How Functional is a Functional Neck Dissection ?

How Functional is a Functional Neck Dissection ? Barry Scott, Senior 1 Physiotherapist Aintree Hospitals NHS Trust Quality of Life in Head and Neck Cancer Liverpool Maritime Museum 2006 Photo by Christine Hodgson

Shoulder Dysfunction Radical Neck Dissection Selective Neck Dissection

Introduction • SND has an established role in the management of oral and oropharyngeal cancer • Previous studies using UWQoL questionnaire have suggested relatively little morbidity associated with a selective neck dissection (SND) • Paucity of literature comparing objective measurements of the operated versus non-operated sides of the neck following a SND

Aims • To investigate cervical spine and shoulder movements following unilateral selective neck dissection • To compare functional outcomes between physiotherapy assessment of cervical spine and shoulder movements, and patient self-completed questionnaires

Patients and Methods • Performed on 100 consecutive oncology patients under follow-up between September 2003 and July 2004 • Patients attending the joint oncology cancer clinic were asked to participate in the study • Only exclusion newly diagnosed patients • Of the 100 patients assessed 63 had unilateral selective neck dissections

Patients and Methods Two shoulder-specific questionnaires used; - Neck Dissection Impairment Index (NDII) - Shoulder Disability Questionnaire (SDQ) and - UWQoL Questionnaire (version 4) All patients had an objective assessment measuring their shoulder, shoulder girdle and cervical spine ranges of movement. Both operated and non – operated sides were recorded.

Neck and Shoulder Study Cervical Measurement System (CMS)

Neck and Shoulder Study Goniometry Tape Measure Method

Results • 63 patients who had SND; 30 female / 33 male • Median age at assessment in this study; • 61.0 years (IQR 55-68 years) • Median time from operation to assessment; 10 months (IQR 3-32 months) • 70% had oral cavity tumours • 63% had T Stage 1 or 2 tumours • 29% had nodal involvement • 41% had radiotherapy; mostly (23/26) post op

Operated v’s Non-Operated

Cervical Lymph Node Involvement

Shoulder Flexion / UWQoL Scores 100 – “I have no problems with my shoulder” 70 – “My shoulder is stiff but it has not affected my activity or strength” 30 – “Pain or weakness in my shoulder has caused me to change my work / hobbies” 0 – “I cannot work or do my hobbies due to problems with my shoulder” UWQoL Shoulder Domain

Shoulder Abduction / UWQoL Scores 100 – “I have no problems with my shoulder” 70 – “My shoulder is stiff but it has not affected my activity or strength” 30 – “Pain or weakness in my shoulder has caused me to change my work / hobbies” 0 – “I cannot work or do my hobbies due to problems with my shoulder” UWQoL Shoulder Domain

Discussion • Of all the measurements recorded the significant differences between the non-operated and operated side were only in shoulder flexion and abduction • The significance of deficits recorded on objective measurement was reflected in the questionnaires • Significant differences were recorded between the node negative and node positive patients

Conclusion • Shoulder dysfunction is evident in the post-operative SND patient • Cervical lymph node involvement in the SND patient favours a poorer functional outcome • The shoulder domain of the UWQoL questionnaire can assist Physiotherapists in the screening of dysfunction allowing the opportunity of further assessments and possible treatment

Particular acknowledgement to Simon Rogers and Derek Lowe

How Functional is a Functional Neck Dissection ?