The relationship between physical impairments, quality of life and disability of the neck and upper limb in patients following neck dissection

  • Elise M. Gane
  • Steven M. McPhail
  • Anna L. Hatton
  • Benedict J. Panizza
  • Shaun P. O’Leary
Article
  • 13 Downloads

Abstract

Purpose

The purpose of this study was to examine the relationship between physical impairments, quality of life and disability in patients following neck dissection, with consideration of patient and clinical characteristics.

Methods

Cross-sectional study of patients < 5 years after neck dissection for head and neck cancer. Quality of life and self-reported disability were measured with the Neck Dissection Impairment Index, Quick Disabilities of the Arm, Shoulder and Hand, and Neck Disability Index. Active neck and shoulder range of motion and isometric muscle strength were also assessed. Generalised linear modelling was used to explore relationships between variables.

Results

Eighty-four participants (68% male, median age 61 years) demonstrated reduced quality of life (median (interquartile range) score = 76 (49, 93) from 0 (worst) to 100 (best)), and mild levels of upper limb (14 (2, 32)) and neck disability (14 (6, 28)) (from 0 (best) to 100 (worst)). Bilateral neck dissection was associated with reduced quality of life (coeff (95% CI) = − 12.49 (− 24.69, − 0.29)). Post-operative chemoradiation therapy was associated with reduced quality of life (− 21.46 (− 37.57, − 5.35)) and neck disability (0.71 (0.10, 1.32)). Measures of shoulder flexibility or strength were associated with quality of life and self-reported disability.

Conclusions

Quality of life and musculoskeletal disability after neck dissection are associated with factors from multiple domains including physical motor function and treatment modality.

Implications for Cancer Survivors

Having reduced shoulder flexibility or strength is related to functional deficits and quality of life after neck dissection for head and neck cancer.

Keywords

Head and neck neoplasms Neck dissection Shoulder Neck Pain Quality of life 

Notes

Acknowledgements

The authors wish to thank research assistant Annette Stouter for her contribution to this study (data entry and data management); and the Medical, Nursing, Physiotherapy and Administrative staff from the participating hospitals.

Sources of funding

This study was supported by the Physiotherapy Research Foundation (grant no. S15-029). E.G. is supported by an Australian Government Research Training Program Scholarship. S.M.P. is supported by a National Health and Medical Research Council (of Australia) Fellowship (no. 1090440).

Role of funders

The Physiotherapy Research Foundation, the Australian Government and the National Health and Medical Research Council did not have any influence over the study design, data collection, analysis or manuscript preparation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants

This study was approved by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee (reference no. HREC/14/QRBW/71).

Informed consent

Informed consent was obtained from all individual participants included in this study.

