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. Design Cross-sectional convenience sample Setting Otolaryngology clinics at tertiary care hospital and Veterans Affairs medical center Patients 5-year, disease-free, HNC survivors 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. Main Outcome Measurements University of Washington Quality of Life (UWQOL), Functional Assessment of Cancer Therapy Head and Neck (FACT-HN), and Performance Status Scale for Head and Neck (PSS-HN). 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/entertainment, speech, shoulder disability, and willingness to eat in public, FACT functional well-being, and FACT-HN (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/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 HNC survivors. 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 HNC survivors.

13 / Factors Influencing Neck and Shoulder Function After Oral Oncology Treatment: A Five-Year Prospective Cohort Study in 123 Patients

“…The negative effect of the extent of neck dissection surgery on shoulder abduction and forward flexion has been described before, and it is partly related to accessory nerve damage [6,23,24]. The only previous cross-sectional study to describe shoulder function at five-year follow-up also reported a negative effect for the extent of ND surgery [10]. The negative effect of bone graft/flap reconstruction is in line with previous studies, which have reported negative effects for extensive reconstructive surgery [6,25].…”

“…Reports on prevalence of shoulder dysfunction exhibit wide variation in how the limitations in function progress over time, and they are often limited to one-year follow-up or a single moment of measurement [9]. One cross-sectional study measuring shoulder range of motion at five-year follow-up reports slightly lower scores for shoulder function, as compared to studies reporting oneyear measurements [10]. There is thus no definitive prognostic information that can be provided to patients during rehabilitation.…”

Development and Feasibility of a Prehabilitation Protocol for Patients Diagnosed with Head and Neck Cancer

“…Swelling of the face and neck and potential nerve damage may cause further motor, sensory, and functional deficits, such as diminished neck and/or shoulder range of motion (ROM). Significant QoL issues result from this sequelae, causing difficulty managing both basic and advanced activities of daily living (ADLs) [ 9 ]. In partnership with speech language pathologists (SLP) who address potential swallowing and speech limitations, PTs are often consulted to address the negative sequelae of H&N cancer and its treatments.…”

Laryngeal adductor function following potassium titanyl phosphate laser welding of the recurrent laryngeal nerve

“…During head and neck surgery, cranial nerve transection is sometimes anticipated or can occur unintentionally . Cranial nerve injuries can lead to significant morbidity including facial paralysis, dysphagia, shoulder disability, and aspiration . Following complete nerve transection, primary neurorrhaphy with microsuture is the most commonly used repair technique, provided the nerve endings have enough length for primary anastomosis …”