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Treating head and neck lymphedema in cancer patients

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Leila Little with patient.JPGBy Lindsay Lewis, MD Anderson Staff Writer

Brad Smith and Leila Little are speech pathologists. But their job is a little different than you might think.

As certified lymphedema therapists in the Speech Pathology and Audiology section of Head and Neck Surgery, Smith and Little work with patients to reduce head and neck lymphedema -- swelling that can be a complication of their cancer treatments.

"It may or may not look like a lot of swelling, but it's substantial to our patients," says Smith, who explains that lymphedema in the region of the head and neck can be devastating to a patient's self-image and affect basic functions such as speaking, swallowing, vision or breathing.

Personalized head and neck lymphedema treatment for cancer patients
The Speech Pathology and Audiology section comprises a team of clinicians who manage a range of treatment complications, many of which affect the head and neck region, and work to restore patients' quality of life.

One of the complications they address is post-treatment head and neck lymphedema, which can further complicate a patient's recovery. When swelling is significant in the head and neck region, restoring basic functions such as swallowing or talking, and managing associated cosmetic issues become critically important.

"There's such a focus on cancer that patients don't see past the diagnosis and treatment to understand the outcomes they'll face and the quality of life challenges that lie ahead," says Jan S. Lewin, Ph.D., professor in the department of Head and Neck Surgery and section chief of Speech Pathology and Audiology. Lewin provides pre-treatment evaluations to help determine how different treatment alternatives, such as surgery or radiation, will impact patients.

"We look at how our interventions will affect long-term outcomes," she says. "A chef needs to be able to taste. A preacher needs to be able to speak."

First of its kind for treating head and neck lymphedema
While a common complication of some cancer treatments, lymphedema in the head and neck region isn't well understood or managed.

 "We are the first in the country to offer management of head and neck lymphedema by speech pathologists who are certified to provide this therapy," Lewin says.

Head and neck lymphedema occurs when the body is unable to transport fluid due to damage to the lymphatic system. It happens when scarring from a surgery blocks lymphatic vessels in the neck or the lymphatic system is damaged by radiation therapy.

Because the fluid isn't easily moved, it rarely recedes on its own. In response, Lewin and her colleagues developed a treatment regimen to manage head and neck lymphedema using a method that combines massage, compression bandaging, skin care techniques and therapeutic exercises.

Smith and Little spend a couple of hours with each new patient to evaluate the severity of the swelling and its impact on other treatment outcomes. Custom-fit compression pads are created for each patient to help soften the fluid prior to doing exercises designed to move it.

The head and neck lymphedema program incorporates both outpatient and home therapy programs. Patients and caregivers learn therapeutic regimens, including gentle massage and use of custom-fit compression garments that work to disperse the fluid to unaffected parts of the body. Exercises also may be performed while wearing the compression garments to enhance treatment effectiveness.

"This isn't like a typical deep muscle massage," Smith says. "It's a combination of light, circular motions that stretch the skin and begin moving fluid to an area that has not been damaged and can drain more effectively."

Dramatic improvements for cancer patients with head and neck lymphedema

Three-dimensional photographs and measurements are taken at the beginning of, and periodically throughout treatment to evaluate and track treatment progress. Sometimes it takes months to decrease the swelling, according to Smith, but some patients begin seeing results in as little as one session.

"The improvement often is dramatic," Lewin adds. "Patients look more like they did before their cancer treatment. They're extremely pleased with the improvement in overall appearance and functioning. This is one therapy with few missed appointments."

A longer version of this article originally appeared in Messenger, MD Anderson's bimonthly publication for employees.

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