers, a paucity of information
exists
about the presentation and treatment of the condition in patients with
head and
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
of
lymphedema following treatment of head and neck cancer.
Data collection included patient and disease characteristics, site and
severity
of lymphedema, and the type of complete decongestive therapy each
patient
received (outpatient or at home).
Investigators stratified patients by type of cancer treatment and
decongestive
therapy regimen. Outcomes were assessed by clinical examination, and
improvement
was defined as a reduction in lymphedema stage, resolution of the
lymphedema
site, or ≥2% decrease in total surface area affected.
Complete decongestive therapy conformed to recognized standards and
consisted of
manual lymphatic drainage massage, use of compression bandages,
physical
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
weeks, followed
by maintenance home therapy. Patients who were unwilling or unable to
complete
the outpatient regimen were assigned to a self-administered home-based
regimen.
The study population consisted of 270 patients, 30% of whom were
treated with
definitive external beam radiation therapy, 9% with surgery alone, and
61% with
surgery and radiation therapy.
The neck was the most common site of lymphedema (89%), followed by the
submental
(84%), facial (32%), and intraoral (6%) areas. Some patients had more
than one
affected area.
Lewin reported that 53% of the patients had moderately severe
lymphedema,
defined as M.D. Anderson stage 1b (reversible, pitting edema).
Combined therapy
resulted in significantly worse lymphedema (P=0.001).
Overall, 161 (60%) patients reported functional problems related to
lymphedema,
including difficulty swallowing in 80 patients (30%) and speech
problems in 31
(11%).
Outcome data were available for 152 patients who received complete
decongestive
therapy and returned for follow-up evaluation (an average of 10.7
weeks after
initial evaluation).
Lewin and colleagues found that 54% (82 of 152) of patients had
improved
clinically at follow-up (15 of 20 who had outpatient therapy and 67 of
132 who
had home-based therapy).
Improvement was observed in 83% of patients treated by surgery alone,
55% of
patients treated with definitive radiation therapy, and 49% of
patients treated
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.
http://www.medpagetoday.com/MeetingCoverage/MHNCS/18779