Factors associated with external and internal lymphedema in patients with head-and-neck cancer.
OBJECTIVE
The purpose of this study was to examine factors associated with the presence of secondary external and internal lymphedema in patients with head-and-neck cancer (HNC).


METHODS
The sample included 81 patients ≥3 months after HNC treatment. Physical and endoscopic examinations were conducted to determine if participants had external, internal, and/or combined head-and-neck lymphedema. Logistic regression analysis was used to examine the factors associated with the presence of lymphedema.


RESULTS
The following factors were statistically significantly associated with presence of lymphedema: (1) location of tumor associated with presence of external (P=.009) and combined lymphedema (P=.032); (2) time since end of HNC treatment associated with presence of external (P=.004) and combined lymphedema (P=.005); (3) total dosage of radiation therapy (P=.010) and days of radiation (P=.017) associated with the presence of combined lymphedema; (4) radiation status of surgical bed was associated with the presence of internal lymphedema, including surgery with postoperative radiation (P=.030) and (salvage) surgery in the irradiated field (P=.008); and (5) number of treatment modalities associated with external (P=.002), internal (P=.039), and combined lymphedema (P=.004). No demographic, health behavior-related, or comorbidity factors were associated with the presence of lymphedema in the sample.


CONCLUSIONS
Select tumor and treatment parameters are associated with increased occurrence of lymphedema in patients with HNC. Larger and longitudinal studies are needed to identify adjusted effects and causative risk factors contributing to the development of lymphedema in patients with HNC.
School of Nursing, Vanderbilt University, Nashville, TN 37240, USA. jie.deng@vanderbilt.edu
Jie
J
Deng
Sheila H
SH
Ridner
Mary S
MS
Dietrich
Nancy
N
Wells
Kenneth A
KA
Wallston
Robert J
RJ
Sinard
Anthony J
AJ
Cmelak
Barbara A
BA
Murphy
D003430:Cross-Sectional Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D008209:Lymphedema / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D012307:Risk Factors; D016879:Salvage Therapy; D013997:Time Factors