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

Isabella J Lao; Jacklyn Berry; Jinhong Li; Zainab Balogun; Baher Elgohari; Heath Skinner; Jonas Johnson; Marci L Nilsen

doi:10.1002/lary.31396

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

Laryngoscope. 2024 Mar 19. doi: 10.1002/lary.31396. Online ahead of print.

Authors

Isabella J Lao¹, Jacklyn Berry², Jinhong Li³, Zainab Balogun¹, Baher Elgohari⁴, Heath Skinner⁴, Jonas Johnson⁵, Marci L Nilsen^{5

6}

Affiliations

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.

PMID: 38501703
DOI: 10.1002/lary.31396

Abstract

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 <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.

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, 2024.

Keywords: head and neck cancer; lymphedema; patient-reported outcome measures; prognostic factors; quality of life; survivorship.