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

• Published in: The Laryngoscope 2024-08, Vol.134 (8), p.3656-3663
• Main Authors: Lao, Isabella J., Berry, Jacklyn, Li, Jinhong, Balogun, Zainab, Elgohari, Baher, Skinner, Heath, Johnson, Jonas, Nilsen, Marci L.
• Format: Article
• Language: English
• Subjects: Aged; Body mass index; Cancer Survivors - statistics & numerical data; Cancer therapies; Cross-Sectional Studies; Deglutition Disorders - epidemiology; Deglutition Disorders - etiology; Female; Head & neck cancer; head and neck cancer; Head and Neck Neoplasms - complications; Head and Neck Neoplasms - radiotherapy; Head and Neck Neoplasms - therapy; Humans; Lymphedema; Lymphedema - etiology; Lymphedema - therapy; Male; Middle Aged; Neck; Patient Reported Outcome Measures; Prognosis; prognostic factors; Quality of Life; Radiation; Risk Factors; Squamous Cell Carcinoma of Head and Neck - complications; Squamous Cell Carcinoma of Head and Neck - therapy; Surveys and Questionnaires; survivorship; Swallowing
• ISSN: 0023-852X; 1531-4995; 1531-4995
• DOI: 10.1002/lary.31396

Objectives The 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. Methods This 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 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. Results Of 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). Conclusion Higher 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 Evidence 4 Laryngoscope, 134:3656–3663, 2024 Head and neck cancer (HNC) patients who receive radiation therapy often develop neck and submental lymphedema as a treatment‐related side‐effect. Lymphedema can greatly impact a patient's physical functioning and quality of life. The purpose of this study is to determine the predictors of neck lymphedema and toexplore its association with symptoms and patient‐reported outcomes in HNC patients who underwent non‐operative treatment.