PhD in Nursing Science Program

Jie Deng

The Impact of Secondary Lymphedema After Head and Neck Cancer Treatment on Symptoms, Functional Status and Quality of Life

 

Dissertation under the direction of Professor Sheila H. Ridner

 

Because surgery, radiation, and/or chemotherapy disrupt lymphatic structures, damage soft tissue leading to scar tissue formation and fibrosis, and further affect lymphatic function, head and neck cancer patients may be at high risk for developing secondary lymphedema. Head and neck cancer patients may develop secondary lymphedema externally (e.g., face) and internally (e.g., larynx). It not only influences patients’ most visible body areas (e.g., face and neck), but it also impacts critical physical functions (e.g., breathing and swallowing). These issues are understudied. The possible factors contributing to secondary lymphedema after head and neck cancer are unknown.

The study was conducted to examine the associations among the severity of lymphedema, symptoms, functional status, and quality of life in head and neck cancer patients. The study also examined the possible factors contributing to the presence of secondary lymphedema in head and neck cancer patients. A convenience sample of 103 head and neck cancer patients were recruited at the Vanderbilt-Ingram Cancer Center.

Several significant findings were generated from this study. First, the study findings suggest that lymphedema in head and neck cancer patients is a very common late-effect. The study identified that head and neck cancer patients may not only develop external lymphedema (such as facial and neck area), but also have internal lymphedema (such as pharynx and larynx) after their cancer treatment. The findings from this study demonstrated that the severity of lymphedema was statistically significantly associated with swallowing difficulty, mucous/dry mouth-related symptoms, and impaired body image. The study found that the severity of combined (internal and external) lymphedema was statistically significantly associated with head and neck cancer patients’ quality of life status. In addition, the study found that types and dosages of cancer treatment were statistically significantly associated with whether or not head and neck cancer patients presented with lymphedema. Thus, the study provides an insight regarding the importance of addressing lymphedema in head and neck cancer patients.