A prospective evaluation of neck and shoulder function following treatments of early-stage human papillomavirus-associated oropharynx cancer

Arushi Gulati; Karolina Plonowska-Hirschfeld; Erika M Stephens; Sagar Kansara; Aaron L Zebolsky; Edgar Ochoa; Mary J Xu; Patrick K Ha; Chase M Heaton; Sue S Yom; Jason W Chan; Alain P Algazi; Hyunseok Kang; William R Ryan

doi:10.1111/coa.14076

A prospective evaluation of neck and shoulder function following treatments of early-stage human papillomavirus-associated oropharynx cancer

Clin Otolaryngol. 2023 Sep;48(5):756-765. doi: 10.1111/coa.14076. Epub 2023 May 22.

Authors

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA.
² Department of Otolaryngology-Head and Neck Surgery, University of Tennessee-Memphis, Memphis, Tennessee, USA.
³ Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Department of Radiation Oncology, University of California, San Francisco, California, USA.
⁵ Division of Hematology and Oncology, University of California, San Francisco, California, USA.

PMID: 37212448
DOI: 10.1111/coa.14076

Abstract

Objectives: To compare post-treatment neck and shoulder function between human papillomavirus-associated oropharynx squamous cell carcinoma (HPV + OPSCC) treatments.

Design: Prospective, repeated-measures study.

Setting: Tertiary care center.

Participants: Treatment-naïve patients with American Joint Committee on Cancer eighth edition stage T0-3/N0-2 HPV+OPSCC.

Main outcome measures: Patients completed the Neck Dissection Impairment Index (NDII) pre-treatment and 3-months and 1-year post-treatment. The NDII assesses 10 neck and shoulder functions scored 0-5 (total score 0-100), with higher scores suggesting better function.

Results: A total of 106 patients underwent: surgery alone (SA, n = 46, 43%), surgery with adjuvant radiation ± chemotherapy (S + a[C]XRT, n = 18, 17%), or definitive radiation ± chemotherapy (d[C]XRT, n = 42, 40%). cTN classification and pre-treatment NDII scores did not differ between groups. SA patients reported worsened 3-month post-treatment versus pre-treatment self-care (4.6 vs. 5.0), lifting light (4.6 vs. 5.0) and heavy (4.2 vs. 4.8) objects, overhead reach (4.5 vs. 4.9), activity (4.5 vs. 4.9), socialization (4.7 vs. 4.9), recreation (4.6 vs. 4.9), and overall score (86.8 vs. 95.3) (all p < 0.05). One-year post-treatment scores (n = 34) were no different than pre-treatment in all domains. S + a[C]XRT patients reported worsened 3-month versus pre-treatment stiffness (4.0 vs. 4.8), lifting heavy objects (3.8 vs. 4.9), overhead reach (4.2 vs. 4.9), socialization (4.6 vs. 5.0), recreation (4.4 vs. 4.9) and overall score (82.4 vs. 96.0) (all p < 0.05). One-year post-treatment scores (n = 13) were no different than pre-treatment in all domains. d[C]XRT patients reported worsened 3-month versus pre-treatment difficulty lifting heavy objects (4.3 vs. 4.7) and recreation (4.3 vs. 4.7). One-year posttreatment scores (n = 21) were no different than pre-treatment in all domains.

Conclusion: HPV + OPSCC patients may experience mild shoulder/neck dysfunction 3 months after treatment that usually resolves by 1 year, independent of treatment modality.

Keywords: human papillomavirus; neck function; oropharyngeal squamous cell carcinoma; patient reported outcomes; quality of life; shoulder function.