{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:56:17Z","timestamp":1791381377482,"version":"4.3.3"},"reference-count":30,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,2,3]],"date-time":"2024-02-03T00:00:00Z","timestamp":1706918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Verwelius Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: To assess the prevalence of chronic lymphedema and trismus in patients &gt; 6 months after head and neck cancer (HNC) treatment, and to explore how the severity of these conditions correlates with body image and quality of life. Methods: The cross-sectional sample included 59 patients, treated for HNC between six months to three years ago. Physical measurements were performed to assess the presence of external lymphedema and trismus (&lt;36 mm). Furthermore, participants completed two questionnaires regarding body image (BIS) and quality of life (UW-QoL V4). Results: Lymphedema prevalence was 94.1% (95% CI 0.86\u20130.98), with a median severity score of 9 (range 0\u201324). Trismus prevalence in this sample was 1.2%. The median BIS score was 2, indicating a positive body image. The UW-QoL score showed a good QOL with a median of 100. Only the domain of saliva and overall related health had a lower median of 70 and 60, respectively. There was no correlation between lymphedema and body image (r = 0.08, p = 0.544). Patients with higher lymphedema scores reported poorer speech with a moderate correlation (r = \u22120.39, p = 0.003). Conclusion: Lymphedema is a highly prevalent, but moderately severe late side-effect of HNC with a limited impact on quality of life domains except for speech, in our cohort.<\/jats:p>","DOI":"10.3390\/cancers16030653","type":"journal-article","created":{"date-parts":[[2024,2,6]],"date-time":"2024-02-06T05:36:43Z","timestamp":1707197803000},"page":"653","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Lymphedema and Trismus after Head and Neck Cancer, and the Impact on Body Image and Quality of Life"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3750-6657","authenticated-orcid":false,"given":"Coralie R.","family":"Arends","sequence":"first","affiliation":[{"name":"Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0514-2142","authenticated-orcid":false,"given":"Lisette","family":"van der Molen","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"},{"name":"Amsterdam Center for Language and Communication, University of Amsterdam, 1012 WP Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6470-4344","authenticated-orcid":false,"given":"Josephine E.","family":"Lindhout","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"},{"name":"Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 LK Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3023-134X","authenticated-orcid":false,"given":"Karoline","family":"Bragante","sequence":"additional","affiliation":[{"name":"Department of Physical Rehabilitation, Federal University of Health Science of Porto Alegre, Porto Alegre 90050-170, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7006-7807","authenticated-orcid":false,"given":"Arash","family":"Navran","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6338-6743","authenticated-orcid":false,"given":"Michiel W. M.","family":"van den Brekel","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"},{"name":"Amsterdam Center for Language and Communication, University of Amsterdam, 1012 WP Amsterdam, The Netherlands"},{"name":"Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7794-7767","authenticated-orcid":false,"given":"Martijn M.","family":"Stuiver","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"},{"name":"Center for Quality of Life and Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"},{"name":"Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1091 GC Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"lgz005","DOI":"10.1093\/jncimonographs\/lgz005","article-title":"Late Soft Tissue Complications of Head and Neck Cancer Therapy: Lymphedema and Fibrosis","volume":"2019","author":"Deng","year":"2019","journal-title":"J. Natl. Cancer Inst. Monogr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1177\/1943387520917518","article-title":"Etiopathogenesis of Trismus in Patients with Head and Neck Cancer: An Exploratory Literature Review","volume":"13","author":"Raj","year":"2020","journal-title":"Craniomaxillofacial Trauma Reconstr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1002\/hed.26120","article-title":"Long-term swallowing, trismus, and speech, outcomes after combined chemoradiotherapy and preventive rehabilitation for head and neck cancer; 10-year plus update","volume":"42","author":"Karsten","year":"2020","journal-title":"Head Neck"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/MOO.0b013e3283393799","article-title":"The role of Lymphedema Management in Head And Neck Cancer","volume":"18","author":"Smith","year":"2010","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1177\/0194599814558402","article-title":"Lymphedema outcomes in patients with head and neck cancer","volume":"152","author":"Smith","year":"2015","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3364","DOI":"10.1002\/hed.26394","article-title":"Comparing the prevalence, location, and severity of head and neck lymphedema after postoperative radiotherapy for oral cavity cancers and definitive chemoradiotherapy for oropharyngeal, laryngeal, and hypopharyngeal cancers","volume":"42","author":"Jeans","year":"2020","journal-title":"Head Neck"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.jpainsymman.2011.03.019","article-title":"Prevalence of secondary lymphedema in patients with head and neck cancer","volume":"43","author":"Deng","year":"2012","journal-title":"J. Pain Symptom Manag."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1007\/s00520-015-2893-4","article-title":"Differences of symptoms in head and neck cancer patients with and without lymphedema","volume":"24","author":"Deng","year":"2016","journal-title":"Support. Care Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1002\/hed.23816","article-title":"Impact of trismus on health-related quality of life and mental health","volume":"37","author":"Johnson","year":"2015","journal-title":"Head Neck"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1080\/0284186X.2016.1223341","article-title":"Predictors for trismus in patients receiving radiotherapy","volume":"55","author":"Kamstra","year":"2016","journal-title":"Acta Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1186\/s40064-016-2295-1","article-title":"Health-related quality of life up to 1 year after radiotherapy in patients with head and neck cancer (HNC)","volume":"5","author":"Loorents","year":"2016","journal-title":"Springerplus"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1002\/hed.23084","article-title":"Impact of secondary lymphedema after head and neck cancer treatment on symptoms, functional status, and quality of life","volume":"35","author":"Deng","year":"2013","journal-title":"Head Neck"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s11864-017-0484-y","article-title":"Overview of the 8th Edition TNM Classification for Head and Neck Cancer","volume":"18","author":"Huang","year":"2017","journal-title":"Curr. Treat. Options Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.oraloncology.2015.01.005","article-title":"Assessment and measurement of head and neck lymphedema: State-of-the-science and future directions","volume":"51","author":"Deng","year":"2015","journal-title":"Oral Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.ejon.2016.02.001","article-title":"Preliminary evaluation of reliability and validity of head and neck external lymphedema and fibrosis assessment criteria","volume":"22","author":"Deng","year":"2016","journal-title":"Eur. J. Oncol. Nurs."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Saund, D.S., Pearson, D., and Dietrich, T. (2012). Reliability and validity of self-assessment of mouth opening: A validation study. BMC Oral Health, 12.","DOI":"10.1186\/1472-6831-12-48"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ijom.2008.10.001","article-title":"Variation in repeated mouth-opening measurements in head and neck cancer patients with and without trismus","volume":"38","author":"Dijkstra","year":"2009","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.ijom.2005.08.001","article-title":"Criteria for trismus in head and neck oncology","volume":"35","author":"Dijkstra","year":"2006","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0959-8049(00)00353-1","article-title":"A body image scale for use with cancer patients","volume":"37","author":"Hopwood","year":"2001","journal-title":"Eur. J. Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1007\/s11136-014-0907-1","article-title":"Reliability and validity of the Dutch-translated Body Image Scale","volume":"24","author":"Vrijland","year":"2015","journal-title":"Qual. Life Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1007\/s00520-018-4145-x","article-title":"A systematic review of the measurement properties of the Body Image Scale (BIS) in cancer patients","volume":"26","author":"Melissant","year":"2018","journal-title":"Support. Care Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1001\/archotol.127.5.489","article-title":"Analysis of the Performance Characteristics of the University of Washington Quality of Life Instrument and Its Modification (UW-QOL-R)","volume":"127","author":"Weymuller","year":"2001","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.tjem.2018.08.001","article-title":"User\u2019s guide to correlation coefficients","volume":"18","author":"Akoglu","year":"2018","journal-title":"Turk. J. Emerg. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3408","DOI":"10.1002\/hed.25836","article-title":"Prevalence of trimsus in patients with head and neck cancer: A systematic review with meta-analysis","volume":"41","author":"Watters","year":"2019","journal-title":"Head Neck"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1007\/s00520-010-0847-4","article-title":"A systematic review of trismus induced by cancer therapies in head and neck cancer patients","volume":"18","author":"Bensadoun","year":"2010","journal-title":"Support. Care Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/s10006-010-0220-2","article-title":"Limited mouth opening after primary therapy of head and neck cancer","volume":"14","author":"Weber","year":"2010","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3521","DOI":"10.1007\/s00405-014-3379-6","article-title":"Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises","volume":"272","author":"Kraaijenga","year":"2015","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1002\/hed.25573","article-title":"Radiation dose to the masseter and medial pterygoid muscle in relation to trismus after chemoradiotherapy for advanced head and neck cancer","volume":"41","author":"Kraaijenga","year":"2019","journal-title":"Head Neck"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e13549","DOI":"10.1111\/ecc.13549","article-title":"The impact of dysphagia prehabilitation on swallowing outcomes post-chemoradiation therapy in head and neck cancer: A systematic review","volume":"31","author":"Brady","year":"2022","journal-title":"Eur. J. Cancer Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"358","DOI":"10.4103\/jehp.jehp_508_20","article-title":"Quality of life in Iranian patients with head-and-neck cancer","volume":"9","author":"Hashemipour","year":"2020","journal-title":"J. Educ. Health Promot."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/3\/653\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:54:15Z","timestamp":1760104455000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/3\/653"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,3]]},"references-count":30,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["cancers16030653"],"URL":"https:\/\/doi.org\/10.3390\/cancers16030653","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,3]]}}}