Article

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.
CI - Copyright (c) 2014 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS