Prevalence of function-limiting late effects in survivors of head and neck cancer

Background: Survivors of head and neck cancer (HNC) are commonly affected by multiple complex and interrelated long-term and late effects that can adversely affect their function and quality of life. Objective: To define the prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects affecting function and quality of life in survivors of HNC. Design: Retrospective cohort analysis. Setting: Outpatient cancer rehabilitation clinic at a physical medicine and rehabilitation hospital that includes a freestanding inpatient rehabilitation unit along with an outpatient clinic. Participants: One hundred thirty survivors of HNC who sought specialized cancer rehabilitation services to address complex functional impairments. Interventions: Not applicable. Main Outcome Measures: Prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects affecting function and quality of life in survivors of HNC. Results: The majority underwent surgery (53.8%), chemotherapy (22.3%), and radiation therapy (93.8%) as part of their treatment. Neuromuscular complications such as myelopathy (45.4%), radiculoplexopathy (58.5%), mononeuropathy (84.6%), and myopathy (57.7%) were prevalent. Musculoskeletal impairments included dysphagia (92.3%), dysarthria (60.8%), trismus (40.8%), cervical dystonia (47.7%), and shoulder dysfunction (27.7%). Visceral disorders encompassed lymphedema (86.2%), hypothyroidism (26.2%), and baroreceptor failure (19.2%). Additionally, oncologic complications, including recurrence (18.5%), metastasis (5.4%), and secondary malignancies (8.5%) were observed. Pain (74.6%) and fatigue (31.5%) were reported as major function-limiting impairments. Most survivors (96.9%) were referred to therapy including physical therapy (85.4%), occupational therapy (13.1%), speech-language pathology (84.6%), and lymphedema therapy (72.3%). Most (85.4%) required two or more therapy disciplines. Conclusion: Survivors of HNC accessing cancer rehabilitation services commonly present with diverse, complex, and interrelated neuromuscular, musculoskeletal, visceral, and oncologic late effects that can severely affect function and quality of life. Comprehensive rehabilitation should include evaluation and management of these complex and interrelated late effects by a rehabilitation team that includes cancer rehabilitation physicians, physical therapists, occupational therapists, lymphedema therapists, and speech-language pathologists, among others.