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

Abstract

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.

Swallowing-related muscle inflammation and fibrosis induced by a single dose of radiation exposure in mice

“…Chronic aspiration is a life-threatening manifestation of dysphagia, affecting 30% of HNC survivors treated with irradiation [ 14 ]. RAD is not only caused by RIF of the cervical region (e.g., strap muscles, intrinsic laryngeal musculature, recurrent laryngeal nerve, and lymphatics) [ 7 , 9 , 15 ] but also by sensory deficits associated with cranial nerve neuropathies caused by radiation-induced hypoxia [ 8 , 16 ]. Tedla et al [ 7 ] demonstrated that swallowing dysfunction after irradiation is caused, at least partially, by a reduction in intrinsic laryngeal muscle mass and by changes in the laryngeal nerves in human models, which are involved in aspiration prevention.…”

Lymphovenous Anastomosis for the External and Internal Types of Head and Neck Lymphedema: A Case Series and Preliminary Clinical Results

“… 1 However, a retrospective study based on an integrated US healthcare database showed that only 6.5% of head and neck cancer survivors were diagnosed as HNL, and merely 3% of head and neck cancer survivors received lymphedema treatment, implying that HNL was underdiagnosed and undertreated. 2 The first-line therapy for HNL, according to the American Cancer Society head and neck cancer survivorship care guideline, is manual lymphatic drainage (MLD). 3 Currently, the most commonly used treatment for HNL is complete decongestion therapy (CDT), including MLD, customized compression garments, physical exercise, and skin care.…”

Prognostic Factors and Outcomes Associated With Neck Lymphedema in Head and Neck Cancer Survivors

“…5 Reports indicate an increasing prevalence of lymphedema following HNC therapy, with some studies stating the presence of lymphedema in up to 90% of survivors. 6,7 While most reports of lymphedema have been associated with patients treated with multimodal therapy in breast cancer, the addition of radiation therapy to surgical treatment has been found to increase lymphedema risk, suggesting that radiation may play an important role in lymphedema development. 8,9 In addition, several factors have been found to be correlated with lymphedema development in HNC patients treated with multiple modalities.…”