Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA.
Policy Analysis Inc. (PAI), 822 Boylston Street, Suite 206, Chestnut Hill, MA, USA.
Support Care Cancer. 2023 Mar 23;31(4):229. doi: 10.1007/s00520-023-07698-3.
Head and neck cancer (HNC) will be diagnosed in approximately 54,000 Americans in 2022 with more than 11,000 dying as a result. The treatment of HNC often involves aggressive multimodal therapy including surgery, radiotherapy, and systemic therapy. HNC and its treatments are associated with multiple painful and function-limiting neuromusculoskeletal and visceral long-term and late effects. Among these is head and neck lymphedema (HNL), the abnormal accumulation of protein rich fluid, in as many as 90% of survivors. Though HNL is common and potentially contributory to other function-limiting issues in this population, it is notoriously understudied, underrecognized, underdiagnosed, and undertreated. This study seeks to determine the incidence of HNC-related lymphedema diagnosis and treatment in a large US healthcare claims repository database.
A retrospective observational cohort design and data from an integrated US healthcare claims repository-the IBM MarketScan Commercial Claims and Encounters (CCAE) and Medicare Supplemental and Coordination of Benefits (MDCR) Databases spanning the period April 1, 2012 through March 31, 2020.
Of the 16,654 HNC patients eligible for evaluation, 1,082 (6.5%) with a diagnosis of lymphedema were identified based on eligibility criteria. Of the 521 HNC patients evaluated for lymphedema treatment, 417 (80.0%) patients received 1.5 courses of MLD, 71 (13.6%) patients were prescribed compression garments, and 45 (8.6%) patients received an advanced pneumatic compression device.
HNL in this population of HNC survivors was underdiagnosed and treated compared with contemporary assessments HNL incidence.
2022 年，约有 54000 名美国人被诊断出患有头颈部癌症（HNC），其中超过 11000 人因此死亡。HNC 的治疗通常包括积极的多模式治疗，包括手术、放疗和全身治疗。HNC 及其治疗与多种疼痛和功能受限的神经肌肉骨骼和内脏长期和晚期效应有关。其中包括多达 90%的幸存者中出现的头颈部淋巴水肿（HNL），即富含蛋白质的液体异常积聚。尽管 HNL 很常见，并且可能导致该人群中其他功能受限问题，但它的研究却很少，认识不足，诊断不足，治疗不足。本研究旨在通过大型美国医疗保健索赔数据库确定 HNC 相关淋巴水肿诊断和治疗的发生率。
回顾性观察队列设计和来自美国综合医疗保健索赔数据库-IBM MarketScan 商业索赔和遭遇（CCAE）和医疗保险补充和福利协调（MDCR）数据库的数据，该数据库的时间跨度为 2012 年 4 月 1 日至 2020 年 3 月 31 日。
在符合评估条件的 16654 名 HNC 患者中，有 1082 名（6.5%）根据入选标准诊断为淋巴水肿。在 521 名接受淋巴水肿治疗评估的 HNC 患者中，417 名（80.0%）患者接受了 1.5 个疗程的手动淋巴引流（MLD），71 名（13.6%）患者被处方了压缩衣，45 名（8.6%）患者接受了高级气动压缩设备。
与当代评估 HNL 发病率相比，该 HNC 幸存者人群中的 HNL 诊断不足且治疗不足。
