Shoulder function in patients undergoing selective neck dissection with or without radiation and chemotherapy

Watkins, Jeremy P.; Williams, Glenn B.; Mascioli, Anthony A.; Wan, Jim Y.; Samant, Sandeep

doi:10.1002/hed.21503

Cited by 31 publications

(24 citation statements)

References 26 publications

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“…Our data suggest that use of radiation therapy and/or chemotherapy is correlated with poorer shoulder function and quality of life. This is in contrast to findings from Watkins et al, 18 in which shoulder impairment was documented in patients who underwent SND, but there was no significant effect for patients who received adjuvant therapy. In the study by Watkins et al, radiation therapy and chemotherapy did not confer poorer shoulder function, but the total sample was 34 patients, and only 7 of these patients had neck dissection alone.…”

Section: Discussioncontrasting

confidence: 56%

Association Between Multimodality Neck Treatment and Work and Leisure Impairment

Gallagher

Sacco

Lee

et al. 2015

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEThis study describes the effect of adjuvant treatment on shoulder-related quality of life, leisure activities, and employment for patients undergoing neck dissection for head and neck cancer.OBJECTIVE To explore the association between treatment outcome and shoulder-related on critical daily life functions such as employment and recreation. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of patients with head and neck cancer at a tertiary care hospital.EXPOSURES Level V-sparing selective neck dissection or modified radical neck dissection sparing the accessory nerve, with or without radiation therapy and/or chemotherapy. MAIN OUTCOMES AND MEASURESPatients completed the Neck Dissection Impairment Index (NDII), with scores ranging from 0 to 100 and higher scores indicating better shoulder functioning and shoulder-related quality of life, and underwent objective testing with the Constant-Murley Shoulder Function Test (Constant test) at least 12 months after the completion of all adjuvant treatment. Additional outcome measures related to physical therapy, pain medication use, leisure activity, and employment status. CONCLUSIONS AND RELEVANCE More aggressive treatment, either in the form of increased surgical dissection, radiation therapy, or chemotherapy, was associated with worse shoulder function and quality of life. The degree of impairment perceived by the patient and measured in objective testing was correlated with leisure activity and employment status. These findings may stimulate further investigation related to optimizing quality of life following neck dissection.

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Section: Discussioncontrasting

confidence: 56%

Association Between Multimodality Neck Treatment and Work and Leisure Impairment

Gallagher

Sacco

Lee

et al. 2015

JAMA Otolaryngol Head Neck Surg

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“…Others have shown that disability improved with time, and rehabilitation played an important role in promoting function and reducing pain. 9,[21][22][23][24] Some studies have focused on wrist mobility, but the effect of RFF flap harvest on this parameter is unclear. [7][8][9][10] In addition, it has been shown that objective measurements do not accurately reflect the patient's experience.…”

Section: Discussionmentioning

confidence: 99%

Upper extremity morbidity after radial forearm flap harvest: a prospective study

et al. 2013

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Objective: To determine the effect of radial forearm free (RFF) flap harvest on patient-reported postoperative upper extremity disability. Methods: Patients undergoing RFF flap reconstruction following resection of head and neck cancer were recruited and matched with similar patients undergoing non-RFF reconstruction. All subjects completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire preoperatively and at least 1 year postoperatively. Results: Postoperative DASH scores were significantly higher (more severe disability) in patients undergoing RFF flap reconstruction (6.93 AE 5.54; n ¼ 52) compared with those undergoing non-RFF flap surgeries (2.95 AE 4.42; n ¼ 52). Preoperative DASH score, flap size, patient age and tumour stage were significantly correlated with postoperative DASH score. Conclusion: Excluding the effect of neck dissection, RFF flap reconstruction has a significant deleterious effect on upper extremity function.

