572 - Ablative Fractional Laser Scar Treatment as Part of a Multidisciplinary Approach to Improve Functional Outcomes in Patients with Head and Neck Cancer

Objectives: Head and neck cancer (HNC) patients often experience long-term sequelae from their cancer treatment, including scars, fibrosis, and lymphedema. We sought to assess the efficacy of rehabilitative occupational therapy (OT) in combination with ablative fractional laser (AFL) treatment to improve patient functional outcomes, with a specific focus on increasing neck active range of motion (AROM).

Design: We conducted a retrospective, facility-approved quality improvement project of HNC patients treated with AFL and OT between January 2022 and May 2023. OT measured neck AROM serially by goniometry, including immediately pre- and post- AFL when feasible.

Results: Seven HNC patients received at least one AFL treatment for scarring/fibrosis (5), radiodermatitis (4), and/or lymphedema (6). Topical triamcinolone was applied post-laser to 5 patients for assisted drug delivery, and all patients received multiple OT sessions to assist with functional outcomes. Following the first AFL treatment, aggregate neck AROM improved by a mean of 29 degrees (20%), with two of three subsequent AFL treatments yielding further improvement. Three of four patients who continued participating in OT after AFL saw a further increase in AROM; all four final AROM measurements were higher compared to initial evaluation. The only noted side effect of AFL was temporary erythema. An eighth patient attempted AFL treatment but had intolerable pain, including after local anesthesia. Over the course of OT therapy, patients were observed to have improvements in one or more of the following: pain level, lymphedema, tightness, flexibility, sleep, activity tolerance, and/or self-image, among others.

Conclusions: Our quality improvement project suggests that AFL provides an immediate increase in AROM in HNC patients, with some sustained response that is best maintained with OT. In our experience, optimization of a multidisciplinary treatment plan facilitates patient functional status improvement, and our use of AFL followed by continued OT is supported.