Head and neck lymphedema management: Evaluation of a therapy program

Pigott, Amanda; Nixon, James W.; Fleming, Jennifer; Porceddu, Sandro

doi:10.1002/hed.25086

Cited by 30 publications

(60 citation statements)

References 15 publications

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“…17,18 A change of one level, for example, 1b to 1a, was understood to be a clinically relevant change. 14 Module (EORTC QLQ-H&N43). 19 The EORTC QLQ-H&N43 contains the core 30 questions from the EORTC QLQ-C30 version three and an additional 43 questions measuring QOL in patients with head and neck cancer.…”

Section: Assessment Of Lymphedemamentioning

confidence: 99%

“…T A B L E 3 Individual participant scores for the control and intervention groups on lymphedema measures at baseline (T0) and follow-up (T1) The MCID reference for this study was the use of the MDACCHNL Rating Scale. 14 The authors found this measure highly subjective and difficult to categorize as many participants presented with both fibrotic and soft edema in different regions. A recent study using the MDACCHNL rating scale as the MCID stated that it was useful in supporting the reduction in lymphedema, however, is a generous measure for the use of a MCID.…”

Section: Body Image Swallowing and Qolmentioning

confidence: 99%

“…A recent study using the MDACCHNL rating scale as the MCID stated that it was useful in supporting the reduction in lymphedema, however, is a generous measure for the use of a MCID. 14 Although not formally assessed, the weekly telephone calls to participants allowed the researches to maintain a client-centered approach and discuss concerns during the cancer treatment journey.…”

Section: Body Image Swallowing and Qolmentioning

confidence: 99%

“…Self-lymphatic drainage is a large contributor of the overall effectiveness of the home program. 14 To determine adherence with self-management techniques and the subsequent effect on head and neck lymphedema, it is important to record all aspects of the home program. 14 at both T0 and T1 appointments and received clarification on the ALOHA protocol from the authors, internal validity may be weakened due to limited time using this protocol.…”

Section: Body Image Swallowing and Qolmentioning

confidence: 99%

“…13 Despite this, the majority of head and neck lymphedema treatment is focused on therapist-directed treatment followed by self-management. 2,14 There is a clear need to develop an effective self-management protocol from the onset of treatment to reduce treatment burden. 8,10,13 The lymphedema treatment program at Sir Charles Gardiner Hos-…”

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confidence: 99%

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A randomized pilot study on self‐management in head and neck lymphedema

McLaughlin

Broadhurst

Harris

et al. 2020

Laryngoscope Investig Oto

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Background: The purpose of this pilot trial was to determine the feasibility of a selfmanaged lymphedema randomized control trial to test the effectiveness of a head and neck-specific exercise protocol. Methods: Nine participants were randomized to receive usual treatment provided by an Australian metropolitan teaching hospital (n = 4) or usual treatment with an added head and neck exercise regime (n = 5). Feasibility was assessed through ease of recruitment, adherence, and safety. Lymphedema reduction and quality of life (QOL) data were assessed at baseline (0 week) and follow-up (6 weeks). Results: The study was feasible in terms of safety and participant retention. However, a slow recruitment rate and low adherence may impact future trials. There were no significant differences in lymphedema reduction or QOL between groups. Conclusion: This pilot feasibility study demonstrated that a self-management trial can be implemented, however, modifications will be required due to the slow recruitment and poor adherence rates. Level of evidence: 1b: Individualized randomized control trial. K E Y W O R D S head, lymphedema, neck, self-management, treatment 1 | INTRODUCTION Head and neck lymphedema is a significant issue for patients following head and neck cancer treatment 1 with a prevalence rate between 12% 2 and 90%. 3 Head and neck lymphedema may involve both external anatomical sites (eg, skin, face, neck, head) and internal structures (eg, oral cavity, pharynx), 4-6 resulting in symptom burden, functional impairments (speech 5 swallowing, 6,7 breathing 5), and decreased quality of life (QOL). 1,4-6,8 Due to cosmetic changes, this population experiences body image and psychological sequelae, such as anxiety and depression. 1 Head and neck lymphedema treatment guidelines are focused on a combination of complete decongestive therapy modalities including external compression, exercise, skin care, manual-lymphatic drainage, and patient education for self-management. 2 There is a lack of consensus on the combination of these therapy modalities, in particular, head and neck specific exercises and external compression. 9-11 Other treatment modalities, such as manual-lymphatic drainage, may be more applicable for head and neck lymphedema due to the low adherence and difficulty in applying compression to this body region. 10 Despite the suggested benefit, an added exercise protocol may increase treatment burden to this vulnerable population. 11 There is a

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Section: Assessment Of Lymphedemamentioning

confidence: 99%

Section: Body Image Swallowing and Qolmentioning

confidence: 99%

Section: Body Image Swallowing and Qolmentioning

confidence: 99%

Section: Body Image Swallowing and Qolmentioning

confidence: 99%

mentioning

confidence: 99%

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A randomized pilot study on self‐management in head and neck lymphedema

McLaughlin

Broadhurst

Harris

et al. 2020

Laryngoscope Investig Oto

View full text Add to dashboard Cite

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Rehabilitation Interventions for Head and Neck Cancer–Associated Lymphedema

Cheng

Leite

Tennison

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceHead 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.ObjectiveTo identify and appraise the current evidence for rehabilitation interventions in HNCaL.Evidence ReviewFive 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.FindingsOf 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 RelevanceThe 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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Treatment approaches and outcomes of a head and neck lymphedema service at an Australian comprehensive cancer center

et al. 2023

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Background Patients treated for head and neck cancer are at high risk of developing head and neck lymphedema (HNL). We describe outcomes of HNL management at an Australian institution from 2018 to 2020. Methods Electronic records from Chris O'Brien Lifehouse were retrospectively reviewed from January 1, 2018 to December 31, 2020. Objective changes in HNL were assessed using The M. D. Anderson Cancer Center (MDACC) HNL rating scale and Assessment of Lymphedema of the Head and Neck (ALOHA). Results Among the 100 patients referred for management of HNL, surgery was the most frequent treatment modality (80%; 70% with neck dissection) and 69% underwent radiotherapy. Manual lymphatic drainage (MLD) was most often prescribed (96%), followed by self‐MLD (93%). Small but significant improvements in ALOHA measurements were observed for 50 patients (50%). Only 5/29 (17%) patients had post‐treatment improvements on the MDACC scale. Conclusions Standardized, prospective measurement of treatment approaches and outcomes is needed to further evaluate the service.

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Head and neck lymphedema management: Evaluation of a therapy program

Cited by 30 publications

References 15 publications

A randomized pilot study on self‐management in head and neck lymphedema

A randomized pilot study on self‐management in head and neck lymphedema

Rehabilitation Interventions for Head and Neck Cancer–Associated Lymphedema

Treatment approaches and outcomes of a head and neck lymphedema service at an Australian comprehensive cancer center

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