Swallowing Outcomes Following Early Treatment of Head and Neck Cancer-Related Lymphedema.

OBJECTIVE(S): Head and neck cancer-related lymphedema (HNCRL) is a common, chronic consequence of head and neck cancer (HNC) treatment that contributes to progressive fibrosis, functional impairment, and reduced quality of life. Although early intervention is advocated, its association with longitudinal swallow outcomes remains poorly understood. This study evaluated whether early HNCRL treatment was associated with improved objective and patient-reported swallowing outcomes following radiation treatment (RT) and/or chemoradiation (CRT).

METHODS

Medical records from 110 patients enrolled in a standardized HNC care pathway were retrospectively reviewed. Internal HNCRL was identified in all participants at 3-months post-RT/CRT, when lymphedema treatment was recommended. Seventy-two patients completed treatment with an advanced pneumatic compression device (APCD) or manual lymphatic drainage (MLD), while 38 did not. Swallowing physiology, patient-reported outcomes, and maximum interincisal opening (MIO) were evaluated at baseline, 3-months, and 15-months post-RT/CRT. Longitudinal within- and between-group comparisons were performed.

RESULTS

Treated patients demonstrated significantly more favorable longitudinal DIGEST outcomes for overall severity, swallowing safety, and swallowing efficiency (all p < 0.001), greater improvement in EAT-10 (-3.63 vs. +1.13, p = 0.001) and RSI (-5.21 vs. +2.55, p < 0.001), and no significant difference in MIO change (p = 0.259) or cancer recurrence. Associations for DIGEST, EAT-10, and RSI remained significant after multivariable adjustment.

CONCLUSIONS

Early HNCRL treatment was associated with greater improvements in swallowing physiology and patient-reported swallowing outcomes. These findings support routine HNCRL surveillance and timely intervention within multidisciplinary HNC care pathways.