References

  1. 1.
    National Comphrehensive Cancer Network (2016) Head and neck cancers, version 1.2016. https://www.nccn.org/professionals/physician_gls/PDF/head-and-neck.pdf. Accessed 9 Jan 2017.
  2. 2.
    Rathod S, Livergant J, Klein J, Witterick I, Ringash J. A systematic review of quality of life in head and neck cancer treated with surgery with or without adjuvant treatment. Oral Oncol. 2015;51(10):888–900.  https://doi.org/10.1016/j.oraloncology.2015.07.002. CrossRefPubMedGoogle Scholar
  3. 3.
    van Wilgen CP, Dijkstra PU, van der Laan BF, Plukker JT, Roodenburg JL. Shoulder complaints after neck dissection; is the spinal accessory nerve involved? Br J Oral Maxillofac Surg. 2003;41(1):7–11.CrossRefPubMedGoogle Scholar
  4. 4.
    Teymoortash A, Hoch S, Eivazi B, Werner JA. Postoperative morbidity after different types of selective neck dissection. Laryngoscope. 2010;120(5):924–9.  https://doi.org/10.1002/lary.20894. PubMedGoogle Scholar
  5. 5.
    Agha-Mir-Salim P, Schulte-Mattler W, Funk U, Lautenschlager C, Bloching M, Berghaus A. Origin of shoulder pain after “neck dissection”. Importance of the cervical plexus. HNO. 2002;50(6):544–52.CrossRefPubMedGoogle Scholar
  6. 6.
    Cappiello J, Piazza C, Giudice M, De Maria G, Nicolai P. Shoulder disability after different selective neck dissections (levels II–IV versus levels II–V): a comparative study. Laryngoscope. 2005;115(2):259–63.  https://doi.org/10.1097/01.mlg.0000154729.31281.da.CrossRefPubMedGoogle Scholar
  7. 7.
    Laverick S, Lowe D, Brown J, Vaughan E, Rogers S. The impact of neck dissection on health-related quality of life. Arch Otolaryngol Head Neck Surg. 2004;130:149–54.CrossRefPubMedGoogle Scholar
  8. 8.
    Gallagher K, Sacco A, Lee J, Taylor R, Chanowski E, Bradford C, et al. Association between multimodality neck treatment and work and leisure impairment: a disease-specific measure to assess both impairment and rehabilitation after neck dissection. JAMA Otolaryngol Head Neck Surg. 2015;141(10):888–93.PubMedGoogle Scholar
  9. 9.
    van Wilgen CP, Dijkstra PU, van der Laan BFAM, Plukker JTM, Roodenburg JLN. Shoulder complaints after nerve sparing neck dissections. Int J Oral Max Surg. 2004;33(3):253–7.CrossRefGoogle Scholar
  10. 10.
    Chepeha D, Taylor R, Chepeha J, Teknos T, Bradford CR, Sharma P, et al. Functional assessment using Constant’s shoulder scale after modified radical and selective neck dissection. Head Neck. 2002;24:432–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Robbins KT, Clayman G, Levine PA, Medina JE, Sessions RB, Shaha A, et al. Neck dissection classification update. Arch Otolaryngol Head Neck Surg. 2002;128:751–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Robbins KT, Medina JE, Wolfe GT, Levine PA, Sessions RB, Pruet CW. Standardizing neck dissection terminology. Arch Otolaryngol Head Neck Surg. 1991;117:601–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Robbins KT, Shaha AR, Medina JE, Califano JA, Wolf GT, Ferlito A, et al. Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg. 2008;134(5):536–8.  https://doi.org/10.1001/archotol.134.5.536.CrossRefPubMedGoogle Scholar
  14. 14.
    Gane EM, Michaleff ZA, Cottrell MA, McPhail SM, Hatton AL, Panizza BJ, et al. Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: a systematic review. Eur J Surg Oncol. 2017;43:1199–218.  https://doi.org/10.1016/j.ejso.2016.10.026. CrossRefPubMedGoogle Scholar
  15. 15.
