Self Reported Oral Pain and Dysfunctions Associated with Radiation Induced Oral Mucositis among Head and Neck Cancer Patients: A Prospective Observational Study
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Objectives: This study aimed at identifying and describing self reported oral pain and dysfunctions associated with oral mucositis among patients with head and neck cancer treated with radiation . Method: A prospective observational study was conducted on 30 head and neck cancer patients who were undergoing radiation therapy and consented to participate. Data was collected by using a baseline proforma, WHO Oral Toxicity scale and Patient reported oral mucositis symptom scale .The patients were followed up during the entire course of radiation therapy and were monitored for the development of oral mucositis and were asked to rate their pain and associated dysfunctions on 100 mm scale. Result: The present study findings revealed that all the subjects developed oral mucositis at the end of third week which was progressed to grade 3 or 4 mucositis by the end of therapy. The scores of oral pain and oral dysfunctions were progressively increased during the course of treatment with its peak at the end of treatment. Cumulative dose of radiation therapy and receipt of concurrent chemotherapy were found to have a significant association with oral dysfunction. The study also noted a significant positive correlation with severity of mucositis and oral dysfunctions. Conclusion: Severe and painful oral mucositis is a dose limiting adverse effect of radiation therapy and its detrimental effect on oral functions is significant .Hence adequate preventive measures of mucositis to be identified to enhance the quality of life of head and neck cancer patients receiving radiation therapy.Keywords:
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Background: Oral mucositis is a major problem affecting all head and neck cancer (HNC) patients received radiotherapy. Till now, available treatment is just symptomatic with limited effects. Preventive strategies may be better to avoid this complication. Animal models studies have illustrated that anti-cancer treatment toxicity display prominent daily variations; therefore, undesirable side effects could be significantly reduced by administration of radiotherapy at specific times when they are better tolerated.
Aim: To compare “soreness quality score” (SQS) between 2 groups of head and neck cancer patients received radiotherapy at different daily time.
Methods: 2 groups of head neck cancer patients treated at Mansoura university hospital; each group included 80 cases. Group A received radiotherapy at early morning between 6 and 8 am, while Group B received radiotherapy in the afternoon between 1 and 3 pm. Oral mucositis survey was self-reported weekly during and at the end of treatment by using “soreness quality score” (SQS).
Results: For group A, mild mucositis (score 1 and 2) was recorded in 53 cases (66%) and severe mucositis was recorded in 27 cases (34%). For group B, mild mucositis was recorded in 29 cases (36%) and severe mucositis was recorded in 51 cases (64%). There was statistically significant difference (0.003) between both groups as regards development of severe oral mucositis.
Conclusion: Better toxicity profile as regards oral mucositis could be obtained by giving radiotherapy for (HNC) patients at early morning compared to late afternoon. Further studies are worthwhile to confirm our findings.
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Abstract Background: Oral mucositis is a very painful and debilitating complication of radiotherapy, occurring in nearly all head and neck cancer patients. It can severely affect quality of life and lead to treatment interruptions that subsequently impact clinical outcomes. With limited treatment options, there is an urgent need to develop new strategies for mucositis prevention. Animal studies have shown that sensitivity to genotoxic stress strongly depends on the time of a day therapy is administered. Therefore, radiotherapy could be conducted at optimal times of a day associated with best tolerability, to reduce mucosal damage. This hypothesis is partially supported by two clinical trials that reported less severe oral mucositis in head and neck cancer patients treated in the morning vs. late afternoon; but results were not significant and times of a day not fully covered. Methods: This study examined the associations between timing of radiotherapy and development of oral mucositis in 219 head neck cancer patients treated at Roswell Park Comprehensive Cancer Center, using data from Electronic Medical Records. Patients’ treatment time was consistent throughout a 6/7-week course, and mucositis survey was self-reported weekly during treatment, providing a unique resource for this study. The primary endpoint is “soreness quality score” (SQS), a five-level score “0-no, 1-a little, 2-moderate, 3-quite a lot, and 4-extreme” in assessing patients’ soreness severity for mouth and throat in the past 24 hours. We used a generalized linear model approach to assess the association between radiotherapy time and the maximum SQS (MSQS) reported during treatment, adjusting for age, smoking, treatment type, survey week and cancer site. Results: Multivariate analyses revealed treatment time to be significantly associated with MSQS (p-value=0.025), with lowest MSQS (lsmean=2.26, ste=0.18) seen for patients treated in the early morning (8:30-<9:30am). MSQS increased in patients treated at later times, peaking in the early afternoon (lsmean=2.92 (ste 0.21) and 2.84 (ste 0.18) for patients treated at 12:00-<13:30pm and 13:30-<15:00pm, respectively), then decreased for patients treated in late afternoon (lsmean=2.37, ste=0.25). Among patients treated between 8:30-<9:30am, 43.2% developed severe oral mucositis (SQS grade 3 or 4), compared to 69.2% among those treated between 13:30-<15:00pm. Conclusion: To our knowledge, this is the first study to find a significant variation of oral mucositis severity by treatment hour of radiotherapy; the variation shows an arc shape with the peak in the early afternoon. Our results suggest that identifying an optimal time of a day for radiotherapy may substantially prevent severe oral mucositis in head and neck cancer patients. Further studies are worthwhile to confirm our findings, and to find optimal treatment times for individual patients. Citation Format: Fangyi Gu, William D. Duncan, YingDong Feng, Austin Miller, Nicolas Schlecht, Alan Hutson, Anurag K. Singh. Association between timing of radiotherapy and severity of oral mucositis in head-neck cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4860.
