title: Prevalence of secondary lymphedema in patients with head and neck cancer.
abstract: BACKGROUND
  Because surgery, radiation, and/or chemotherapy disrupt lymphatic structures, damage soft tissue leading to scar tissue formation and fibrosis, and further affect lymphatic function, patients with head and neck cancer may be at high risk for developing secondary lymphedema. Yet, no published data are available regarding the prevalence of secondary lymphedema after head and neck cancer treatment.
  
  
  OBJECTIVE
  The aim of this study was to examine prevalence of secondary lymphedema in patients with head and neck cancer.
  
  
  METHODS
  The study included 81 patients with head and neck cancer who were three months or more post-treatment. External lymphedema was staged using Foldi's lymphedema scale. Internal lymphedema was identified through a flexible fiber-optic endoscopic or mirror examination. Patterson's scale was used to grade degrees of internal lymphedema.
  
  
  RESULTS
  Of the 81 patients, 75.3% (61 of 81) had some form of late-effect lymphedema. Of those, 9.8% (6 of 61) only had external, 39.4% (24 of 61) only had internal, and 50.8% (31 of 61) had both types.
  
  
  CONCLUSIONS
  Lymphedema is a common late effect in patients with head and neck cancer, and it develops in multiple external and internal anatomical locations. During physical examination and endoscopic procedures, clinicians should assess patients with head and neck cancer for late-effect lymphedema. Referral for treatment should be considered when lymphedema is noted. Research is needed to examine risk factors of lymphedema in patients with head and neck cancer and its effects on patients' symptoms, function, and quality of life.
authors.affiliation: School of Nursing, Vanderbilt University, Nashville, Tennessee 37240, USA. jie.deng@vanderbilt.edu
authors.forename: Jie
authors.initials: J
authors.lastname: Deng
authors.forename: Sheila H
authors.initials: SH
authors.lastname: Ridner
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.forename: Nancy
authors.initials: N
authors.lastname: Wells
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Wallston
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sinard
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Cmelak
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Murphy
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008209:Lymphedema / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology; D016896:Treatment Outcome