Functional Impairments after Neck Dissection and Adjuvant Treatment: Patterns of Care

Abstract

Objective: Shoulder pain or weakness, lymphedema, and xerostomia are known treatment-related impairments of head and neck cancer, often leading to significant disability. The purpose of this study is to determine the referral patterns to rehabilitation for these impairments in patients who underwent primary surgery that included neck dissection and to identify potential predictors of need for rehabilitation. Design: Retrospective chart review. Setting: Tertiary hospital. Patients: Patients who had ten or more lymph nodes removed via neck dissection. Methods and Outcome Measurements: Demographics, cancer history, symptoms and referrals to rehabilitation for shoulder pain or weakness, lymphedema, and xerostomia were recorded. Results: 155 patients with a mean age of 61.4 were identified. 29 patients (20.1%) had shoulder pain or weakness, 39 patients (27.9%) had lymphedema, and 72 subjects (50.7%) had xerostomia. No rehabilitation referrals were made for 24.1% of patients with shoulder pain or weakness, 51.3% with lymphedema, and 61.1% with xerostomia. Adjuvant radiation was associated with shoulder pain or weakness (p=0.0004), lymphedema (p=0.001), and xerostomia (p 4 days post-operatively (p=0.002) were associated with lymphedema. Conclusion: The majority of patients with shoulder pain or weakness were referred to rehabilitation, but less than half of patients with lymphedema or xerostomia were referred for appropriate rehabilitation treatment. In addition to radiation, which is a known association for these common impairments after HNC treatment, greater number of lymph nodes removed and prolonged drain placement may identify patients at risk of lymphedema.