Impact of Different Types of Oral Care on Oral Mucositis and Quality of Life for Head and Neck Cancer Patients During Radiotherapy

2.50
Hdl Handle:
http://hdl.handle.net/10755/335283
Category:
Full-text
Type:
Presentation
Title:
Impact of Different Types of Oral Care on Oral Mucositis and Quality of Life for Head and Neck Cancer Patients During Radiotherapy
Author(s):
Huang, Yi-Ying; Liu, Hsueh-Erh; Chi, Kwan-Hwa; Hao, Sheng-Po; Tsay, Pei Kwei
Lead Author STTI Affiliation:
Non-member
Author Details:
Yi-Ying Huang, MS, yiying0123@hotmail.com; Hsueh-Erh Liu, PhD, RN; Kwan-Hwa Chi, MD; Sheng-Po Hao, MD; Pei Kwei Tsay, PhD
Abstract:
Session presented on Saturday, July 26, 2014: Aim: The purpose of this longitudinal study was to examine the impact of different types of oral care on grades of radiation-induced oral mucositis, body weight, and quality of life for the head and neck cancer patients during radiotherapy. Introduction: Oral cavity is the major location that exhibits the toxic effects of radiotherapy and chemotherapy for head and neck cancer patients. Oral mucositis is one of the most common complications among these patients. Severe oral mucositis can lead to secondary complications (ie. loss of body weight) and delay the planned treatment protocols. Literature shows that oral care or used honey as agent can reduce the incidence of oral mucositis. What will happen if we combine these two strategies as a protocol for oral care? Therefore, we conducted this clinical trial to find the impact of combination. Patients and methods: Patients were recruited from a medical center, Taiwan. During May 2012 and August 2013, a total of 97 head and neck cancer patients undergoing radiotherapy were contacted and 94 subjects completed the whole study protocol. The reasons of drop out were: side-effect (1), too afraid of treatment(1), and move to other hospital(1). Informed consent was obtained before the study started. Inclusion and exclusion criteria: Those who diagnosed with head and neck cancer, plan to receive radiotherapy with least doses of 6000cGy as part of their treatment protocol, and older than 20 years were recruited. Those who have been diagnosed as DM with HbA1C > 7% within 3 months, Karnofsky Performance Scale < 60, or suffering from grade 4 oral mucositis were all excluded. Study design: They were randomly stratified into three groups, where group 1 received honey mouthwash, instruction of oral care, and routine care; group 2 received instruction of oral care and routine care; and group 3 as control group, received routine care only. The honey mouthwash was to swish 20 cc nature and undiluted honey in mouth for 2 minutes and then swallowed it prior to RT, at 15 minutes and 6 hours after RT respectively. Prior to radiotherapy, all patients completed Chinese version of EORTC QLQ-C30 and EORTC QLQ-H&N35. An evaluation of their oral mucosa was conducted at the same time by a single researcher. These questionnaires also need to be completed while the cumulative RT dose at 40Gy and at the end of RT course. Their oral mucosa was evaluated when the RT doses were cumulated up to 10, 20, 30, 40, 50, 60 Gy and at the end of RT course respectively. Their body weight was measured at the beginning of the study and weekly during the period of treatment. Statistical analysis: Data were analyzed by the Statistical package for the Social Sciences 18 (SPSS) program. Descriptive (mean, SD, %) and inferential statistics (chi-square, Survival Analysis, One way ANOVA, Generalized Estimating Equation) were performed. Results: The results showed that these three groups were homogeneous in their demographic variables and disease-related variables prior to radiotherapy. Mucositis (Primary Outcome): The first onset of grade 1 mucositis was significantly different among these three groups by Log-Rank test survival analysis (F= 8.29, p<.001) whereas the results of Post Hoc Bonferroni analysis showed that the first onset of grade 1 mucositis in control group was significant quicker than group 1 and 2. Mean value of the first onset of these 3 groups were: 11th day (group?, SD= 4.20, range= 6~26 day); 10th day (group?, SD= 4.47, range= 4~30 day); and 9th day (control group, SD= 2.63, range= 4~14 day) respectively. In regard to the ratio for occurrence of oral mucositis at each point of assessment, group?and?had a trend of lower ratio than the control group at the 3rd, 4th, and 6th assessment. None of the patients developed grade 4 mucositis. However, when the dose of RT cumulated > 40 Gy, the ratio of grade 3 mucositis was significant lower in group 1 and 2 when compared with control group (X2 = 19.06~40.98, p<.001). Body Weight(Secondary Outcome): The comparisons of weekly changes in body weight showed that