Association Between Multimodality Neck Treatment and Work and Leisure Impairment A Disease-Specific Measure to Assess Both Impairment and Rehabilitation After Neck Dissection

IMPORTANCE This study describes the effect of adjuvant treatment on shoulder-related quality of life, leisure activities, and employment for patients undergoing neck dissection for head and neck cancer. OBJECTIVE To explore the association between treatment outcome and shoulder-related on critical daily life functions such as employment and recreation. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of patients with head and neck cancer at a tertiary care hospital. EXPOSURES Level V-sparing selective neck dissection or modified radical neck dissection sparing the accessory nerve, with or without radiation therapy and/or chemotherapy. MAIN OUTCOMES AND MEASURES Patients completed the Neck Dissection Impairment Index (NDII), with scores ranging from 0 to 100 and higher scores indicating better shoulder functioning and shoulder-related quality of life, and underwent objective testing with the Constant-Murley Shoulder Function Test (Constant test) at least 12 months after the completion of all adjuvant treatment. Additional outcome measures related to physical therapy, pain medication use, leisure activity, and employment status. RESULTS We evaluated 167 patients who underwent 121 selective neck dissections and 46 modified radical neck dissections. The median (range) NDII score was 90 (10-100). Patients with modified radical neck dissection reported lower scores than those with selective neck dissection (85 [10-100] vs 92 [30-100]; P = .01). Multivariable analysis showed that advanced-stage disease (mean, 77 [range, 25-100] vs 87 [18-100]; P = .006), radiation therapy (80 [10-100] vs 88 [50-100]; P = .03), and chemotherapy (77 [30-100] vs 83 [18-100]; P = .002) were associated with greater shoulder impairment. The NDII and Constant test were well correlated (0.64; P < .001). Change in leisure activity was correlated with greater impairment (median [range] NDII score, 90 [18-100] for patients with no change vs 53 [10-100] for patients with change, P = .005; Constant score, 85 [12-100] vs 68 [10-88], P = .004). Patients who remained employed or resumed working had higher median (range) NDII scores (94 [10-100] and 88 [75-100], respectively) than those who limited or stopped working (70 [10-100]), which also correlates with greater shoulder impairment (P < .001). CONCLUSIONS AND RELEVANCE More aggressive treatment, either in the form of increased surgical dissection, radiation therapy, or chemotherapy, was associated with worse shoulder function and quality of life. The degree of impairment perceived by the patient and measured in objective testing was correlated with leisure activity and employment status. These findings may stimulate further investigation related to optimizing quality of life following neck dissection.