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van Hinte G.1, Wetzels J.-W.2, Merkx T.2, de Haan A.3, Koole R.4, Speksnijder C.M.2,4
1Radboud UMC; Physical Therapy, Nijmegen, Netherlands, 2Radboud UMC; Oral and Maxillofacial Surgery, Nijmegen, Netherlands, 3Radboud UMC; Health Evidence, Nijmegen, Netherlands, 4UMC Utrecht; Oral and Maxillofacial Surgery and Special Dental Care, Utrecht, Netherlands
Background: Survivors of oral cancer commonly experience treatment related morbidity that impairs oral functions, general physical condition and causes limitations in shoulder and neck function. A decrease in neck and shoulder function can lead to functional limitations that hamper activities of daily life (ADL) and decrease Quality of Life. The reports on prevalence of shoulder dysfunction show a large variation in factors influencing neck and shoulder function over time and are often limited to 1 year follow up. Consequently, there is no definitive information on factors influencing neck and shoulder function to provide to patients or to develop patient tailored rehabilitation programs.
Purpose: The purpose of this prospective cohort study was to prospectively explore clinical factors and patient characteristics which increase a patient's risk of shoulder and/or neck morbidity in patients who were treated for oral cancer for up to 5 year after treatment.
Methods: Patients were recruited between January 2007 and August 2009 at the UMC Utrecht and the Radboudumc of Nijmegen. Lateral flexion of the neck, ipsilateral forward flexion and abduction of the shoulder were measured 4-6 weeks before intervention (baseline) and 4-6 weeks, 6, 12, and 60 months post intervention. Potential risk factors were entered into a linear mixed model analysis (manual backward-stepwise elimination) to create a multivariable model to describe the results.
Results: In time all neck and shoulder outcomes are all negatively influenced by a higher age before oral oncological intervention. Contralateral flexion of the neck is influenced by type of oncological intervention and ipsilateral flexion by the amount of >1 beverage alcohol per day at baseline. The 5 year course of ipsilateral shoulder abduction is different for T of TNM state, type of neck dissection and type of oral reconstruction related to the surgery. The 5 year course of ipsilateral forward flexion is different for tumor location, T of TNM state, type of neck dissection and type of oral reconstruction related to the surgery.
Conclusion(s): This study gives physical therapists insight into factors influencing the course of lateral flexion of the neck, ipsilateral abduction and forward flexion of the shoulder for patients with oral cancer. This can be used to inform patients and tailor interventions.
Implications: Seventy three percent of the patients report the need for physical therapy during treatment and 23% after 8-11 years. The late effects of the oral oncological intervention are also often underappreciated by both patients and clinicians. The number of rehabilitation intervention studies aimed at minimizing neck and shoulder complaints is scarce. In our opinion a limitation in the existing intervention studies is the lack of tailored care to patients at risk for neck and/or shoulder complaints. With this study we investigated the influence of significant risk factors on neck and shoulder function in long-term survivors to develop patient centered risk stratified rehabilitation programs.
Funding acknowledgements: This study was funded by the University Medical Center of Utrecht
Topic: Oncology, HIV & palliative care
Ethics approval: A medical ethical waiver was obtained from the medical ethics committee at UMC Utrecht and Radboudumc of Nijmegen.
All authors, affiliations and abstracts have been published as submitted.