    Taylor R, Chepeha J, Teknos T, Bradford C, Sharma P, Terrell J, et al. Development and validation of the neck dissection impairment index: a quality of life measure. Arch Otolaryngol Head Neck Surg. 2002;128(1):44–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Stuiver MM, ten Tusscher MR, van Opzeeland A, Brendeke W, Lindeboom R, Dijkstra PU, et al. Psychometric properties of 3 patient-reported outcome measures for the assessment of shoulder disability after neck dissection. Head Neck. 2016;38:102–10.CrossRefPubMedGoogle Scholar
  17. 17.
    Beaton D, Wright J, Katz J, Group TUEC. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg. 2005;87-A(5):1038–46.Google Scholar
  18. 18.
    LeBlanc M, Stineman M, DeMichele A, Stricker C, Mao JJ. Validation of QuickDASH outcome measure in breast cancer survivors for upper extremity disability. Arch Phys Med Rehabil. 2014;95(3):493–8.  https://doi.org/10.1016/j.apmr.2013.09.016.CrossRefPubMedGoogle Scholar
  19. 19.
    MacDermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, et al. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther. 2009;39(5):400–17.  https://doi.org/10.2519/jospt.2009.2930. CrossRefPubMedGoogle Scholar
  20. 20.
    Vernon H, Mior S. The neck disability index: a study of reliability and validity. J Manip Physiol Ther. 1991;14:409–15.Google Scholar
  21. 21.
    Vernon H. The neck disability index: state-of-the-art, 1991–2008. J Manip Physiol Ther. 2008;31:491–502.CrossRefGoogle Scholar
  22. 22.
    Struyf F, Nijs J, Mottram S, Roussel NA, Cools AMJ, Meeusen R. Clinical assessment of the scapula: a review of the literature. Br J Sports Med. 2014;48:883–90.CrossRefPubMedGoogle Scholar
  23. 23.
    Yang J-I, Lin J-J. Reliability of function-related tests in patients with shoulder pathologies. Sports Phys Ther. 2006;36(8):572–6.CrossRefGoogle Scholar
  24. 24.
    Hanney WJ, George SZ, Kolber MJ, Young I, Salamh PA, Cleland JA. Inter-rater reliability of select physical examination procedures in patients with neck pain. Physiother Theory Pract, Early Online. 2013(1–8).Google Scholar
  25. 25.
    Hoving JL, Buchbinder R, Green S, Forbes A, Bellamy N, Brand C, et al. How reliably do rheumatologists measure shoulder movement? Ann Rheum Dis. 2002;61:612–6.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Kolber MJ, Saltzman SB, Beekhuizen KS, Cheng MS. Reliability and minimal detectable change of inclinometric shoulder mobility measurements. Physiother Theory Pract. 2009;25(8):572–81.CrossRefPubMedGoogle Scholar
  27. 27.
    Clarkson HM. Joint motion and function assessment: a research-based practical guide. Philadelphia: Lippincott Williams & Wilkins; 2005.Google Scholar
  28. 28.
    Van Wyk L, Jull G, Vicenzino B, Greaves M, O'Leary S. A comparison of craniocervical and cervicothoracic muscle strength in healthy individuals. J Appl Biomech. 2010;26(4):400–6.CrossRefPubMedGoogle Scholar
  29. 29.
    O'Leary S, Lorass Fagermoen C, Hasegawa H, Slettevold Thorsen A, Van Wyk L. Differential strength and endurance parameters of the craniocervical and cervicothoracic extensors and flexors in healthy individuals—technical note. J Appl Biomech. 2016;33:166–70.CrossRefPubMedGoogle Scholar
  30. 30.
    Cadogan A, Laslett M, Hing W, McNair P, Williams M. Reliability of a new hand-held dynamometer in measuring shoulder range of motion and strength. Man Ther. 2011;16:97–101.CrossRefPubMedGoogle Scholar
  31. 31.
    Hayes K, Walton JR, Szomor ZL, Murrell GAC. Reliability of 3 methods for assessing shoulder strength. J Shoulder Elb Surg. 2002;11:33–9.CrossRefGoogle Scholar
  32. 32.
    Huber PJ. The behaviour of maximum likelihood estimates under nonstandard conditions. Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability. Berkeley: University of California Press; 1967. p. 221–33.Google Scholar
  33. 33.
    White H. A heretoskedasticity–consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica. 1980;48:817–30.CrossRefGoogle Scholar
