Poster Presentation Joint Scientific Meeting of the Australian & NZ Head & Neck Cancer Society & NZ Association of Plastic Surgeons

Head and neck lymphoedema and dysphagia following chemoradiotherapy for head and neck cancer: A 12 month longitudinal investigation (1346)

Claire Jeans 1 2 , Bena Brown 3 4 5 , Elizabeth C Ward 1 3 , Anne E Vertigan 6 7 8 , Amanda E Pigott 1 9 , Jodie L Nixon 1 9 , Christopher Wratten 10 , May Boggess 11
  1. School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia
  2. Head & Neck Speech Pathology Newcastle, Gateshead, NSW, Australia
  3. Centre for Functioning and Health Research (CFAHR), Buranda, Queensland, Australia
  4. Speech Pathology Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  5. Menzies School of Health Research, Brisbane, Queensland, Australia
  6. Speech Pathology Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
  7. School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
  8. Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, New Lambton Heights, New South Wales, 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 , United States of America

Purpose: Head and neck lymphoedema (HNL) is prevalent following head and neck cancer (HNC) treatment, and has been associated with more severe dysphagia. However, little is known about its trajectory post-treatment and how this impacts swallowing. The aim of this prospective longitudinal cohort study was to: (1) examine the trajectory of HNL in patients with HNC treated with chemoradiotherapy (CRT); and (2) examine the association between HNL and dysphagia.

Methodology: Thirty-three patients (91% male, 91% oropharyngeal tumours) were recruited and data collected at 3, 6 and 12 months post CRT. External HNL (E-HNL) was assessed with the Assessment of Lymphoedema of the Head and Neck and the MD Anderson Cancer Centre Lymphoedema Rating Scale. Internal HNL (I-HNL) was assessed with Patterson’s Radiotherapy Oedema Rating Scale. Swallowing was assessed via instrumental, clinical and patient-reported outcome measures. Associations between HNL and swallowing were examined with multivariable regression models.

Results: E-HNL was prevalent at 3 months (71%), had begun to improve at 6 months (58%), and was largely resolved by 12 months (10%). The majority had moderate/severe I-HNL at 3 months (96%) and 6 months (84%), with some reduction at 12 months (64%). More severe penetration/aspiration and increased diet modification were associated with higher severities of E-HNL (p=0.001, 0.036, respectively) and I-HNL (p<0.001, 0.007, respectively), and more diffuse I-HNL (p =0.043, 0.001, respectively). More difficulty eating solid foods was also associated with a higher severity of E-HNL (p=0.004) and more diffuse I-HNL (p=0.002).

Conclusion: E-HNL is most prevalent at 3 months post CRT and has largely resolved by 12 months, whereas I-HNL persists. There is some reduction in I-HNL severity/diffuseness, but it did not fully resolve over 12 months. Patients who have more severe E-HNL and I-HNL or have more diffuse I-HNL may also experience more severe dysphagia.

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