Systematic review of head and neck lymphedema assessment

Fadhil, Matthew; Singh, Ravjit; Havas, Thomas; Jacobson, Ian

doi:10.1002/hed.27136

Cited by 21 publications

(29 citation statements)

References 64 publications

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“…This is just over half of the historically reported low range of 12% and a small fraction of the incidence of 90% reported in contemporary studies. [8][9][10][11][12] Our database only identi ed 521 HNC survivors who received treatment for lymphedema suggesting marked undertreatment of the disorder. The primary treatment modality for those referred was MLD (80%) with only a small percentage receiving compassion garments (13.6%) and even fewer (8.6%) receiving APCD.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 The reported prevalence of lymphedema in HNC survivors ranges from 12% to more than 90%. [8][9][10][11][12] This variation is due to methodological differences between studies with contemporary studies favoring the high range of prevalence. 8,12 HNL is not simply a cosmetic issue.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11][12] This variation is due to methodological differences between studies with contemporary studies favoring the high range of prevalence. 8,12 HNL is not simply a cosmetic issue. It is both an external and internal phenomenon with signi cant clinical sequelae.…”

Section: Introductionmentioning

confidence: 99%

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Under recognition and treatment of lymphedema in head and neck cancer survivors – a database study

Stubblefield

Weycker

2023

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Purpose: Head and neck cancer (HNC) will be diagnosed in approximately 54,000 Americans in 2022 with more than 11,000 dying as a result. The treatment of HNC often involves aggressive multimodal therapy including surgery, radiotherapy, and systemic therapy. HNC and its treatments are associated with multiple painful and function-limiting neuromusculoskeletal and visceral long-term and late effects. Among these is head and neck lymphedema (HNL), the abnormal accumulation of protein rich uid, in as many as 90% of survivors. Though HNL is common and potentially contributory to other function-limiting issues in this population, it is notoriously understudied, underrecognized, underdiagnosed, and undertreated. This study seeks to determine the incidence of HNC-related lymphedema diagnosis and treatment in a large US healthcare claims repository database. Methods: A retrospective observational cohort design and data from an integrated US healthcare claims repository-the IBM MarketScan Commercial Claims and Encounters (CCAE) and Medicare Supplemental and Coordination of Bene ts (MDCR) Databases spanning the period April 1, 2012 through March 31, 2020.Results: Of the 16,654 HNC patients eligible for evaluation, 1,082 (6.5%) with a diagnosis of lymphedema were identi ed based on eligibility criteria. Of the 521 HNC patients evaluated for lymphedema treatment, 417 (80.0%) patients received 1.5 courses of MLD, 71 (13.6%) patients were prescribed compression garments, and 45 (8.6%) patients received an advanced pneumatic compression device. Conclusion: HNL in this population of HNC survivors was underdiagnosed and treated compared with contemporary assessments HNL incidence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Under recognition and treatment of lymphedema in head and neck cancer survivors – a database study

Stubblefield

Weycker

2023

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“…Only 1 observational study identified in the present review used this tool. Another recent systematic review on HNCaL assessment highlighted 2 objective measures: (1) computed tomography for external and internal HNCaL and (2) ultrasonography for external lymphedema . In the present review, 1 RCT used ultrasonography, and none used computed tomography.…”

Section: Discussionmentioning

confidence: 86%

“…In the present review, 1 RCT used ultrasonography, and none used computed tomography. For monitoring internal lymphedema, the current criterion standard is endoscopy-based measures . This review identified 6 studies (2 RCTs, 4 observational studies) of adjunct therapies that used various endoscopic measures, with none showing clear improvement.…”

Section: Discussionmentioning

confidence: 99%

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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Initial Proof‐of‐Concept Study on Immediate Effects of External Advanced Pneumatic Compression on Pharyngeal and Laryngeal Internal Lymphedema Using a Fluoroscopic Measurement Tool

Gregor,

Chang,

Keole

et al. 2024

Head & Neck

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BackgroundExternal and internal head and neck cancer related lymphedema (HNCRL) is a common consequence of radiation treatment (RT). Currently, internal HNCRL can be clinically assessed endoscopically using a visuoperceptual, ordinal rating scale. Use of fluoroscopy to identify and measure internal HNCRL has been explored but is not widely used in clinical practice. Advanced Pneumatic Compression (APC) has shown external HNCRL reduction after a single treatment, whereas internal HNCRL reduction has not yet been assessed.MethodsFluoroscopic lateral scouts and TIMS Review software (TIMS Medical) were used to assess immediate internal HNCRL measures of 30 HNC patients with RT history following a single APC treatment. Pre and post external measures were also obtained. Paired t‐test was used to assess changes in pre and post measures. A post‐treatment survey was completed.ResultsAll 30 patients had both immediate external and internal HNCRL reductions, and all reductions were statistically significant. All reported positive benefit.ConclusionsA single, external APC treatment immediately impacted the extent of pharyngeal and laryngeal edema in post‐radiated HNC survivors. Fluoroscopy can be a clinically useful and complementary modality to detect, surveil, and measure internal HNCRL.

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Systematic review of head and neck lymphedema assessment

Cited by 21 publications

References 64 publications

Under recognition and treatment of lymphedema in head and neck cancer survivors – a database study

Under recognition and treatment of lymphedema in head and neck cancer survivors – a database study

Rehabilitation Interventions for Head and Neck Cancer–Associated Lymphedema

Initial Proof‐of‐Concept Study on Immediate Effects of External Advanced Pneumatic Compression on Pharyngeal and Laryngeal Internal Lymphedema Using a Fluoroscopic Measurement Tool

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