Smith, B.G., Hutcheson, K.A., Little, L.G., Skoracki, R.J., Rosenthal, D.I., Lai, S.Y., & Lewin, J.S. (2015). Lymphedema outcomes in patients with head and neck cancer. Otolaryngology: Head and Neck Surgery, 152, 284–291. 

To describe the management of lymphedema in patients treated for head and neck cancer using complete decongestive therapy

This was a retrospective medical record review of patents evaluated and treated for lymphedema with head and neck cancer. Documented results were obtained at baseline and at the first evaluation after complete decongestive therapy (CDT). Patients had at least one training session for self-administration of manual lymph drainage, compression garments, skin care, and exercises for the face, neck,and oral cavity. Patients with severe lymphedema received two to five sessions of CDT with a therapist for two to four weeks as well as a daily self-administered home session, which was continued for as many as three months.

• N = 733  
• MEDIAN AGE = 61 years (range = 21–91 years)
• MALES: 79%, FEMALES: 21%
• KEY DISEASE CHARACTERISTICS: The most common tumor sites were the oropharynx, oral cavity, and larynx. The most common primary surgery prior to referral was total laryngectomy, and 54% of participants received lymph node dissections. The most common sites of edema were the neck and submental regions. Sixty-eight percent of patients had difficulty swallowing, 39% had difficulty breathing, and the majority had cosmetic concerns.

• SITE: Single site  
• SETTING TYPE: Outpatient    
• LOCATION: Texas

Retrospective, descriptive study

• Clinical evaluation using Foldi's Stages of Lymphedema Scale
• Measurements were summed to create a composite score.

The median time from the baseline assessment to follow-up was 69 days with a range of 9–371 days. Eighty-seven percent of patients reported at least partial adherence to self-administered home management. Overall, 60% of patients showed an improvement in lymphedema. Those who received therapist-administered sessions were more likely to show improvement at follow-up (72%) compared to those who only received the self-administered program (58%, p = 0.014). Those with the worst lymphedema demonstrated the most improvement.

CDT can be beneficial for the treatment of lymphedema in patients with head and neck cancer.

• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Measurement/methods not well described
• Measurement validity/reliability questionable
• Other limitations/explanation: There was no standard timing for the follow-up assessment and lymphedema measurement. The method of measurement was not sensitive or responsive enough to identify anything other than gross changes.

The measurement of lymphedema associated with head and neck cancer treatment is difficult. CDT has been shown to be effective in the management of lymphedema of the extremities, and this study suggests that it also is helpful for head and neck lymphedema. The differences among those who received therapist-delivered CDT versus those who did self-administered therapy are not clear because of measurement limitations, patient adherence, and other factors.