Edge task force on head and neck cancer outcomes a systematic review of outcome measures for quantifying external lymphedema

Background: Survivors of head and neck cancer (HNC) and its treatment experience high rates of lymphedema. Unlike the extremities, the head and neck is difficult to measure and does not easily lend itself to having a contralateral side for comparison. Being an irregularly shaped part of the body, measures of edema for the extremities cannot be adapted for the head and neck. The need exists for outcome measures to objectively quantify head and neck lymphedema using evidence-based practice guidelines. Purpose: The purpose of this study is to identify and recommend external edema outcome measures for lymphedema in the HNC population. Methods: A systematic review of the literature on edema measures for use in the HNC patient population was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model was used to guide which articles were chosen for inclusion, determination of eligibility, screening, and identification for the final review. Recommendations are based on the quality of psychometric properties, clinical feasibility, and previous use in HNC-related research. Six edema outcome measures were reviewed and none are recommended at this time; however, several hold great promise for future use in the clinic. Conclusions: This systematic review provides an overview for physical therapists on measures of external edema for the HNC patient population. The edema measures included in this review have been tested on HNC patients but have not been rigorously tested due to their novelty. At this time, no outcome measures for objectively quantifying external edema for the HNC population can be recommended. There is need for more research on this topic prior to providing definitive recommendations.