Shires Courtney Brooke, Harris Patricia, Dewan Karuna
West Cancer Center Germantown Tennessee USA.
Louisiana State University Shreveport Louisiana USA.
Laryngoscope Investig Otolaryngol. 2022 May 9;7(3):774-778. doi: 10.1002/lio2.810. eCollection 2022 Jun.
Lymphedema after treatment for head and neck cancer negatively impacts the quality of life and can produce neck tissue stiffness, dysphagia, pain, and swelling. One form of treatment for lymphedema is machine-delivered sequential lymphedema massage, which is home based and self administered. This study was undertaken to determine economic and system access to home-based lymphedema therapy and to measure patient-reported outcomes among those able to access therapy.
This study is a retrospective cohort study of 84 head and neck cancer patients who met the criteria for referral for home-based lymphedema treatment. Patients who were able to access lymphedema therapy were surveyed prior to initiation of therapy and again after therapy.
Thirty-five out of 84 patients were approved for home-based therapy and received the equipment. Medicare denial of coverage (21/84) was the most common cause of the inability to access therapy. Of the 35 patients who accessed therapy, presenting complaints included: stiffness (31), pain (29), dysphagia (20), and swelling (19). The average time from completion of cancer treatment to initiation of lymphedema therapy was 9 months. Thirty-four (97%) reported compliance with prescribed therapy, 33 (94%) reported reduced fibrosis, and 30 (89%) reported improvement in activities of daily living. All reported symptoms improved with therapy in 30 (86%) patients. Thirty-two (91%) reported overall satisfaction with home-based lymphedema treatment.
Stiffness and pain were the most common complaints of our patients with head and neck lymphedema. Forty-two percent of patients who were recommended home lymphedema machine use were able to obtain this with cost coverage by their insurance company or by donation from the company. We found a high compliance rate and a highly reported improvement in symptoms with the machine. The only identifiable factor for the patients with less improvement in symptoms was a greater time gap between treatment and initiation of use of home lymphedema machine.
2 Retrospective cohort analysis.
头颈癌治疗后的淋巴水肿会对生活质量产生负面影响，并可导致颈部组织僵硬、吞咽困难、疼痛和肿胀。淋巴水肿的一种治疗方式是通过机器进行序贯性淋巴水肿按摩，这种治疗是居家自行操作的。本研究旨在确定居家淋巴水肿治疗的经济可行性和系统可及性，并衡量能够接受治疗的患者报告的结局。
本研究是一项回顾性队列研究，纳入了84例符合居家淋巴水肿治疗转诊标准的头颈癌患者。能够接受淋巴水肿治疗的患者在治疗开始前和治疗后均接受了调查。
84例患者中有35例被批准接受居家治疗并收到了设备。医疗保险拒绝承保（21/）是无法接受治疗的最常见原因。在接受治疗的35例患者中，主要症状包括：僵硬（31例）、疼痛（29例）、吞咽困难（20例）和肿胀（19例）。从癌症治疗结束到开始淋巴水肿治疗的平均时间为9个月。34例（97%）报告遵守了规定的治疗，33例（94%）报告纤维化减轻，30例（89%）报告日常生活活动有所改善。30例（86%）患者的所有报告症状均随治疗而改善。32例（91%）报告对居家淋巴水肿治疗总体满意。
僵硬和疼痛是我们头颈淋巴水肿患者最常见的症状。42%被推荐使用居家淋巴水肿治疗仪的患者能够通过保险公司的费用承保或公司捐赠获得该设备。我们发现患者对该仪器的依从率很高，且症状改善情况的报告率也很高。症状改善较少的患者唯一可识别的因素是治疗与开始使用居家淋巴水肿治疗仪之间的时间间隔较长。
2级回顾性队列分析。