group 1 and 2 had less changes than the control group (X2= 15.88~.9.00, p<.001). The range of changes in body weight were 0.95 to -2.52 kg (group?), 0.75 ~ -1.81 kg (group?), and -0.81 ~ -4.77 kg (control group) respectively. Quality of Life (Secondary Outcome): The study found that, for all patients, the overall quality of life were significantly decreased along with the cumulated doses of radiation (Wald X2= 44.99, p <.001). After adjusting the group, time and interaction effects, the results of GEE for EORTC QOL-C30 and EORTC QOL-H&N35 found that, at RT 40 Gy, the symptom scales of "appetite(Wald X2= 5.47, p=0.02)" and "sociability eating(Wald X2= 4.74, p=0.03)" were significantly less problems in group 1 when compared with control group. At the end of RT, the functional scales of "physical functioning(Wald X2= 7.23, p=0.01; Wald X2= 4.43, p=0.04)" in group 1 and group 2 were significantly better than the control group. In addition, the functional scales of "role functioning(Wald X2= 4.28, p=0.04)" in group?was significantly better and the symptom scales of "appetite(Wald X2= 6.38, p=0.01)", "speech problems(Wald X2= 7.13, p=0.01)", "sociability eating(Wald X2= 4.28, p=0.04)", and "social contact(Wald X2= 5.68, p=0.02)" were significantly less problems than the control group. Conclusion: This study showed that, when compared with the control group, patients in both experimental group reported less occurrence and late onset of first mucositis, less severe oral mucositis, less weekly body changes, and even better quality of life during research period. Therefore, the application of honey mouthwash plus instruction of oral care or instruction of oral care alone were strongly suggested in clinical practice.
Keywords:
quality of life; types of oral care; radiation-induced mucositis
Repository Posting Date:
17-Nov-2014
Date of Publication:
17-Nov-2014 ; 17-Nov-2014
Other Identifiers:
INRC14PST116
Conference Date:
2014
Conference Name:
25th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International, the Honor Society of Nursing
Conference Location:
Hong Kong
Description:
International Nursing Research Congress, 2014 Theme: Engaging Colleagues: Improving Global Health Outcomes. Held at the Hong Kong Convention and Exhibition Centre, Wanchai, Hong Kong

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.language.isoenen
dc.type.categoryFull-texten
dc.typePresentationen
dc.titleImpact of Different Types of Oral Care on Oral Mucositis and Quality of Life for Head and Neck Cancer Patients During Radiotherapyen
dc.contributor.authorHuang, Yi-Yingen
dc.contributor.authorLiu, Hsueh-Erhen
dc.contributor.authorChi, Kwan-Hwaen
dc.contributor.authorHao, Sheng-Poen
dc.contributor.authorTsay, Pei Kweien
dc.contributor.departmentNon-memberen
dc.author.detailsYi-Ying Huang, MS, yiying0123@hotmail.com; Hsueh-Erh Liu, PhD, RN; Kwan-Hwa Chi, MD; Sheng-Po Hao, MD; Pei Kwei Tsay, PhDen
dc.identifier.urihttp://hdl.handle.net/10755/335283-
dc.description.abstractSession presented on Saturday, July 26, 2014: Aim: The purpose of this longitudinal study was to examine the impact of different types of oral care on grades of radiation-induced oral mucositis, body weight, and quality of life for the head and neck cancer patients during radiotherapy. Introduction: Oral cavity is the major location that exhibits the toxic effects of radiotherapy and chemotherapy for head and neck cancer patients. Oral mucositis is one of the most common complications among these patients. Severe oral mucositis can lead to secondary complications (ie. loss of body weight) and delay the planned treatment protocols. Literature shows that oral care or used honey as agent can reduce the incidence of oral mucositis. What will happen if we combine these two strategies as a protocol for oral care? Therefore, we conducted this clinical trial to find the impact of combination. Patients and methods: Patients were recruited from a medical center, Taiwan. During May 2012 and August 2013, a total of 97 head and neck cancer patients undergoing radiotherapy were contacted and 94 subjects completed the whole study protocol. The reasons of drop out were: side-effect (1), too afraid of treatment(1), and move to other hospital(1). Informed consent was obtained before the study started. Inclusion and exclusion criteria: Those who diagnosed with head and neck cancer, plan to receive radiotherapy with least doses of 6000cGy as part of their treatment protocol, and older than 20 years were recruited. Those who have been diagnosed as DM with HbA1C > 7% within 3 months, Karnofsky Performance Scale < 60, or suffering from grade 4 oral mucositis were all excluded. Study design: They were randomly stratified into three groups, where group 1 received