Evidence Based Practice and Nursing Research

Jie Deng

August 2013

Jie Deng, PhD, RN, OCN
Assistant Professor
Vanderbilt University School of Nursing

Type of project: Research
Title of project: Factors Associated with External and Internal Lymphedema in Patients with Head-and-Neck Cancer
Co-authors involved in this publication: Sheila H. Ridner, PhD, RN, FAAN; Mary S. Dietrich, PhD; Nancy Wells, DNSc, RN, FAAN; Kenneth A. Wallston, PhD; Robert J. Sinard, MD; Anthony J. Cmelak, MD; Barbara A. Murphy, MD

Description of project: The study aimed to examine factors associated with the presence of secondary external (e.g., facial swelling) and internal (e.g., laryngeal edema) lymphedema in patients with head-and-neck cancer. The study recruited a convenience sample of 103 patients who were at least 3 months after completion of head-and-neck cancer treatment. The study examined associations between demographic characteristics, health-related behaviors (smoking and/or alcohol use), comorbidities, tumor-related factors, and cancer treatment parameters and the presence of lymphedema after head-and-neck cancer treatment.

Why you chose this project: More than one-half million head-and-neck cancer survivors are alive in the United States. This number is expected to be increased over the next decade due to the following two reasons: 1) aggressive multimodality therapy that has led to improvement in survival; and 2) an epidemic of human papillomavirus-related head-and-neck cancers with improved survival. Thus, oncology clinicians will spend more time and effort to identify and manage late effects from head-and-neck cancer therapy. One of the commonly neglected late effects of head-and-neck cancer treatment is lymphedema (swelling or scar-like tissue involved in external sites or internal structures). Lymphedema could cause physical symptoms (e.g., skin swelling and tightness, swallowing difficulties) and psychological symptoms (e.g., body image disturbance). However, no studies have been available to systematically examine possible risk factors for development of lymphedema in head-and-neck cancer patients. Thus, this is the first study the authors are aware of that systematically examined possible factors associated with presence of head and neck lymphedema. The study found that select tumor and cancer treatment parameters are associated with presence of lymphedema in patients with head-and-neck cancer.

Presentation and publication as a result of this project:

  1. Post-treatment Lymphedema in Head and Neck Cancer Patients: Prevalence, Severity and Associated Symptom Burden. Multidisciplinary Head and Neck Cancer Symposium. Phoenix, AZ, January 27, 2012. (Podium presentation).
  2. Head and Neck Cancer Lymphedema. Lymphedema Management SIG Meeting at the 38th Annual ONS Congress. Washington DC, April 26, 2013. (Podium presentation).
  3. Deng, J., Ridner, S.H., Dietrich, M.S., Wells, N., Wallston, K.A., Sinard, R.J., Cmelak, A.J., & Murphy, B.A. Factors associated with external and internal lymphedema in patients with head and neck cancer. International Journal of Radiation Oncology *Biology* Physics. 2012 Nov 1; 84(3). Epub 2012 May 30. (Publication)

Notes from the spotlight: There are several implications from the study findings. Oncology clinicians need to evaluate lymphedema status as a part of routine clinical examination, especially for individuals with high risks (e.g., multimodality head-and-neck cancer treatment). If lymphedema is found, clinicians need to make a referral to lymphedema therapy. More studies are warranted to identify risk factors of development of lymphedema in head-and-neck cancer patients.

If you have any questions about Dr. Deng's project she can be reached via email at Jie.Deng@Vanderbilt.Edu

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