Affiliation:
1. University of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A.
2. UPMC Rehabilitation Institute Pittsburgh Pennsylvania U.S.A.
3. Department of Biostatistics University of Pittsburgh School of Public Health Pittsburgh Pennsylvania U.S.A.
4. Department of Radiation Oncology University of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A.
5. Department of Otolaryngology University of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A.
6. Department of Acute and Tertiary Care University of Pittsburgh School of Nursing Pittsburgh Pennsylvania U.S.A.
Abstract
ObjectivesThe purpose of this study is to determine the predictors of neck lymphedema and to explore its association with symptoms and patient‐reported outcomes (PROs) in Head and Neck Cancer (HNC) patients who underwent non‐operative treatment.MethodsThis study involved a cross‐sectional secondary analysis of data from patients diagnosed with head and neck squamous cell carcinoma who underwent radiation therapy (±chemotherapy). Patients with visits <6 weeks or >2 years following completion of radiation and those with recurrent or metastatic cancer were excluded. Presence of post‐treatment lymphedema, demographics, clinical characteristics, health‐related behaviors, and symptoms were collected. PROs were obtained using validated questionnaires that assessed depression, anxiety, swallowing dysfunction, and quality of life (QOL). Multivariable regression models were used to examine the relationship between lymphedema with predictors and symptoms.ResultsOf the 203 patients included, 88 (43.4%) developed post‐treatment lymphedema. In multivariable analysis, pre‐treatment Body Mass Index (BMI) (odds ratio [OR] = 1.07, 95% confidence interval [CI] [1.01, 1.14] p = 0.016) and N stage (OR = 1.96, 95% CI [1.06, 3.66], p = 0.032) were found to be independently associated with lymphedema. Regarding PROs, lymphedema was associated with greater swallowing dysfunction (3.48, 95% CI [0.20, 6.75], p = 0.038), decreased mouth opening (−3.70, 95% CI [−7.31, −0.10], p = 0.044), and increased fatigue (1.88, 95% CI [1.05, 3.38], p = 0.034).ConclusionHigher pre‐treatment BMI and greater N stage are identified as independent predictors for lymphedema development in non‐operative HNC patients. Additionally, patients experiencing lymphedema reported worsening swallowing dysfunction and increased symptoms related to trismus and fatigue. Recognizing patients at elevated risk for lymphedema allows for early intervention, alleviation of symptom burden, and optimization of health care resources.Level of Evidence4 Laryngoscope, 134:3656–3663, 2024