  34. 34.
    McNeely M, Parliament M, Seikaly H, Jha N, Magee D, Haykowsky M, et al. Effect of exercise on upper extremity pain and dysfunction in head and neck cancer survivors: a randomized controlled trial. Cancer. 2008;133:214–22.CrossRefGoogle Scholar
  35. 35.
    McGarvey A, Hoffman G, Osmotherly P, Chiarelli P. Maximizing shoulder function after accessory nerve injury and neck dissection surgery: a multicentre randomized controlled trial. Head Neck. 2015;37:1022–31.CrossRefPubMedGoogle Scholar
  36. 36.
    Ward ECD. As-brooks CJv. Head and neck cancer: treatment, rehabilitation, and outcomes. Vol book, whole. San Diego: Plural Publishing; 2014.Google Scholar
  37. 37.
    Deng J, Ridner SH, Dietrich MS, Wells N, Wallston KA, Sinard RJ, et al. Factors associated with external and internal lymphedema in patients with head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2012;84(3):e319–28.  https://doi.org/10.1016/j.ijrobp.2012.04.013.CrossRefPubMedGoogle Scholar
  38. 38.
    Dijkstra P, Van Wilgen P, Buijs R, Brendeke W, De Goede C, Kerst A, et al. Incidence of shoulder pain after neck dissection: a clinical explorative study for risk factors. Head Neck. 2001;23(11):947–53.CrossRefPubMedGoogle Scholar
  39. 39.
    Erisen L, Basel B, Irdesel J, Zarifoglu M, Coskun H, Basut O, et al. Shoulder function after accessory nerve-sparing neck dissections. Head Neck. 2004;26(11):967–71.CrossRefPubMedGoogle Scholar
  40. 40.
    van Wouwe M, de Bree R, Kuik DJ, de Goede CJ, Verdonck-de Leeuw IM, Doornaert P, et al. Shoulder morbidity after non-surgical treatment of the neck. Radiother Oncol. 2009;90(2):196–201.  https://doi.org/10.1016/j.radonc.2008.11.003.CrossRefPubMedGoogle Scholar
  41. 41.
    Inoue H, Nibu K, Saito M, Otsuki N, Ishida H, Onitsuka T, et al. Quality of life after neck dissection. Arch Otolaryngol. 2006;132(6):662–6.CrossRefGoogle Scholar
  42. 42.
    Chaplin J, Morton R. A prospective, longitudinal study of pain in head and neck cancer patients. Head Neck. 1999;21:531–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Speksnikder C, van der Bilt A, Slappendel M, de Wijer A, Merkx M, Koole R. Neck and shoulder function in patients treated for oral malignancies: a 1-year prospective cohort study. Head Neck. 2013;35:1303–13.CrossRefGoogle Scholar
  44. 44.
    Chepeha D, Taylor R, Chepeha J, Teknos T, Bradford C, Sharma P, et al. Functional assessment using Constant’s shoulder scale after modified radical and selective neck dissection. Head Neck. 2002;24(5):432–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Karaman M, Tek A, Uslu C, Akduman D, Bilac O. Effect of functional neck dissection and postoperative radiotherapy on the spinal accessory nerve. Acta Otolaryngol. 2009;129:872–80.CrossRefPubMedGoogle Scholar
  46. 46.
    Pignon J-P, Maître AL, Maillard E, Bourhis J. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol. 2009;92(1):4–14.  https://doi.org/10.1016/j.radonc.2009.04.014. CrossRefPubMedGoogle Scholar
  47. 47.
    Rivelli TG, Mak MP, Martins RE, da Costa sa Silva VT, de Castro G Jr. Cisplatin based chemoradiation late toxicities in head and neck squamous cell carcinoma patients. Discov Med. 2015;20(108):57–66.PubMedGoogle Scholar
  48. 48.
  49. 49.
    Berger A, Abernathy A, A A, B AM, B WS, Cella D, et al. Cancer-related fatigue. J Natl Compr Cancer Netw. 2010;8:904–31.CrossRefGoogle Scholar
  50. 50.
    Ghiam MK, Mannion K, Dietrich MS, Stevens KL, Gilbert J, Murphy BA. Assessment of musculoskeletal impairment in head and neck cancer patients. Support Care Cancer. 2017;25:2085–92.  https://doi.org/10.1007/s00520-017-3603-1. CrossRefPubMedGoogle Scholar
  51. 51.
