Internal head and neck lymphedema—a fluid accumulation in the oral cavity, pharynx, or larynx caused by cancer treatment damage—affects 74% to 96% of patients. According to a cross-sectional observational study published in the European Journal of Cancer Care on July 14, 2026, by Karin Sjögren’s team at Lund University, Swedish rehabilitation professionals lack consistent assessment routines, sufficient competence, and evidence-based management methods for this condition.
Evaluating Internal Lymphedema Practice in Sweden
Researchers conducted a web survey distributed between January 11 and February 29, 2024, targeting speech-language pathologists, physiotherapists, and lymphedema therapists. Out of 69 total respondents, 65 met the eligibility criteria of having treated more than one head and neck cancer patient during the previous year. The cohort included 28 speech-language pathologists and 37 physiotherapists and/or lymphedema therapists. Documentation habits proved sparse across both groups. Only 25% of professionals in each category routinely documented internal lymphedema, while 39% of speech-language pathologists and 25% of physiotherapists and lymphedema therapists never recorded it.
Assessment Tools and Professional Divergence
Assessment methods varied sharply by profession. Flexible endoscopic evaluation of swallowing was accessible to 75% of speech-language pathologists, yet only 7.1% utilized the revised Patterson Edema Scale. Conversely, physiotherapists and lymphedema therapists relied primarily on palpation, unaided inspection, patient reports, or notes from colleagues. When providing care, physiotherapists and lymphedema therapists adapted external lymphedema strategies—such as manual drainage, physical activity, and compression. Speech-language pathologists rarely treated internal swelling directly, typically referring patients elsewhere. Even so, 54% of speech-language pathologists noted that internal lymphedema influenced dysphagia rehabilitation, and 89% reported an impact on voice rehabilitation.
Clinical Insight: Self-rated competence among surveyed Swedish clinicians was predominantly nonexistent or limited. Only 8% of speech-language pathologists and 11% of physiotherapists or lymphedema therapists rated their own competence as good or very good, with nearly nine in ten expressing a desire for further education.
Qualitative Findings on Care Gaps
Systematic text condensation of open-ended survey responses identified four interconnected themes explaining current care barriers: a general lack of awareness, the difficult-to-observe anatomical location of the swelling, insufficient methods and guidelines, and weak multidisciplinary collaboration. These factors often result in unclear responsibilities and delayed patient referrals. The study authors concluded that combining the distinct strengths of both professional groups—physiotherapists’ knowledge of lymphatic physiology and speech-language pathologists’ expertise in swallowing, voice, and upper-airway function—through shared routines and teamwork could help bridge the care gap.
Causes and symptoms of internal head and neck lymphedema
What causes internal head and neck lymphedema?
The condition develops when cancer treatments damage or obstruct lymphatic drainage, leading to fluid buildup in the oral cavity, pharynx, or larynx.
What are the primary symptoms?
Affected patients can experience impairments in swallowing, breathing, speech, voice, and overall quality of life.
Why do Swedish clinicians struggle to treat the condition?
According to the Lund University study, clinicians face a lack of consistent assessment routines, limited self-rated competence, sparse evidence-based guidelines, and weak multidisciplinary coordination.
What interventions do therapists currently use?
Physiotherapists and lymphedema therapists generally adapt external lymphedema techniques, including manual drainage, physical activity, and compression methods.
Related reading