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Oral mucositis is regarded as one of the major complications of radiation therapy especially in patients with head and neck cancer. The aim of this study was to evaluate the efficacy of glutamine in preventing or minimizing the development of mucositis of the oral cavity. Subjects and methods: Forty-six participants were randomly selected amongst those who were planned to receive radiation therapy for head and neck region cancers. They were randomly divided into two groups of 23 subjects, one group received glutamine and the second group received a placebo. Results: Glutamine had a statistically significant effect in reducing the occurrence and/or severity of oral mucositis in the treated patients compared to patients in the control group. Gender and age had no effect in the development or severity of oral mucositis in the studied patients. Conclusions: It can be concluded that glutamine can be used effectively to prevent or minimize oral mucositis amongst cancer patients who receive radiation therapy. Key wards: Oral mucositis, head and neck cancer, radiation therapy, glutamine. (J Bagh Coll Dentistry 2013; 25(4):56- 59).
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Oral mucositis is a frequent adverse event in patients receiving concurrent chemoradiotherapy for head and neck cancer. Although the management of oral mucositis is essential to improve treatment completion rates, no detailed studies on the time of oral mucositis appearance have been reported. We conducted a retrospective study on the timing of the appearance of oral mucositis induced by concurrent chemoradiotherapy with S-1 for head and neck cancer. A total of 11 patients with head and neck cancer who received concurrent chemoradiotherapy with S-1 were examined. All patients developed oral mucositis within 13.8 ± 5.6 days after the initiation of radiotherapy (20.4 ± 8.1 Gy). In addition, the effects of pain-associated symptoms caused by oral mucositis on the patients' nutritional status, including reduction in caloric intake (24.4% ± 31.1%), weight loss (5.2% ± 5.2%), and duration of a regular diet (24.5 ± 17.1 days), were observed and lasted until the completion of radiation therapy. The delineation of the timing of oral mucositis appearance has become a key motivator for the patients to perform oral care proactively to limit severity and serves as a necessary index for monitoring oral health and managing pain and nutrition.
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Objective To explore the effects of two different gargles on acute oral mucositis during radiotherapy in patients with head and neck cancer.Methods A total of 87 patients with head and neck cancer were randomly assigned to receive either self-made gargle(n=43) or chlorhexidine mouthwash(n=44) within 1 week from the beginning of radiotherapy until week 7(4~5 times per day,10 mL per time).The curative effect and oral mucosa injury were assessed according to the RTOG/EORTC acute radiation mucositis grading standard.Results Compared with chlorhexidine mouthwash group,the self-made gargle induced an increase in the efficiency and a decrease in the incidence of grade Ⅲ acute radiation mucositis(P0.05).Conclusion Oral mucositis is an inevitable complication of radiation therapy for head and neck cancer.The self-made gargle is simple,cheap and effective in prevention and treatment of radiotherapy-induced oral mucositis in patients with head and neck cancer.
