Purpose: Lymphedema is a common consequence of head and neck cancers and their treatments. Prevalence of lymphedema after head and neck cancer treatment has been reported as high as 75% (Deng et al 2012). Patients with lymphedema have higher symptom burden than their counterparts without lymphedema (Deng et al 2016). Thus, lymphedema treatment is an important component of post head and neck cancer rehabilitation. High levels of response to treatment have been previously reported (Smith et al 2015). One common challenge to lymphedema treatment is the availability of skilled therapists in the geographic region of the patient. Thus, the purpose of this study was to compare outcomes in patients treated through a home-based program to patients receiving a hybrid approach including both clinical and home treatment.
Methods: Lymphedema outcomes were assessed in 39 patients receiving post-treatment lymphedema rehabilitation. Baseline measures of neck, submental, and facial edema were obtained and repeated after ~3 months of treatment. A composite measure of response to treatment averaged the percentage change in neck measures, submental measures, and facial measures. Patients unable to participate in clinical intervention were trained in a home treatment protocol including manual lymphatic drainage, compression, skin care, and exercise. Those receiving hybrid care completed the same home program, but also met with the lymphedema therapist every 1-2 weeks for treatment. Their outcomes were compared using standard statistical analysis.
Results: Thirty-nine consecutive individuals with pre- and post-treatment assessments were included in analysis. Surgery was performed in 62% of participants while 38% underwent non-operative treatment only. Home-based treatment was completed by 20 patients while hybrid clinical/home treatment was completed for 19 patients. MD Anderson Cancer Center Stage severity rating of lymphedema 1a (non-pitting lymphedema) and 1b (reversible pitting lymphedema) were noted in 53% and 47% of those in the hybrid treatment group and 65% and 25% of the home treatment group respectively. Stage 0 lymphedema was noted in 10% of those in the home treatment group. The average percent of reduction of lymphedema was 2.37% in the home-based treatment group and 3.05% in the hybrid group (P=0.48). Adherence of at least 50% of recommended treatment was reported in 65% those receiving home-based treatment and 68% of those receiving hybrid care.
Conclusions: While improvements may be more robust in some patients receiving hybrid-based lymphedema therapy, comparable benefits were observed in this cohort regardless as to treatment strategy. This data suggests that in a selected group of patients, a home-based treatment strategy may be appropriate if the patient is unable to participate in clinical sessions. Given these findings, future investigations should consider strategies to optimize the outcomes of home-based treatments for lymphedema.