Adjuvant Treatments After Neck Dissection Reduce Shoulder Function, QoL

Shoulder function impairment is linked to the use of adjuvant treatment for head and neck cancer

medwireNews: Research has highlighted the significant impact of aggressive adjuvant therapy on shoulder function and quality of life (QoL) in head and neck cancer patients who undergo neck dissection.

The investigators found that radiotherapy and chemotherapy, as well as the extent of surgical dissection, correlated with patients’ ability to return to work and leisure activities a year after level V-sparing selective neck dissection or a modified radical neck dissection sparing the accessory nerve.

“These findings may stimulate further investigation related to optimizing quality of life following neck dissection”, say Douglas Chepeha, from the University of Toronto in Ontario, Canada, and team.

The median Neck Dissection Impairment Index (NDII) in the 167 patients was 90 out of a possible 100, with a higher score indicating better shoulder function and shoulder-related QoL, the authors write in JAMA Otolaryngology and Head & Neck Surgery.

However, the 46 patients who underwent modified radical neck dissection had a lower score than those who underwent level V-sparing selective neck dissection, at a median NDII score of 85 versus 92.

In multivariate analysis, increasing shoulder impairment was predicted by advanced stage disease (mean 77 vs 87 points with early-stage disease), and receipt of chemotherapy (77 vs 83 points without chemotherapy) or radiotherapy (80 vs 88 points without radiotherapy).

Moreover, 12 months or longer after completion of adjuvant therapy, there was a significant correlation between NDII score and the Constant-Murley Shoulder Function Test (Constant score).

Patients who had a negative change in leisure activities after treatment had a lower median NDII score and a higher Constant score – indicating greater shoulder impairment – than those who maintained their leisure activity levels.

And patients who continued to work during treatment or returned to work after treatment had a higher median NDII score than those who reduced or stopped their working hours (94 and 88 vs 70, respectively). These subjective NDII scores, in turn, correlated with the objective Constant test score for shoulder impairment.

Finally, there was a correlation between use of pain medication and greater shoulder impairment, and while NDII scores did not indicate a benefit for physical therapy, there was a significant improvement in Constant scores when patients perceived physical therapy to be beneficial.

Douglas Chepeha et al observe that neck dissections sacrificing cranial nerve (CN) XI – the spinal accessory nerve – are associated with reduced shoulder function and QoL but note that this nerve was spared in all the patients in the current study.

“Our study suggests that the additional dissection of level V involved in CN XI–sparing [modified radical neck dissection] leads to impaired shoulder function”, they conclude.

“This information could be used in counseling patients with respect to postoperative expectations to help tailor post–neck dissection rehabilitation.”

Reference

Gallagher KK, Sacco AG, Lee J S-J, et al. Association between multimodality neck treatment and work and leisure impairment. JAMA Otolaryngol Head Neck Surg 2015; Advance online publication 1 October. doi:10.1001/jamaoto.2015.2049

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