Feasibility of machine‐delivered sequential massage for the management of lymphedema in the head and neck cancer survivor

Abstract

Background: Lymphedema after treatment for head and neck cancer negatively impacts the quality of life and can produce neck tissue stiffness, dysphagia, pain, and swelling. One form of treatment for lymphedema is machine-delivered sequential lymphedema massage, which is home based and self administered. This study was undertaken to determine economic and system access to home-based lymphedema therapy and to measure patient-reported outcomes among those able to access therapy.Methods: This study is a retrospective cohort study of 84 head and neck cancer patients who met the criteria for referral for home-based lymphedema treatment.Patients who were able to access lymphedema therapy were surveyed prior to initiation of therapy and again after therapy.Results: Thirty-five out of 84 patients were approved for home-based therapy and received the equipment. Medicare denial of coverage (21/84) was the most common cause of the inability to access therapy. Of the 35 patients who accessed therapy, presenting complaints included: stiffness (31), pain (29), dysphagia (20), and swelling (19). The average time from completion of cancer treatment to initiation of lymphedema therapy was 9 months. Thirty-four (97%) reported compliance with prescribed therapy, 33 (94%) reported reduced fibrosis, and 30 (89%) reported improvement in activities of daily living. All reported symptoms improved with therapy in 30 (86%) patients. Thirty-two (91%) reported overall satisfaction with home-based lymphedema treatment.Conclusions: Stiffness and pain were the most common complaints of our patients with head and neck lymphedema. Forty-two percent of patients who were recommended home lymphedema machine use were able to obtain this with cost coverage by their insurance company or by donation from the company. We found a high compliance rate and a highly reported improvement in symptoms with the machine.The only identifiable factor for the patients with less improvement in symptoms was

Rehabilitation Interventions for Head and Neck Cancer–Associated Lymphedema

“…All studies found benefit with APCD use, which was also found to be safe and feasible in 1 RCT and 3 observational studies reporting adverse events. The one RCT compared a 2-month intervention with a waitlist control condition and found improvement in the APCD group in clinician-rated external lymphedema and subjective swallowing, but no improvement in endoscopic assessment of internal lymphedema .…”

“…Anatomical disease sites were mixed HNC in all studies. Baseline lymphedema severity was not reported in most studies (13 studies). When baseline lymphedema was assessed (4 of 17 studies), all studies reported stages 1b (range, 0-3) on the MDACC-HNL Rating Scale .…”

“…When baseline lymphedema was assessed (4 of 17 studies), all studies reported stages 1b (range, 0-3) on the MDACC-HNL Rating Scale . Serious intervention-related adverse effects were either not found (7 studies) or not reported (10 studies) . The timing of interventions was mostly posttreatment except for 1 study intervention that included patients who were undergoing cancer treatment .…”

“…The one RCT (n = 49) found that most participants who had either completed treatment with or did not have access to CDT used the device for one 32-minute session per day rather than the prescribed 2 sessions per day for the 8-week company-funded trial . Of the observational trials, most participants used the device for one 32-minute session per day . Intervention duration ranged from 1 session to 6 months .…”

“…Intervention duration ranged from 1 session to 6 months . Most studies of APCDs included participants who had completed CDT or underwent concurrent CDT . One study explicitly stated that CDT was not used by any participants .…”