Perceived Symptom Experience in Head and Neck Cancer Patients with Lymphedema

Abstract

Clinicians need to inquire about tissue swelling and associated symptoms early in the post-treatment period to initiate lymphedema management strategies in a timely manner and facilitate reduction of long-term symptom burden and functional deficits.

Patient perceptions of living with head and neck lymphoedema and the impacts to swallowing, voice and speech function

“…These findings offer support for the notion that HNL in the oral cavity may further impair the functioning of the structures used in articulation (Lewin et al., ). The findings are also consistent with a small number of studies that have noted patient‐reported speech imprecision and unintelligibility in patients who experience HNL (Deng, Ridner, Murphy et al., ; Deng et al., ; Piso et al., ).…”

“…Feelings of tightness, heaviness and feeling swollen on the external face and neck were highlighted, which is consistent with previous research (Deng, Ridner, Murphy et al., ; Deng et al., ; McGarvey et al., ). The vast majority also described altered sensation in relation to the presence of internal HNL, which has also been previously documented (Deng et al., ). The presence of altered sensation is often one of the first symptoms described by patients with HNL (Smith & Lewin, ).…”

“…The vast majority of participants felt that that their HNL had altered their swallow function; which many attributed to the feeling of tightness and swelling within their pharynx. Multiple authors have suggested an association between HNL and increased issues with swallowing (Deng, Murphy et al., ; Deng et al., ; Jackson et al., ; Murphy & Gilbert, ; Murphy & Ridner, ; Murphy et al., ; Piso et al., ; Smith et al., ). Internal HNL has the potential to cause significant thickening and stiffness of the pharyngeal and laryngeal structures; thereby affecting their range of movement and contractibility (Eisbruch et al., ; Jackson et al., ; Murphy et al., ).…”

“…Patients with HNL may experience a wide range of physical, functional and psychological symptoms. Patients have been shown to encounter altered sensation within the head and neck region causing tightness, heaviness and hardness of the skin (Deng, Ridner, Murphy, & Dietrich, ; Deng et al., ; McGarvey et al., ); reduced range of movement in the neck (Deng, Murphy et al., ; Deng et al., , ; McGarvey et al., ; Tacani, ); difficulties with breathing (Bruns et al., ; Deng et al., ; Micke et al., ; Murphy & Ridner, ); trismus; and blurred vision (Deng, Ridner, Murphy et al., ; Deng et al., ). Patients who experience HNL are also known to experience negative effects on quality of life, body image and reduced socialisation (Brake et al., ; Bruns et al., ; Deng, Murphy et al., ; Deng, Ridner, Murphy et al., ; McGarvey et al., ; Micke et al., ; Smith et al., ).…”

“…() reported an association between the severity of HNL and increased self‐reported dysphagia and dysphonia. Two qualitative studies have also noted these issues (Deng et al., ; McGarvey et al., ), with one patient commenting that “my tongue swelling, it impacted my speech… it impacted my ability to eat” (Deng et al., , p. 1271). Such studies have suggested that patients may also perceive a link between their HNL and their swallowing, voice and/or speech function.…”