Association between external and internal lymphedema and chronic dysphagia following head and neck cancer treatment

Claire Jeans; Elizabeth C Ward; Bena Brown; Anne E Vertigan; Amanda E Pigott; Jodie L Nixon; Chris Wratten; May Boggess

doi:10.1002/hed.26484

Association between external and internal lymphedema and chronic dysphagia following head and neck cancer treatment

Head Neck. 2021 Jan;43(1):255-267. doi: 10.1002/hed.26484. Epub 2020 Oct 1.

Authors

Claire Jeans^{1

2}, Elizabeth C Ward^{1

3}, Bena Brown^{1

3

4}, Anne E Vertigan^{5

6

7}, Amanda E Pigott^{3

8

9}, Jodie L Nixon^{8

9}, Chris Wratten¹⁰, May Boggess¹¹

Affiliations

¹ Division of Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
² Speech Pathology Department, Calvary Mater Newcastle, Waratah, New South Wales, Australia.
³ Centre for Functioning and Health Research, Metro South Health Services District, Queensland Health, Buranda, Queensland, Australia.
⁴ Speech Pathology Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
⁵ Speech Pathology Department, John Hunter Hospital and Belmont Hospital, New Lambton Heights, New South Wales, Australia.
⁶ School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.
⁷ Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
⁸ Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
⁹ Occupational Therapy Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
¹⁰ Radiation Oncology Department, Calvary Mater Newcastle, Waratah, New South Wales, Australia.
¹¹ School of Mathematical and Statistical Sciences, Arizona State University, Tempe, Arizona, USA.

PMID: 33001529
DOI: 10.1002/hed.26484

Abstract

Background: To examine the relationship between chronic external and internal head and neck lymphedema (HNL) and swallowing function in patients following head and neck cancer (HNC) treatment.

Methods: Seventy-nine participants, 1-3 years post treatment were assessed for external HNL using the MD Anderson Cancer Centre Lymphedema Rating Scale, and internal HNL using Patterson's Radiotherapy Edema Rating Scale. Swallowing was assessed via instrumental, clinical and patient-reported outcome measures.

Results: HNL presented as internal only (68%), combined external/internal (29%), and external only (1%). Laryngeal penetration/aspiration was confirmed in 20%. Stepwise multivariable regression models, that accounted for primary site, revealed that a higher severity of external HNL and internal HNL was associated with more severe penetration/aspiration (P < .004 and P = .006, respectively), diet modification (P < .001 both), and poorer patient-reported outcomes (P = .037 and P = .014, respectively).

Conclusion: Increased swallowing issues can be expected in patients presenting with more severe external HNL and/or internal HNL following HNC treatment.

Keywords: aspiration; dysphagia; head and neck cancer; lymphedema; radiotherapy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Deglutition
Deglutition Disorders* / etiology
Head and Neck Neoplasms* / complications
Head and Neck Neoplasms* / radiotherapy
Humans
Lymphedema* / etiology
Neck