title: Quality of life, shoulder range of motion, and spinal accessory nerve status in 5-year survivors of head and neck cancer.
abstract: OBJECTIVE
  To determine the association of neck dissection and radiation treatment for head and neck cancer (HNC) with subsequent shoulder range of motion (ROM) and quality of life (QOL) in 5-year survivors.
  
  
  METHODS
  A cross-sectional convenience sample.
  
  
  METHODS
  Otolaryngology clinics at tertiary care hospital and Veterans Affairs medical center.
  
  
  METHODS
  Five-year, disease-free survivors of HNC.
  
  
  METHODS
  Demographic and cancer treatment information was collected, including type of neck dissection (none, spinal accessory "nerve sparing," and "nerve sacrificing") and radiation. QOL questionnaires were administered, and shoulder ROM was measured.
  
  
  METHODS
  University of Washington Quality of Life (UWQOL), Functional Assessment of Cancer Therapy (FACT) Head and Neck, and Performance Status Scale for Head and Neck. Shoulder ROM measurements included abduction, adduction, flexion, extension, internal and external rotation.
  
  
  RESULTS
  One hundred and five survivors completed QOL surveys; 85 survivors underwent additional shoulder ROM evaluations. The nerve sacrifice group exhibited significantly poorer scores for UWQOL measures of disfigurement, level of activity, recreation and/or entertainment, speech and shoulder disability, and willingness to eat in public, FACT functional well-being, and FACT Head and Neck (P < .05). Shoulder ROM for flexion and abduction was poorest in the nerve sacrifice group (P < .05). Radiation was associated with significantly worse UWQOL swallowing (P < .05), but no other differences were found for QOL or ROM measurements. Decreased QOL scores were associated with decreased shoulder flexion and abduction (P < .05). Survivors with decreased shoulder abduction had significantly (P < .05) worse scores in disfigurement, recreation and/or entertainment, employment, shoulder disability, and FACT emotional well-being.
  
  
  CONCLUSIONS
  Sparing the spinal accessory nerve during neck dissection is associated with significantly less long-term shoulder disability in 5-year survivors of HNC. QOL measures demonstrated the highest level of function in the no dissection group, an intermediate level of functioning with nerve sparing, and poorest function when the nerve is sacrificed. Decreased shoulder flexion and abduction is associated with reduced QOL in long-term survivors of HNC.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI∗. Electronic address: seickmeyer@mcw.edu.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Eickmeyer
authors.affiliation: Rehabilitation Services, Froedtert Hospital, Milwaukee, WI†
authors.forename: Christine K
authors.initials: CK
authors.lastname: Walczak
authors.affiliation: Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI‡
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Myers
authors.affiliation: Osler Medical Ear, Nose and Throat Specialty Practice, Melbourne, FL§
authors.forename: D Richard
authors.initials: DR
authors.lastname: Lindstrom
authors.affiliation: Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI||
authors.forename: Peter
authors.initials: P
authors.lastname: Layde
authors.affiliation: Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI¶
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Campbell
mesh_terms: D000055:Accessory Nerve / Q000502:physiology*; D000368:Aged; D003430:Cross-Sectional Studies; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000503:physiopathology* / Q000534:rehabilitation* / Q000628:therapy; D006801:Humans; D008297:Male; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology*; D012782:Shoulder / Q000502:physiology*; D011795:Surveys and Questionnaires; D017741:Survivors