Evaluation of Neck Disability Using Computed-Tomography in Head and Neck Cancer Survivors

Alexandria Harris; Barton Branstetter; Jinhong Li; Sara R Piva; Jonas T Johnson; Marci Lee Nilsen

doi:10.3389/fpain.2022.910247

Evaluation of Neck Disability Using Computed-Tomography in Head and Neck Cancer Survivors

Front Pain Res (Lausanne). 2022 May 17:3:910247. doi: 10.3389/fpain.2022.910247. eCollection 2022.

Authors

Alexandria Harris¹, Barton Branstetter², Jinhong Li³, Sara R Piva⁴, Jonas T Johnson¹, Marci Lee Nilsen^{1

5}

Affiliations

¹ Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
² Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
³ Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.
⁴ Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, United States.
⁵ Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States.

Abstract

Objective: We have previously reported that 55% of head and neck cancer survivors have neck disability. However, it is unclear what factors contribute to their neck disability. Our study aim is to determine if survivors with neck disability have evidence of cervical spine degenerative disease assessed by computed tomography (CT).

Materials/methods: Cross-sectional analysis of patient-reported neck disability, prospectively collected on survivors of squamous cell carcinomas without recurrence or metastasis over one-year post-treatment. Neck disability and its impact on daily life was measured using the Neck Disability Index (NDI) and compared with cervical CT scans within 6 months. Scans were evaluated for degeneration of the disc and facet of the cervical vertebrae rated on a 5-point scale where 5 indicates more severe disease. Multivariable linear regression was used to analyze the association between NDI and radiographic findings.

Results: 116 survivors of oropharyngeal carcinomas were identified, predominantly male (81.9%) with an average age of 62.8 ± 8.2 (range 43.8-81.4). Most survivors had advanced stage III-IVa cancer (94.0%) with treatment modalities including surgery (n=26, 52.0%), chemotherapy (n = 45, 90.0%), and radiation therapy (n = 49, 98.0%). Absence of neck disability was observed in 44.0% of survivors, 39.7% had mild disability, and 16.4% moderate disability. The time from treatment to clinic visit was an average of 3.1 ± 2.7 years (range 1.1-13.4). Multivariable analysis of NDI controlling for age, time since treatment, and treatment modality identified an inverse association between NDI and spinal degenerative disease examining cervical discs (-1.46 95% confidence interval (CI) [-2.86, -0.06], p = 0.041) and age (-0.24 95% CI[-0.40, -0.08], p = 0.004).

Conclusions: Our study shows that neck impairment and pain in head and neck cancer survivors is not sufficiently explained by cervical degeneration related to age or trauma, supporting the theory that post-treatment neck disability occurs as a side effect of treatment. These results support the further assessment of structure and function of cervical musculature and degeneration following HNC treatment.

Keywords: computed tomography; head and neck cancer; neck disability; pain; survivorship.