title: Internal Lymphedema Correlates with Subjective and Objective Measures of Dysphagia in Head and Neck Cancer Patients.
abstract: 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.
  
  
  
  To determine the relationship between IL/EL and subjective and objective measures of swallowing function.
  
  
  
  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%).
  
  
  
  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).
  
  
  
  IL correlated with subjective and objective measures of swallow dysfunction. Longitudinal analysis of trajectory and impact of IL/EL on dysphagia is ongoing.
authors.affiliation: 1 Department of Medicine, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Leanne K
authors.initials: LK
authors.lastname: Jackson
authors.affiliation: 2 School of Nursing, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Sheila H
authors.initials: SH
authors.lastname: Ridner
authors.affiliation: 2 School of Nursing, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Jie
authors.initials: J
authors.lastname: Deng
authors.affiliation: 3 Dept of Speech Sciences, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Carmin
authors.initials: C
authors.lastname: Bartow
authors.affiliation: 4 Dept of Surgery, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Kyle
authors.initials: K
authors.lastname: Mannion
authors.affiliation: 5 Department of Radiation Oncology, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Ken
authors.initials: K
authors.lastname: Niermann
authors.affiliation: 1 Department of Medicine, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Jill
authors.initials: J
authors.lastname: Gilbert
authors.affiliation: 6 Department of Biostatistics, Schools of Medicine and Nursing, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.affiliation: 5 Department of Radiation Oncology, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Cmelak
authors.affiliation: 1 Department of Medicine, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Murphy
mesh_terms: D003680:Deglutition Disorders; D006258:Head and Neck Neoplasms; D006801:Humans; D007830:Larynx; D008209:Lymphedema; D011795:Surveys and Questionnaires