A comparison of massage and compression for treatment of head and neck lymphoedema after head and neck cancer treatment.

INTERVENTION: This study employs a randomised controlled trial comparing two therapy modalities for head and neck lymphoedema management. All participants will undergo the same battery of assessments including imaging of their head and neck lymphatics with near infra‐red fluorescence lymphatic imaging. Participants will be randomised to an intervention group. Those randomised to group A will receive treatment with compression therapy, a common component of standard care for head and neck lymphoedema treatment. They will be fitted with a compression neck/face support and a flat foam insert by an occupational therapist or physiotherapist. They will be provided with written and verbal instructions and will be requested to apply the compression themselves as tolerated gradually increasing to 8 hours in every 24 hours. The duration of the intervention is 6 weeks. Those randomised to group B will receive treatment with 30mins manual lymphatic drainage twice weekly from an occupational therapist or physiotherapist and will be requested to complete the same sequence for 30min once daily at home. The duration of the intervention is 6 weeks. Irrespective of group allocation, participants will also be educated about head and neck lymphoedema and will receive a program of active exercises. Exercises will involve active range of motion movements of the face (contraction and relaxation of the lips, nose and eyes), neck (bending forwards, backwards, turning to the side and tilting to the side), and shoulders (circles and rotations) and participants will be requested to complete these 5‐10 times per session for 2 sessions per day for the 6 weeks of the program. The exercises will be completed by the participant alone as a part of their self management training. During the first treatment session all participants will receive 1‐1 training in self management for active exercises and either compression or manual lymphatic drainage. They will also receive written in CONDITION: Cancer ‐ Head and neck Cardiovascular ‐ Diseases of the vasculature and circulation including the lymphatic system Head and neck lymphoedema ;head and neck cancer; ; Head and neck lymphoedema ; head and neck cancer Physical Medicine / Rehabilitation ‐ Occupational therapy Physical Medicine / Rehabilitation ‐ Physiotherapy PRIMARY OUTCOME: Change in tissue dielectric constant readings (as indicative of a reduction in head and neck lymphoedema)[6 weeks] Feasibility of conducting a randomised controlled trial comparing compression and manual lymphatic drainage in the management of head and neck lymphoedema. [6 weeks] SECONDARY OUTCOME: Change in tape measurements (as indicative of head and neck lymphoedema)[12 weeks] INCLUSION CRITERIA: • >18 years of age • A previous diagnosis of oral, nasopharyngeal, oropharyngeal, laryngeal, or hypopharyngeal cancer treated with chemoradiation, postoperative radiation or definitive radiation with curative intent • Life expectancy >12months • Able to provide informed written consent • MD Anderson Cancer Centre (MDACC) HNL rating >1 indicating soft visible oedema; no pitting, reversible