ONS Connections: External lymphedema scale developed for head and neck cancer

PHOENIX—Lymphedema in patients with head and neck cancer can be described through an instrument that has been developed and validated, in research that was reported at the Oncology Nursing Society (ONS) Connections: Advancing Care Through Science conference.

Aggressive multi-modality treatment regimens for locally advanced head and neck cancer often lead to a damaged lymphatic system. Then, patients are at risk for developing secondary lymphedema. Assessing head and neck lymphedema had received little attention prior to this work.

These researchers sought to develop a scale to grade external lymphedema in patients with head and neck cancer. They used a conceptual framework of the continuum from fibrosis to lymphedema to direct the study, which had two phases.

The first phase of the study generated a proposed scale for head and neck external lymphedema. This scale came from the study conceptual framework, a literature review, and analysis of their previous study, which had compared and contrasted four current lymphedema scales to grade external lymphedema in patients with head and neck cancer. Then, they used expert feedback to revise the proposed scale.

The second phase of the study tested the revised scale by physically examining 30 patients with head and neck cancer and facial swelling. The patients had a mean age of 57.67 years (standard deviation 6.54 years), and 40% had oropharyngeal carcinoma.

The interrater reliability of the Head and Neck External Lymphedema Scale (HN-LE) was acceptable, since exact agreement on grading lymphedema severity occurred 83% of the time, 100% of the grades were within one grade, and kappa was 0.752 (P<.001). The research team is further developing and psychometrically testing the HN-LE Scale in a larger sample.

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