A Pneumatic Compression Device for the Treatment of Lymphedema in Patients With Stage II-IV Head and Neck Cancer After Chemoradiation

NCT ID: NCT05512767

Last Updated: 2023-01-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

NA

Study Classification

INTERVENTIONAL

Study Start Date

2022-12-01

Study Completion Date

2024-08-22

Brief Summary

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This clinical trial tests whether adding the use of a pneumatic compression system with manual lymphatic drainage versus manual lymphatic drainage alone in treating patients with lymphedema after chemoradiation for stage II-IV head and neck cancer. Lymphedema can be the result of surgery, radiation therapy, chemotherapy or any combination of these procedures. Internal lymphedema has been shown to negatively affect speech production, swallowing, respiration, and voice. Flexitouch is an advanced pneumatic compression device (APCD) that consists of a 2-piece garment that provides pressure changes to move lymph fluid from the impaired area toward healthy regions of the body. Complete decongestive therapy (CDT) is standard of care for treating external lymphedema and involves manual lymphatic drainage (MLD) performed by licensed therapists followed by compression therapy. CDT has long been used for treating lymphedema of the limbs. Combining a pneumatic compression system with standard of care manual lymphatic drainage may have positive effects on speech, voice, and swallowing.

Detailed Description

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PRIMARY OBJECTIVES:

I. Compare success rates in reducing internal and external lymphedema using manual lymphatic drainage (MLD) versus use of a pneumatic compression device (PCD). Assess efficacy of PCD and MLD.

II. Assess compliance of treatment in both groups. III. Assess changes in voice and swallowing in both groups.

OUTLINE: Patients are assigned to 1 of 2 groups.

GROUP I: Patients undergo 32 minute treatments twice daily for 12 weeks using the FlexiTouch Plus System and treatment with a lymphedema therapist weekly on weeks 2-11. Patients undergo nasolaryngoscopy and videofluoroscopic swallow study at baseline.

GROUP II: Patients undergo standard of care self-manual lymphatic drainage (technique instructions provided) twice daily for 12 weeks and treatment with a lymphedema therapist weekly on weeks 2-11. Patients undergo nasolaryngoscopy and videofluoroscopic swallow study at baseline.

Conditions

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Clinical Stage II HPV-Mediated (p16-pos) Oropharyngeal Carcinoma Clinical Stage III HPV-Mediated (p16-pos) Oropharyngeal Carcinoma Clinical Stage IV HPV-Mediated (p16-pos)Oropharyngeal Carcinoma Head and Neck Carcinoma Stage II Hypopharyngeal Carcinoma AJCC v8 Stage II Laryngeal Cancer AJCC v8 Stage II Lip and Oral Cavity Cancer AJCC v8 Stage II Oropharyngeal (p16-Negative) Carcinoma AJCC v8 Stage III Hypopharyngeal Carcinoma AJCC v8 Stage III Laryngeal Cancer AJCC v8 Stage III Lip and Oral Cavity Cancer AJCC v8 Stage III Oropharyngeal (p16-Negative) Carcinoma AJCC v8 Stage IV Hypopharyngeal Carcinoma AJCC v8 Stage IV Laryngeal Cancer AJCC v8 Stage IV Lip and Oral Cavity Cancer AJCC v8 Stage IV Oropharyngeal (p16-Negative) Carcinoma AJCC v8

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SEQUENTIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Group I (pneumatic therapy, lymphedema management)

Patients undergo 32 minute treatments twice daily for 12 weeks using the FlexiTouch Plus System and treatment with a lymphedema therapist weekly on weeks 2-11. Patients undergo nasolaryngoscopy and videofluoroscopic swallow study at baseline.

Group Type EXPERIMENTAL

Consensus Auditory-Perceptual Evaluation of Voice

Intervention Type OTHER

Ancillary studies

Diagnostic Imaging

Intervention Type PROCEDURE

Undergo photographs of face and neck

Lymphedema Management

Intervention Type OTHER

Undergo skilled lymphedema treatment by a therapist

Modified Barium Swallow

Intervention Type PROCEDURE

Undergo swallow study

Nasopharyngeal Laryngoscopy

Intervention Type PROCEDURE

Undergo Nasolaryngoscopy

Pneumatic Compression Therapy

Intervention Type DEVICE

Undergo compression therapy - Flexitouch Plus System is an advanced pneumatic compression device (APCD) that consists of a 2-piece garment that provides systematic and sequential pressure changes to move fluid to intact lymphatic chains.