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“…9,10 Once developed, shoulder-related symptoms have been found to persist rather than improve even in cases of SAN recovery, and little is known about effective management of this condition over the long term. 2,11 The results from our randomized controlled trial of upper extremity (UE) progressive resistance exercise training (PRET) demonstrated significant improvements in patient-rated shoulder pain and disability, UE strength and endurance, and range of motion in post-surgical HNC survivors. 12 All other outcomes, including fatigue, neck dissection impairment, and quality of life (QOL), favoured the PRET group at the end of the 12-week intervention but did not reach statistical significance.…”

Section: Ré Sumémentioning

confidence: 99%

Sustainability of Outcomes after a Randomized Crossover Trial of Resistance Exercise for Shoulder Dysfunction in Survivors of Head and Neck Cancer

McNeely

Parliament

Seikaly³

et al. 2015

Physiotherapy Canada

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Purpose: Shoulder pain and dysfunction may occur after surgery for head and neck cancer (HNC) as a result of damage to or resection of the spinal accessory nerve. Previous research found that 12 weeks of upper extremity progressive resistance exercise training (PRET) improved shoulder outcomes in survivors of HNC; the purpose of this study was to determine whether benefits persisted over the longer term. Methods: Survivors of HNC were assigned at random to PRET (n ¼ 27) or a standard therapeutic protocol (TP; n ¼ 25), with an opportunity for crossover in the TP group after 12 weeks. At 12-month follow-up, participants were mailed a questionnaire that assessed quality of life (QOL), shoulder outcomes, and exercise behaviour. Results: Of the 52 participants enrolled in the study, 44 were eligible at 12-month follow-up, and 37 (71%) completed the questionnaires. Overall, self-reported outcomes were largely sustained over the follow-up period. After 12 months, regardless of original group allocation, participants who continued resistance exercise training during the follow-up period reported better neck dissection-related functioning (p ¼ 0.021) and better QOL (p ¼ 0.011) than those who did not. Conclusions: Benefits of PRET were sustained at 12-month follow-up. Ongoing participation in resistance exercise training may prove valuable as a supportive care intervention for survivors of HNC.Key Words: exercise therapy; follow-up studies; head and neck neoplasms; quality of life; shoulder pain RÉ SUMÉObjet : Une douleur à l'é paule et une dysfonction peuvent faire leur apparition aprè s une intervention chirurgicale pour un cancer de la tê te et du cou (CTC) parce que le nerf spinal accessoire a é té endommagé ou ré sé qué . Des recherches anté rieures ont ré vé lé que 12 semaines d'exercice contre ré sistance progressive (ERP) des membres supé rieurs amé lioraient le ré sultat pour l'é paule chez les survivants d'un CTC. Cette é tude visait à dé terminer si les bienfaits persistaient à long terme. Mé thodes : Les survivants d'un CTC ont é té ré partis au hasard pour suivre un programme d'ERP (n ¼ 27) ou un protocole thé rapeutique habituel (PT; n ¼ 25) et ont pu passer au groupe PT aprè s 12 semaines. Au suivi à 12 mois, on a envoyé par la poste aux participants un questionnaire d'é valuation de la qualité de vie (QDV), des ré sultats pour l'é paule et du comportement lié à l'exercice. Ré sultats : Sur les 52 participants inscrits à l'é tude, 44 é taient admissibles au suivi à 12 mois et 37 (71 %) ont ré pondu aux questionnaires. Dans l'ensemble, les ré sultats autodé claré s ont é té maintenus en grande partie au cours de la pé riode de suivi. Aprè s 12 mois, sans é gard à leur affectation au groupe original, les participants qui ont poursuivi leur entraînement par l'exercice à ré sistance au cours de la pé riode de suivi ont signalé un meilleur fonctionnement lié à la dissection subie au cou (p ¼ 0,021) et une meilleure QDV (p ¼ 0,011) que ceux qui ne l'ont pas fait. Conclusions : Les bienfaits de l'ERP persi...

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Shoulder function in patients undergoing selective neck dissection with or without radiation and chemotherapy

Abstract: Selective neck dissection can have a negative effect on shoulder function despite spinal accessory nerve preservation. Adjuvant therapy does not contribute additional detriment to shoulder function.

Cited by 31 publications

References 26 publications

Association Between Multimodality Neck Treatment and Work and Leisure Impairment

Association Between Multimodality Neck Treatment and Work and Leisure Impairment

Upper extremity morbidity after radial forearm flap harvest: a prospective study

Sustainability of Outcomes after a Randomized Crossover Trial of Resistance Exercise for Shoulder Dysfunction in Survivors of Head and Neck Cancer

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