    Swisher AKPTPCCS, Altaha RMD, Arbaugh JDPT, Barr KDPT, Brooks DDPT, Copeland ADPT, et al. Neck and shoulder impairments and the relationship to quality of life in head and neck cancer survivors. Rehabil Oncol. 2012;30(2):3–7.Google Scholar
  52. 52.
    Ritchie C, Hendrikz J, Kenardy J, Sterling M. Derivation of a clinical prediction rule to identify both chronic moderate/severe disability and full recovery following whiplash injury. Pain. 2013;154(10):2198–206.CrossRefPubMedGoogle Scholar
  53. 53.
    Hidalgo-Lozano A, Calderon-Soto C, Domingo-Camara A. Fernandez-de-las-Penas C, Madeleine P, Arroyo-Morales M. Elite swimmers with unilateral shoulder pain demonstrate altered pattern of cervical muscle activation during a functional upper-limb task. J Orthop Sports Phys Ther. 2012;42(6):552–8.  https://doi.org/10.2519/jospt.2012.3875. CrossRefPubMedGoogle Scholar
  54. 54.
    Zabihhosseinian M, Holmes MW, Howarth S, Ferguson B, Murphy B. Neck muscle fatigue differentially alters scapular and humeral kinematics during humeral elevation in subclinical neck pain participants versus healthy controls. J Electromyogr Kinesiol. 2017;33:73–82.  https://doi.org/10.1016/j.jelekin.2017.02.002.CrossRefPubMedGoogle Scholar
  55. 55.
    Christensen SW, Hirata RP, Graven-Nielsen T. The effect of experimental neck pain on pressure pain sensitivity and axioscapular motor control. J Pain. 2015;16(4):367–79.  https://doi.org/10.1016/j.jpain.2015.01.008.CrossRefPubMedGoogle Scholar
  56. 56.
    Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain. 2011;152(3 Suppl):S90–8.  https://doi.org/10.1016/j.pain.2010.10.020. CrossRefPubMedGoogle Scholar
  57. 57.
    Carenfelt C, Eliasson K. Radical neck dissection and permanent sequelae associated with spinal accessory nerve injuries. Acta Otolaryngol. 1981;91(1–2):155–60.CrossRefGoogle Scholar
  58. 58.
    Ewing MR, Martin H. Disability following radical neck dissection: an assessment based on the postoperative evaluation of 100 patients. Cancer. 1952;5:873–83.CrossRefPubMedGoogle Scholar
  59. 59.
    Merve A, Mitra I, Swindell R, Homer JJ. Shoulder morbidity after pectoralis major flap reconstruction for head and neck cancer. Head Neck. 2009;31(11):1470–6.CrossRefPubMedGoogle Scholar
  60. 60.
    Robbins KT, Ferlito A, Shah JP, Hamoir M, Takes RP, Strojan P, et al. The evolving role of selective neck dissection for head and neck squamous cell carcinoma. Eur Archives Oto-rhino-Laryngol. 2013;270(4):1195–202.  https://doi.org/10.1007/s00405-012-2153-x. CrossRefGoogle Scholar
  61. 61.
    Palmer MJ, Epler ME. Fundamentals of musculoskeletal assessment techniques. 2nd ed. Philadelphia: Lippincott; 1998.Google Scholar
  62. 62.
    Wang H-L. Shoulder pain after neck dissection among head and neck cancer patients. ProQuest Dissertations Publishing: Indiana University; 2009.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Elise M. Gane
    • 1
    • 2
  • Steven M. McPhail
    • 2
    • 3
  • Anna L. Hatton
    • 1
  • Benedict J. Panizza
    • 4
    • 5
  • Shaun P. O’Leary
    • 1
    • 6
  1. 1.Division of Physiotherapy, School of Health and Rehabilitation Sciences, Therapies Building 84aThe University of QueenslandBrisbaneAustralia
  2. 2.Centre for Functioning and Health ResearchMetro South Hospital and Health ServiceBrisbaneAustralia
  3. 3.School of Public Health and Social Work and the Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia
  4. 4.School of Medicine, Herston RoadThe University of QueenslandBrisbaneAustralia
  5. 5.Otolaryngology–Head and Neck Surgery DepartmentPrincess Alexandra HospitalBrisbaneAustralia
  6. 6.Physiotherapy DepartmentRoyal Brisbane and Women’s HospitalBrisbaneAustralia

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