Quality-of-Life Assessment

Intervention Type OTHER

Ancillary studies

Questionnaire Administration

Intervention Type OTHER

Ancillary studies

Voice Handicap Index-10

Intervention Type OTHER

Ancillary studies

Group II (standard of care, lymphedema management)

Patients undergo standard of care self-manual lymphatic drainage (technique instructions provided) twice daily for 12 weeks and treatment with a lymphedema therapist weekly on weeks 2-11. Patients undergo nasolaryngoscopy and videofluoroscopic swallow study at baseline.

Group Type ACTIVE_COMPARATOR

Best Practice

Intervention Type OTHER

Undergo self-manual lymphatic drainage

Consensus Auditory-Perceptual Evaluation of Voice

Intervention Type OTHER

Ancillary studies

Diagnostic Imaging

Intervention Type PROCEDURE

Undergo photographs of face and neck

Lymphedema Management

Intervention Type OTHER

Undergo skilled lymphedema treatment by a therapist

Modified Barium Swallow

Intervention Type PROCEDURE

Undergo swallow study

Nasopharyngeal Laryngoscopy

Intervention Type PROCEDURE

Undergo Nasolaryngoscopy

Quality-of-Life Assessment

Intervention Type OTHER

Ancillary studies

Questionnaire Administration

Intervention Type OTHER

Ancillary studies

Voice Handicap Index-10

Intervention Type OTHER

Ancillary studies

Interventions

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Best Practice

Undergo self-manual lymphatic drainage

Intervention Type OTHER

Consensus Auditory-Perceptual Evaluation of Voice

Ancillary studies

Intervention Type OTHER

Diagnostic Imaging

Undergo photographs of face and neck

Intervention Type PROCEDURE

Lymphedema Management

Undergo skilled lymphedema treatment by a therapist

Intervention Type OTHER

Modified Barium Swallow

Undergo swallow study

Intervention Type PROCEDURE

Nasopharyngeal Laryngoscopy

Undergo Nasolaryngoscopy

Intervention Type PROCEDURE

Pneumatic Compression Therapy

Undergo compression therapy - Flexitouch Plus System is an advanced pneumatic compression device (APCD) that consists of a 2-piece garment that provides systematic and sequential pressure changes to move fluid to intact lymphatic chains.

Intervention Type DEVICE

Quality-of-Life Assessment

Ancillary studies

Intervention Type OTHER

Questionnaire Administration

Ancillary studies

Intervention Type OTHER

Voice Handicap Index-10

Ancillary studies

Intervention Type OTHER

Other Intervention Names

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standard of care standard therapy CAPE-V Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) Medical Imaging MBS VFSS Videofluoroscopic Swallowing Study Flexi-touch Plus System Quality of Life Assessment VHI-10 Voice Handicap Index-10 (VHI-10)

Eligibility Criteria

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Inclusion Criteria

* Completed definitive chemoradiation for Stage II or greater, histologically proven cancer of the oral cavity, oropharynx, hypopharynx, pharynx or larynx with a curative intent
* Cognitive function adequate to understand and execute the elements of the protocol
* Willingness and ability to return to Mayo Clinic for follow-up care per protocol
* Resolution of acute dermatitis (skin must be intact without evidence of inflammation, infection or desquamation) as a result of chemoradiotherapy (CRT)
* Must demonstrate oropharyngeal competency that would allow some oral intake

Exclusion Criteria

* Prior surgery, radiation, chemotherapy, or immunotherapy for head or neck cancer
* Acute radiation dermatitis, unhealed surgical wounds or surgical flap less than 2 months post-operative
* Acute facial infection
* Active congestive heart failure (CHF) or pulmonary edema
* Symptomatic carotid artery disease or bradycardia
* Increased intracranial pressure
* History of multiple cerebrovascular accidents (CVAs) or transient ischemic attacks (TIAs)
* \> 50% internal carotid artery (ICA) blockage
* Upper quadrant deep vein thrombosis
* Known esophageal obstruction
* Percutaneous endoscopic gastrostomy (PEG) tube dependence with no oral intake
* Women of child-bearing potential
* (Active) pregnancy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mayo Clinic

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Lisa Crujido

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic

Other Identifiers

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NCI-2022-06767

Identifier Type: REGISTRY

Identifier Source: secondary_id

21-003342

Identifier Type: -

Identifier Source: org_study_id

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