Prehabilitation for lymphedema in head and neck cancer patients at a community cancer center

Patients with head and neck cancer often develop morbidities as a result of their treatment with surgery, radiation, and chemotherapy. One of the most prevalent side effects of the treatment is lymphedema, the accumulation of interstitial fluid in tissues that have inadequate lymph drainage. Secondary lymphedema, an acquired abnormality in the lymphatic network, is commonly caused by cancer and/or its treatment. Lymphedema is both under-recognized and under-treated in head and neck cancer. While recent advances in radiation therapy techniques have resulted in a corresponding drop in other treatment-related morbidities, an estimated 50% of treated head and neck cancer patients will develop lymphedema. Indeed, at some places the incidence is much higher, at 75%, following treatment with surgery and radiation. Clearly, there is an unmet need to recognize and treat lymphedema in head and neck cancer patients. This article describes an early intervention prehabilitation program that was established for the early identification and treatment of patients at risk of lymphedema and compares the observed outcomes before and after the initiation of the program