Faculty Collaboration Database

Quality of life, shoulder range of motion, and spinal accessory nerve status in 5-year survivors of head and neck cancer. PM R 2014 Dec;6(12):1073-80

Date

06/01/2014

Pubmed ID

24880060

Pubmed Central ID

PMC4247358

DOI

10.1016/j.pmrj.2014.05.015

Scopus ID

2-s2.0-84916890222 (requires institutional sign-in at Scopus site)   38 Citations

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: A cross-sectional convenience sample.

SETTING: Otolaryngology clinics at tertiary care hospital and Veterans Affairs medical center.

PATIENTS: Five-year, disease-free survivors of HNC.

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 (FACT) Head and Neck, and Performance Status Scale for Head and Neck. 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 and/or entertainment, speech and shoulder disability, and willingness to eat in public, FACT functional well-being, and FACT Head and Neck (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 and/or 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 survivors of HNC. 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 survivors of HNC.

Author List

Eickmeyer SM, Walczak CK, Myers KB, Lindstrom DR, Layde P, Campbell BH

Author

Bruce H. Campbell MD Emeritus Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Accessory Nerve
Aged
Cross-Sectional Studies
Disease-Free Survival
Female
Head and Neck Neoplasms
Humans
Male
Quality of Life
Range of Motion, Articular
Shoulder
Surveys and Questionnaires
Survivors