Eickmeyer Sarah M, Walczak Christine K, Myers Katherine B, Lindstrom D Richard, Layde Peter, Campbell Bruce H
Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI∗.
Rehabilitation Services, Froedtert Hospital, Milwaukee, WI†
PM R. 2014 Dec;6(12):1073-80. doi: 10.1016/j.pmrj.2014.05.015. Epub 2014 May 28.
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.
目的：确定头颈癌（HNC）患者接受颈部清扫术和放射治疗与5年生存者后续肩部活动范围（ROM）及生活质量（QOL）之间的关联。 设计：横断面便利样本。 地点：三级医疗中心的耳鼻喉科诊所及退伍军人事务医疗中心。 患者：HNC的5年无病生存者。 方法：收集人口统计学和癌症治疗信息，包括颈部清扫术的类型（未进行、保留副神经和切除副神经）及放疗情况。进行生活质量问卷调查，并测量肩部ROM。 主要观察指标：华盛顿大学生活质量量表（UWQOL）、癌症治疗功能评估量表（FACT）头颈模块及头颈性能状态量表。肩部ROM测量包括外展、内收、前屈、后伸、内旋和外旋。 结果：105名生存者完成了生活质量调查；85名生存者接受了额外的肩部ROM评估。切除副神经组在UWQOL的毁容、活动水平、娱乐、言语和肩部残疾以及在公共场合进食意愿、FACT功能健康和FACT头颈模块方面的得分显著更低（P < .05）。切除副神经组的肩部前屈和外展ROM最差（P < .05）。放疗与UWQOL吞咽功能显著更差相关（P < .05），但在生活质量或ROM测量方面未发现其他差异。生活质量得分降低与肩部前屈和外展减少相关（P < .05）。肩部外展减少的生存者在毁容、娱乐、就业、肩部残疾和FACT情绪健康方面的得分显著更差（P < .05）。 结论：在颈部清扫术中保留副神经与HNC 5年生存者长期肩部残疾显著减少相关。生活质量测量显示，未进行颈部清扫术组功能水平最高，保留神经组功能处于中等水平，切除神经组功能最差。HNC长期生存者中肩部前屈和外展减少与生活质量降低相关。
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