Jie Deng1, Sheila H Ridner2, Nancy Wells2, Mary S Dietrich2, Barbara A Murphy2. 1. School of Nursing, Vanderbilt-Ingram Cancer Center, and Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville TN, USA. Electronic address: jie.deng@vanderbilt.edu. 2. School of Nursing, Vanderbilt-Ingram Cancer Center, and Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville TN, USA.
Abstract
PURPOSE: To develop assessment criteria for evaluating and documenting status of external lymphedema and fibrosis in patients with head and neck cancer (HNC). METHODS: This was a two-phase instrument development study. In Phase I, initial assessment criteria for head and neck external lymphedema and fibrosis were generated based on a conceptual framework developed to describe the continuum of lymphedema - fibrosis in HNC patients. The initial Head and Neck External Lymphedema and Fibrosis (HN-ELAF) Assessment Criteria with three components were revised based on expert feedback. In Phase II, a pilot study was conducted to evaluate the revised assessment criteria through direct physical examination of 30 HNC patients with facial swelling and/or scar-like tissue >3 months post-treatment. The following statistical methods were used to evaluate interrater reliability in Phase II: simple percent agreement, the Kappa statistic, and the concordance correlation coefficient. Then, a post-test revision was made to further modify the tool based on the results of the pilot test. RESULTS: In Phase I, the initial HN-ELAF was revised including deleting Grade 0 (subclinical disease) and two components (i.e., symptoms and functional impairments). The revised HN-ELAF Assessment Criteria demonstrated good content/face validity. In Phase II, the assessment criteria had an acceptable interrater reliability, e.g., 83% exact agreement on grading lymphedema and fibrosis severity; and kappa = 0.75 (p < .001). The assessment criteria were further modified including three dimensions: type, severity, and anatomical sites of lymphedema and fibrosis. CONCLUSIONS: Validation of the modified HN-ELAF Assessment Criteria in larger sample sizes is ongoing.
PURPOSE: To develop assessment criteria for evaluating and documenting status of external lymphedema and fibrosis in patients with head and neck cancer (HNC). METHODS: This was a two-phase instrument development study. In Phase I, initial assessment criteria for head and neck external lymphedema and fibrosis were generated based on a conceptual framework developed to describe the continuum of lymphedema - fibrosis in HNC patients. The initial Head and Neck External Lymphedema and Fibrosis (HN-ELAF) Assessment Criteria with three components were revised based on expert feedback. In Phase II, a pilot study was conducted to evaluate the revised assessment criteria through direct physical examination of 30 HNC patients with facial swelling and/or scar-like tissue >3 months post-treatment. The following statistical methods were used to evaluate interrater reliability in Phase II: simple percent agreement, the Kappa statistic, and the concordance correlation coefficient. Then, a post-test revision was made to further modify the tool based on the results of the pilot test. RESULTS: In Phase I, the initial HN-ELAF was revised including deleting Grade 0 (subclinical disease) and two components (i.e., symptoms and functional impairments). The revised HN-ELAF Assessment Criteria demonstrated good content/face validity. In Phase II, the assessment criteria had an acceptable interrater reliability, e.g., 83% exact agreement on grading lymphedema and fibrosis severity; and kappa = 0.75 (p < .001). The assessment criteria were further modified including three dimensions: type, severity, and anatomical sites of lymphedema and fibrosis. CONCLUSIONS: Validation of the modified HN-ELAF Assessment Criteria in larger sample sizes is ongoing.
Authors: Jeffrey M Straub; Jacob New; Chase D Hamilton; Chris Lominska; Yelizaveta Shnayder; Sufi M Thomas Journal: J Cancer Res Clin Oncol Date: 2015-04-25 Impact factor: 4.553
Authors: Jie Deng; Mary S Dietrich; Kenneth J Niermann; Robert J Sinard; Anthony J Cmelak; Sheila H Ridner; Jill Gilbert; Barbara A Murphy Journal: Int J Radiat Oncol Biol Phys Date: 2020-10-14 Impact factor: 8.013