honey mouthwash, instruction of oral care, and routine care; group 2 received instruction of oral care and routine care; and group 3 as control group, received routine care only. The honey mouthwash was to swish 20 cc nature and undiluted honey in mouth for 2 minutes and then swallowed it prior to RT, at 15 minutes and 6 hours after RT respectively. Prior to radiotherapy, all patients completed Chinese version of EORTC QLQ-C30 and EORTC QLQ-H&N35. An evaluation of their oral mucosa was conducted at the same time by a single researcher. These questionnaires also need to be completed while the cumulative RT dose at 40Gy and at the end of RT course. Their oral mucosa was evaluated when the RT doses were cumulated up to 10, 20, 30, 40, 50, 60 Gy and at the end of RT course respectively. Their body weight was measured at the beginning of the study and weekly during the period of treatment. Statistical analysis: Data were analyzed by the Statistical package for the Social Sciences 18 (SPSS) program. Descriptive (mean, SD, %) and inferential statistics (chi-square, Survival Analysis, One way ANOVA, Generalized Estimating Equation) were performed. Results: The results showed that these three groups were homogeneous in their demographic variables and disease-related variables prior to radiotherapy. Mucositis (Primary Outcome): The first onset of grade 1 mucositis was significantly different among these three groups by Log-Rank test survival analysis (F= 8.29, p<.001) whereas the results of Post Hoc Bonferroni analysis showed that the first onset of grade 1 mucositis in control group was significant quicker than group 1 and 2. Mean value of the first onset of these 3 groups were: 11th day (group?, SD= 4.20, range= 6~26 day); 10th day (group?, SD= 4.47, range= 4~30 day); and 9th day (control group, SD= 2.63, range= 4~14 day) respectively. In regard to the ratio for occurrence of oral mucositis at each point of assessment, group?and?had a trend of lower ratio than the control group at the 3rd, 4th, and 6th assessment. None of the patients developed grade 4 mucositis. However, when the dose of RT cumulated > 40 Gy, the ratio of grade 3 mucositis was significant lower in group 1 and 2 when compared with control group (X2 = 19.06~40.98, p<.001). Body Weight(Secondary Outcome): The comparisons of weekly changes in body weight showed that group 1 and 2 had less changes than the control group (X2= 15.88~.9.00, p<.001). The range of changes in body weight were 0.95 to -2.52 kg (group?), 0.75 ~ -1.81 kg (group?), and -0.81 ~ -4.77 kg (control group) respectively. Quality of Life (Secondary Outcome): The study found that, for all patients, the overall quality of life were significantly decreased along with the cumulated doses of radiation (Wald X2= 44.99, p <.001). After adjusting the group, time and interaction effects, the results of GEE for EORTC QOL-C30 and EORTC QOL-H&N35 found that, at RT 40 Gy, the symptom scales of "appetite(Wald X2= 5.47, p=0.02)" and "sociability eating(Wald X2= 4.74, p=0.03)" were significantly less problems in group 1 when compared with control group. At the end of RT, the functional scales of "physical functioning(Wald X2= 7.23, p=0.01; Wald X2= 4.43, p=0.04)" in group 1 and group 2 were significantly better than the control group. In addition, the functional scales of "role functioning(Wald X2= 4.28, p=0.04)" in group?was significantly better and the symptom scales of "appetite(Wald X2= 6.38, p=0.01)", "speech problems(Wald X2= 7.13, p=0.01)", "sociability eating(Wald X2= 4.28, p=0.04)", and "social contact(Wald X2= 5.68, p=0.02)" were significantly less problems than the control group. Conclusion: This study showed that, when compared with the control group, patients in both experimental group reported less occurrence and late onset of first mucositis, less severe oral mucositis, less weekly body changes, and even better quality of life during research period. Therefore, the application of honey mouthwash plus instruction of oral care or instruction of oral care alone were strongly suggested in clinical practice.en
dc.subjectquality of lifeen
dc.subjecttypes of oral careen
dc.subjectradiation-induced mucositisen
dc.date.available2014-11-17T13:48:47Z-
dc.date.issued2014-11-17-
dc.date.issued2014-11-17en
dc.date.accessioned2014-11-17T13:48:47Z-
dc.conference.date2014en
dc.conference.name25th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau International, the Honor Society of Nursingen
dc.conference.locationHong Kongen
dc.descriptionInternational Nursing Research Congress, 2014 Theme: Engaging Colleagues: Improving Global Health Outcomes. Held at the Hong Kong Convention and Exhibition Centre, Wanchai, Hong Kongen
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.