Up to 90% of head and neck cancer survivors develop lymphoedema—a painful swelling in the face and throat—that can make swallowing difficult or impossible. This study tests whether a treatment called Complete Decongestive Therapy (CDT), which uses massage, compression bandages, and exercises to drain fluid, can be practically delivered to these patients within the NHS. Current care often ignores the link between lymphoedema and swallowing problems. Without evidence, clinicians lack a standardised treatment pathway. The researchers will first review existing studies, then work with patients and speech therapists to refine CDT for head and neck cancer survivors. In the final phase, they will test the refined intervention in a small group to see if patients stick with it and if it improves swallowing, quality of life, and swelling. If CDT proves feasible, the team will publish a treatment protocol and logic model that other NHS cancer centres can adopt directly. Long-term, this could lead to a full randomised trial testing whether CDT reduces feeding-tube dependence and improves survival outcomes. The work also lays groundwork for combining CDT with other rehabilitation therapies into multimodal packages.
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Background: As the incidence of head and neck cancer (HaNC) is increasing with the Human Papilloma Virus (HPV), patients are living for longer with late effects of HaNC treatment, including chronic swallowing (dysphagia) impairments and head and neck lymphoedema (HNL). Up to 90% of HaNC survivors will be develop HNL. Emerging evidence supports the use of Complete Decongestive Therapy (CDT) for treating secondary lymphoedema of the head and neck. It is vital to understand how the presence of HNL impacts on the swallow, and if functional dysphagia outcomes improve following treatment. Research Question: Is Complete Decongestive Therapy a feasible and acceptable intervention for patients with lymphoedema following treatment for head and neck cancer? Aim: To refine individualised CDT through co-production and investigate feasibility/acceptability of integrating the intervention into the HaNC care pathway. Objectives Perform an up-to-date systematic review on the effectiveness of CDT as an intervention in HNL patients to improve dysphagia outcomes. Co-production to refine intervention. Address challenges identified in pre-feasibility testing and potential solutions for HaNC survivors' eligibility, recruitment, adherence, compliance and retention rates. This will include uptake time point in their HaNC pathway, intervention components and fidelity. Explore the mechanism of action of intervention delivery using programme theory with an embedded behaviour change framework. Test candidate outcome measures on QOL, patient reported swallowing outcomes measures, objective swallowing outcome measures, and volumetric analysis of HNL. Obtain HaNC survivors and professionals perspectives' on acceptability of the intervention, study processes and integration to usual care using a nested qualitative sub-study. Determine a power calculation for future RCT. Preliminary estimate of intervention cost. Methods: This study development has followed the MRC framework for developing complex interventions via three workstreams packages. WS1: To identify and critically review the content and relevance of the literature on HNL interventions and their impact on dysphagia outcomes, retention and adherence. WS2: Co-Production: Identification of solutions to acceptability, refining the intervention, and materials used with patient and AHP stakeholder workshops, along with a principal patient co-creator. WS3: To deliver a co-produced individualised CDT intervention to HaNC patients with HNL and evaluate its acceptability and feasibility. Timelines for delivery: WS1 and WS2 will be undertaken in years 1-2 and WS3 in years 2-3. Anticipated impact and dissemination: The robust collaborative development and feasibility testing of individualised CDT will allow HaNC teams nationwide to implement and/or adapt the intervention within their own services benefiting HaNC patients nationally. The intervention protocol and results from feasibility testing including a logic model will display the mechanism of action using the COM-B framework. This will be disseminated through published academic journal articles and shared at professional and patient centred conferences. Interactive infographics and animations will be used to deliver accessible information to reach a broad audience. National HaNC charities and patient and public representatives will be used to disseminate through online platforms and face to face. Long term, individualised CDT could be tested as part of a randomised control trial to assess effectiveness and combined with other rehabilitation interventions to create multimodal interventions.
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