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Aims: The present study was done to assess the effect of three alcohol-free mouthwashes on radiation-induced oral mucositis in patients with head and neck malignancies.Materials and Methods: Eighty patients with head and neck malignancies, scheduled to undergo curative radiotherapy, were randomly assigned to receive one of the three alcohol-free test mouthwashes (0.12% chlorhexidine, 1% povidone-iodine, or salt/soda) or a control. The patients were instructed to rinse with 10 ml of the mouthwash, twice a day, for a period of 6 weeks. Mucositis was assessed at baseline and at weekly intervals during radiation therapy, using the World Health Organization criteria for grading of mucositis. The baseline demography of the four groups was matched for age, sex, stage of cancer, and whether the patient had cancer of oral or extraoral regions. A post hoc test for repeated measures was used to find the difference of mean mucositis scores between the groups at various week intervals.Results: Among the 76 patients who completed the study, patients in the povidone-iodine group had significantly lower mucositis scores when compared to the control group from the first week of radiotherapy. Their scores were also significantly lower when compared to the salt/soda and chlorhexidine groups from the fourth and fifth week, respectively, after radiotherapy.Conclusions: This study demonstrates that use of alcohol-free povidone-iodine mouthwash can reduce the severity and delay the onset of oral mucositis due to antineoplastic radiotherapy.
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Oral mucositis during radiotherapy which is harmful to the patients with head and neck is suggested to be related to the oral hygiene and health. Therefore, we evaluated the oral health status in relation to the occurrence of mucositis among patients with head and neck cancer during radiotherapy.Tooth plaque index (PI), periodontal depth, and oral mucositis in 50 patients with head and neck cancer were examined by a dentist for 8 weeks after radiotherapy initiation. Cancer type and site were recorded based on the patients' medical records. In addition, we assessed oral health-related quality of life.The mean age of participants was 56.3 ± 11.6 years, with patients aged > 60 years comprising the largest proportion of the mucositis group. The median (range) of the PI index were 0 (0-3) and 1 (0-3) among participants with mucositis and those without, respectively, with no significant difference (P = 0.761). The median (range) of the total Oral Health Impact Profile score were 54 (42-58) and 41 (14-70) among participants without mucositis and those with mucositis, respectively (P = 0.037).This study showed that patients who developed mucositis during radiotherapy had lower oral health-related quality of life than those who did not. However, there was no difference in oral health status according to mucositis.
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Objective
To describe the characteristics of radiation induced mucositis in patients with head and neck cancer (HNC) during radiotherapy, and analyze the effect of radiation induced mucositis on diet patterns and weight change and the influencing factors for radiation induced mucositis.
Methods
Patients with HNC treated with radiotherapy in one cancer hospital were recruited. Data were collected before, during and at the end of the radiotherapy, which included radiation induced oral and pharyngeal mucositis, pain during eating, diet patterns and weight.
Results
Two hundred and two patients were completely investigated and 43.5% and 34.2% of the patients suffered from moderate to severe(≥grade 2) oral mucositis and pharyngeal mucositis, respectively during the radiotherapy. At the end of radiotherapy, 53.5% and 51.5% of the patients suffered from moderate to severe oral mucositis and pharyngeal mucositis (≥grade 2), respectively. Oral and pharyngeal mucositis were significantly correlated with pain during eating, diet patterns and weight(P<0.05). Tumor site was the main reason that affected the severity of mucositis(Wald χ2=26.033, 14.216; P<0.001).
Conclusion
Radiation induced mucositis was gradually aggravated with radiotherapy progress, which is closely related to pain during eating, change of diet patterns and weight loss. The severity of mucositis is related to the tumor site. Measures should be taken to strengthen the management of adverse reactions and nutritional status of patients.
Key words:
Head and Neck Cancer; Radiation Induced Mucositis; Pain; Diet Pattern; Weight
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Objectives This study evaluated the relationship between oral hygiene and health status and radiation-induced mucositis among patients with head and neck cancer over an 8-week period. Methods We recruited 40 patients with head and neck cancer scheduled to receive radiation therapy (RT), and 25 patients were included in the study. Before commencing RT, a dentist examined the patients for plaque, and determined the gingival index and pocket depth. A dental hygienist assessed the patients for radiation-induced mucositis once weekly, for 8 weeks, during RT. Results The mean patient age was 60.96 (±8.47) years, and 21 (87.5%) patients were male. Twenty patients (83.3%) had been diagnosed with squamous cell carcinoma. Patients with cancer located in the head region had more severe mucositis than those with cancer in the neck region, but this was not significant statistically (P=0.053). However, toothbrushing frequency, plaque, gingival index, and pocket depth were not related to radiation-induced mucositis. During RT, the severity of mucositis significantly worsened compared to that at baseline. Conclusions Mucositis severity worsened during RT, but this was not related to oral hygiene and health status among patients with head and neck cancer.
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