Neck scar perception after neck dissection in HPV-associated oropharyngeal squamous cell carcinoma

Vivienne H Au; Lauren E Miller; Margaret B Mitchell; Andrew R Larson; Derrick T Lin; Allen L Feng; Jeremy D Richmon

doi:10.1016/j.amjoto.2023.104074

Neck scar perception after neck dissection in HPV-associated oropharyngeal squamous cell carcinoma

Am J Otolaryngol. 2024 Jan-Feb;45(1):104074. doi: 10.1016/j.amjoto.2023.104074. Epub 2023 Oct 12.

Authors

Vivienne H Au¹, Lauren E Miller¹, Margaret B Mitchell¹, Andrew R Larson¹, Derrick T Lin¹, Allen L Feng¹, Jeremy D Richmon²

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America.
² Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America. Electronic address: Jeremy_richmon@meei.harvard.edu.

PMID: 37865986
DOI: 10.1016/j.amjoto.2023.104074

Abstract

Importance: While there has been an increased understanding of the impact of visible neck scars in some patients with certain diseases, this has not yet been explored in the HPV+ OPSCC population.

Objective: To understand patients' perception of their scar and the impact on their quality of life (QOL) at least 6 months after neck dissection (ND) for HPV+ oropharyngeal squamous cell carcinoma (OPSCC).

Design, setting, and participants: In this retrospective case-control study, patients who underwent primary transoral robotic surgery (TORS) and ND for HPV+ OPSCC between 2016 and 2021 at a single tertiary care center were identified. Data analysis was performed in January 2022.

Main outcomes and measures: Dermatology Life Quality Index was modified (mDLQI) to assess patients' perceptions of their scars. The primary outcome was the mean mDLQI survey score with higher scores corresponding to worse perceptions. Three questions adapted from the Self-Consciousness Scale (SCS) were also included to assess awareness of appearance. All questions were scaled on a 0-3 Likert Scale. Tweedie generalized linear model was used to understand the relationship between mDLQI score and patient- and procedure-specific factors (including the three SCS survey questions). An additional exploratory logistic regression was performed to understand the risk factors for clinically significant mDLQI score change.

Results: A total of 67 patients (response rate 57 %) completed the survey with a mean mDLQI survey score of 0.84 (max 30). Although there was a statistically significant negative association between private insurance and mDLQI survey score (95 % Confidence Interval [CI]: -2.72 - -0.38), and a positive association between the SCS score and mDLQI survey score (95 % CI: 0.23-0.81) (p < 0.05), these variables were not found to be risk factors for a clinically significant difference in mDLQI on multivariable analysis.

Conclusion: The majority of patients felt their neck scars did not interfere with their daily lives. Patient perceptions of neck scars were consistent despite differing patient characteristics and treatment regimens.

Keywords: Cosmesis; HPV; Neck dissection; Neck scar; Oropharyngeal squamous cell carcinoma.

MeSH terms

Carcinoma, Squamous Cell* / pathology
Case-Control Studies
Cicatrix / etiology
Head and Neck Neoplasms* / surgery
Humans
Neck Dissection / adverse effects
Oropharyngeal Neoplasms* / pathology
Papillomavirus Infections* / complications
Papillomavirus Infections* / surgery
Perception
Quality of Life
Retrospective Studies
Robotic Surgical Procedures* / adverse effects
Squamous Cell Carcinoma of Head and Neck / etiology
Squamous Cell Carcinoma of Head and Neck / surgery