Limited consensus on the diagnosis and treatment of lymphedema after head and neck cancer: results from an International Delphi study.

Abstract

Purpose: To explore current practice variation and degree of consensus among international clinical experts regarding the diagnosis, classification, measurement, and treatment of head and neck lymphedema (HNL) after head and neck cancer treatment.

Materials and methods: We conducted an online Delphi study. Eligible participants were clinical researchers who had (co)authored at least one publication on HNL and healthcare professionals who had treated at least five patients with HNL the last two years. The first round was to collect views about current best practices. The second and third rounds delved deeper into these topics using statements with 7-point adjective rating scales.

Results: An expert panel of seventeen participants (7 clinicians, 8 researchers, and 2 others) from 8 countries completed all rounds. Regarding diagnosis, there was limited consensus on most subjects, with palpation being most endorsed. No consensus was reached on the need to use standardized classification systems. As a treatment method, complex decongestive therapy (CDT) was the most commonly used in practice and investigated in the literature. However, no consensus was reached on the importance of aspects of CDT.

Conclusions: There is substantial intra- and international practice variation in the management of HNL. This calls for more robust evidence and guidelines.