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J Palliat Med. 2016 Sep;19(9):949-56. doi: 10.1089/jpm.2016.0018. Epub 2016 May 26.

Internal Lymphedema Correlates with Subjective and Objective Measures of Dysphagia in Head and Neck Cancer Patients.

Author information

1
1 Department of Medicine, Vanderbilt University Medical Center , Nashville, Tennessee.
2
2 School of Nursing, Vanderbilt University Medical Center , Nashville, Tennessee.
3
3 Dept of Speech Sciences, Vanderbilt University Medical Center , Nashville, Tennessee.
4
4 Dept of Surgery, Vanderbilt University Medical Center , Nashville, Tennessee.
5
5 Department of Radiation Oncology, Vanderbilt University Medical Center , Nashville, Tennessee.
6
6 Department of Biostatistics, Schools of Medicine and Nursing, Vanderbilt University Medical Center , Nashville, Tennessee.

Abstract

BACKGROUND:

Tumor/treatment-related internal lymphedema (IL) and/or external lymphedema (EL) are associated with functional deficits and increased symptom burden in head and neck cancer patients (HNCP). Previously, we noted association between EL/IL and patient-reported dysphagia using the Vanderbilt Head and Neck Symptom Survey (VHNSS) version 1.0.

OBJECTIVE:

To determine the relationship between IL/EL and subjective and objective measures of swallowing function.

METHODS:

Eighty-one HNCP completed: (1) VHNSS version 2.0, including 13 swallowing/nutrition-related questions grouped into three clusters: swallow solids (ss), swallow liquids (sl), and nutrition(nt); (2) physical assessment of EL using Foldi scale; (3) endoscopic assessment of IL using Patterson scale (n = 56); and (4) modified barium swallow study rated by dysphagia outcome and severity scale (DOSS) and in conjunction with a swallow evaluation by National Outcomes Measurement System (NOMS). Examinations were performed at varied time points to assess lymphedema spectrum, from baseline (n = 15, 18.1%) to 18 months post-therapy (n = 20, 24.1%).

RESULTS:

VHNSS swallow/nutrition items scores correlated with NOMS/DOSS ratings (p < 0.001). Highest correlation was with NOMS: ss (-0.73); sl (-0.61); nt (-0.56). VHNSS swallow/nutrition scores correlated with maximum grade of swelling for any single structure on Patterson scale: ss (0.43; p = 0.001); sl (0.38; p = 0.004); nt (0.41; p = 0.002). IL of aryepiglottic/pharyngoepiglottic folds, epiglottis, and pyriform sinus were most strongly correlated with VHNSS and NOMS ratings. NOMS/DOSS ratings correlated with EL (> = -0.34; p < 0.01). No meaningful correlations exist between VHNSS swallow/nutrition items and EL (< ± 0.15, p > 0.20).

CONCLUSIONS:

IL correlated with subjective and objective measures of swallow dysfunction. Longitudinal analysis of trajectory and impact of IL/EL on dysphagia is ongoing.

PMID:
27227341
PMCID:
PMC5011629
DOI:
10.1089/jpm.2016.0018
[Indexed for MEDLINE]
Free PMC Article

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