A Pilot Study to Evaluate the Feasibility and Potential Effectiveness of the Flexitouch System Head and Neck Treatment

Not Applicable

Completed

Conditions: Head and Neck Neoplasms
Head and Neck Lymphedema
Head and Neck Cancer

Interventions: Device: Flexitouch head and neck lymphedema treatment system
Other: Standard home lymphedema care

Registration Number: NCT03332160

Lead Sponsor: Tactile Medical

Brief Summary: The study will evaluate the feasibility and potential effectiveness of the Flexitouch head and neck treatment plus standard home care compared to standard home care regimen alone.

Detailed Description: This study is an open-label, multi-site, stratified randomized, wait list control, pilot study. The study will be conducted at up to 2 sites in the United States and enroll 40 subjects with a diagnosis of head and neck lymphedema following treatment for head and neck cancer. Subjects randomized to receive daily treatment with the Flexitouch pneumatic compression device and home care regimen (SOC) will be seen at baseline and weeks 1, 4, and 8. Subjects randomized to the wait list arm will be seen at baseline and weeks 1, 4, and 8 while receiving SOC treatment. Assessments will include fidelity, satisfaction, symptoms, swelling/inflammation, function, and QOL.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 49

Inclusion Criteria

Age ≥ 18 years.
A previous diagnosis of histologically defined head and neck cancer.
A diagnosis of head and neck lymphedema.
Must be able and willing to participate in all aspects of the study and provide informed consent prior to study participation.
Completed cancer treatment with no evidence of active cancer; all post-surgical swelling must be resolved.
The head and neck garments must fit appropriately. For patients with a tracheostomy, the fit will be assessed to ensure that the garments do not interfere with their tracheostomy.
The subject must have experienced at least one of the following:
Completion of phase 1 lymphedema care in the past 8 weeks;
The inability to participate/complete phase 1 care due to:
Lack of available therapist/clinic,
Lack of insurance coverage or funding to support cost of care.

Exclusion Criteria

Uncontrolled hyperthyroidism or parathyroidism (for which endocrinologist recommends against neck compression).
Carotid sinus hypersensitivity syndrome.
Symptomatic carotid artery disease, as manifested by a recent transient ischemic attack (within 30 days), ischemic stroke, or amaurosis fugax (monocular visual ischemic symptoms or blindness).
Symptomatic bradycardia in the absence of a pacemaker.
Internal jugular venous thrombosis, acute or within 3 months.
Increased intracranial pressure or other contraindications to internal or external jugular venous compression.
Acute radiation dermatitis, unhealed surgical scar, unhealed or open wound(s), surgical flap less than 6-8 weeks post-operative.
Facial or head and neck dermal metastasis.
Acute facial infection (e.g., facial or parotid gland abscess).
Any condition in which increased venous and lymphatic return is undesirable.
History of pulmonary edema or decompensated congestive heart failure with in six (6) week of enrollment.
Subject is pregnant or trying to become pregnant.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Flexitouch head and neck lymphedema treatment system	Flexitouch head and neck lymphedema treatment system	Daily treatment with Flexitouch® pneumatic compression device for treatment of head and neck lymphedema and standard home lymphedema care
Standard of Care	Standard home lymphedema care	Standard home lymphedema care

Primary Outcome Measures

Name	Time	Method
Fidelity/Adherence Via Subject Diary	From baseline to end of treatment at 8 weeks	Evaluate the feasibility and potential effectiveness of the Flexitouch head and neck garments by monitoring fidelity/adherence using a subject diary. Values represent a count of participants who met the prescribed use criteria by week. The prescribed use was defined as two 30 minute sessions in a day.
Adverse Events	From baseline to the end of treatment at 8 weeks	Evaluate the feasibility and potential effectiveness of the Flexitouch head and neck garments by monitoring adverse events using the CTCAE (v4.0). Values represent the count of events per adverse events category.
Treatment Satisfaction	From baseline to the end of treatment at 8 weeks	Evaluate the feasibility and potential effectiveness of the Flexitouch head and neck garments by monitoring treatment satisfaction using a satisfaction survey. A survey assessed participants' perceived ability to control their head and neck lymphedema before (at baseline) and after the usage of the Flexitouch at 8 weeks. Values represent a count of participants who indicated good, very good, or excellent.

Secondary Outcome Measures

Name	Time	Method
Reduction in Swelling/Inflammation - Endoscopy	From baseline to the end of treatment at 8 weeks	The change in percent of sites with visible swelling and inflammation as assessed via endoscopy (using Modified Patterson Scale) from baseline to week 8. The range for each anatomical structure includes 1-4: Normal, Mild, Moderate, and Severe. A lower score means a better outcome. A greater negative value indicates a greater reduction in swelling. Total score range: 0-100%.
Reduction in Swelling/Inflammation - Cytokine Levels	From baseline to the end of treatment at 8 weeks	The presence of swelling and inflammation was assessed in all participants via the change in cytokine levels of Interleukin 6 (IL-6) at baseline to week 8. A lower score means a better outcome. A greater negative value indicates a greater reduction in cytokine levels.
Reduction in Swelling/Inflammation - Digital Photography	From baseline to the end of treatment at 8 weeks	The presence of swelling and inflammation was assessed in all participants by digital photography at baseline and 8 weeks. A lower value means a better outcome. A greater negative value indicates a greater reduction in swelling. Three views were scored each with 30 grids. The percentage of views with visible swelling was determined. The score ranged from 0-100%.
Reduction in Swelling/Inflammation - Grading of External Lymphedema	From baseline to the end of treatment at 8 weeks	The presence of swelling and inflammation was assessed in all participants through grading of external lymphedema via the Head and Neck Lymphedema and Fibrosis Assessment criteria (HNLEF) during a physical examination at baseline and 8 weeks. A total of 9 sites were evaluated for the presence of lymphedema and graded from 1 (mild) to 3 (severe) at each site. The number of sites ranged from 0-9 with a total severity score ranging from 0-27. Results are the change in a total score between baseline and 8 weeks. A lower score indicates a better outcome. A greater negative value indicates a greater reduction in swelling.
Function - Jaw Range of Motion	From baseline to the end of treatment at 8 weeks	The function was assessed in all participants at baseline and week 8 through the jaw range of motion measurements using the Therabite Jaw ROM Scale. The TheraBite Jaw ROM Scale was used to measure in millimeters the jaw opening of the maximum inter-incisal distance (upper right central to lower right central incisor). The values were categorized by grade change. The change of -1 indicates the severity improved by one grade. A value of zero indicates a participant remained stable. A value of 1 indicates a patient worsened by one grade.
Function - Neck Disability Index	From baseline to the end of treatment at 8 weeks	The function was assessed in all participants at baseline and week 8 by the Neck Disability Index (NDI). Values represent a change from baseline. Minimum score: 0 with a minimum disability of 0%. Maximum score: 50 with a maximal disability of 100%. 0 - 20% (minimal) - The patient can cope with most living activities. Usually, no treatment is indicated apart from advice on lifting sitting and exercise. 21 - 40% (moderate) - The patient experiences more pain and difficulty with sitting lifting and standing. Travel and social life are more difficult and they may be disabled from work. The patient can usually be managed by conservative means. 41 - 60% (severe) -Pain remains the main problem in this group but activities of daily living are affected. These patients require a detailed investigation. 61 - 80% (crippled) - Pain impinges on all aspects of the patient's life. Positive intervention is required. 81 - 100% (bed bound) - Need to exclude exaggeration or malingering.
Function - Voice Handicap Index	From baseline to the end of treatment at 8 weeks	The function was assessed in all participants at baseline and week 8 by the Voice Handicap Index (VHI). Values represent a change from baseline. Max / Min Total Score: 0-120. A lower score indicates a better outcome.
Function - Cervical and Shoulder Range of Motion	From baseline to the end of treatment at 8 weeks	The function was assessed in all participants at baseline and week 8 through the cervical range of motion (CROM) and shoulder range of motion (SROM) measurements. A positive value indicates a better outcome. The greater the value, the greater the change from baseline.
Symptoms - Vanderbilt Head and Neck Symptom Survey	From baseline to the end of treatment at 8 weeks	Symptoms were assessed in all participants at baseline and week 8 via the Vanderbilt Head and Neck Symptom Survey plus General Symptom Survey (VHNSS v2.0 plus GSS). Values represent a median score change from baseline. Score range: 0-10. A lower score indicates a better outcome. A more negative value indicates a greater change from baseline. Given this was a self-reported survey, responses were not mandatory and thus missing for some subjects.
Quality of Life - Linear Analog Self-Assessment	From baseline to the end of treatment at 8 weeks	Quality of life was assessed in all participants at baseline and week 8 using the Linear Analog Self-Assessment. The total score for the assessment ranged from 0-50. Each category represents a change in score from the baseline visit which ranged from positive 4 to negative 4. A positive change indicates an improvement. Values represent the count of participants in each category.
Symptoms - Lymphedema Symptom Intensity and Distress Survey	From baseline to the end of treatment at 8 weeks	Lymphedema Symptom Intensity and Distress Survey-Head and Neck (LSIDS-HN) assessed the measurement characteristics of a symptom burden for participants with head and neck lymphedema at baseline and week 8. Each symptom was rated on intensity and distress using a 5-point scale. A maximum response for any symptom within a given cluster was used for the analysis. The total score ranged from 0-10. The values represent a change from baseline. A lower score means a better outcome.