Lymphedema is a frequent and long-lasting issue for many patients who have undergone treatment for head and neck cancer, according to new research from Lund University in Sweden. The study found that individuals with lower levels of physical activity are at greater risk of developing this condition.
Head and neck cancer refers to several types of cancer that occur in different parts of the head and neck region. In Sweden, about 1,800 people are diagnosed each year, with oropharyngeal cancer being one of the most common forms. This type affects areas such as the oropharynx, tonsils, and base of the tongue. While it was once strongly linked to smoking and alcohol use, more than 80 percent of cases today are attributed to HPV infection.
Lymphedema develops when the lymphatic system cannot remove tissue fluid effectively, causing swelling. This often happens after surgical removal of lymph nodes or damage from radiation or chemotherapy. The study included 50 patients with an average age of 64; two-thirds were men.
"It was shown that three months after treatment, 80 per cent of the patients had lymphedema and after nine months the figure was 69 per cent. We were actually surprised that so many had a persistent problem," said Agneta Hagren, doctoral student at Lund University and nurse practitioner at Skåne University Hospital.
Hagren noted that more information is needed on lymphedema risk following cancer treatment because other severe side effects often take priority. "Patients with head and neck cancer are those who report the lowest health-related quality of life. Their cancer affects a sensitive area with a lot of pain and side effects such as speech impairment and problems associated with eating, which in turn impacts many social situations. But it's important to help them, as a changed appearance can easily lead to negative effects on self-esteem and affect mental health."
Previous studies did not provide clear data on how many patients develop lymphedema after oropharyngeal cancer due to subjective assessment methods based mostly on manual examinations.
"When examining lymphedema in the leg or arm, it's possible to use other measurement methods, such as volume measurement with water and compare the limb with oedema on the healthy side. This, for obvious reasons, is not possible with head and neck lymphedema."
To address this gap, researchers used a lymph scanner that provides objective measurements of tissue water content. As a result of these findings, Sweden's Southern Healthcare Region has started using lymph scanners along with specific measuring points identified by this research for more consistent assessments.
"In Sweden there are no guidelines, only recommendations on how lymphedema is to be measured. One result of our study is that the Southern Healthcare Region has now started using lymph scanners and the measuring points we have identified. This is also a prerequisite for the long-term objective assessment of the range of outcomes from therapies."
The study found that participants who reported higher levels of physical activity were less likely to develop lymphedema than those who were less active. Researchers plan further investigation into which types of physical activity may be most effective in reducing risk.
"I think the recommendations for physical activity given by WHO are a good starting point. These state you should be physically active for 20-40 minutes per day at medium intensity, or 10-20 minutes per day at high intensity, and do weight training twice per week," Hagren added.
