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Symptoms Reported by Head and Neck Cancer Patients during Radiotherapy and Association with Mucosal Ulceration Site and Size: An Observational Study.

Gussgard AM, Jokstad A, Wood R, Hope AJ, Tenenbaum H - PLoS ONE (2015)

Bottom Line: ANOVA with pairwise contrasts using the LSD procedure was applied for comparisons of mean changes of PROMS scale values for the participants who experienced an OMAS score of 2 or more during therapy (n=24).Impairment of eating hard foods was more when the OMAS score for ulceration anywhere in the mouth or in the soft palate changed from 1 to 2, compared to between score 0 and 1 (p=.002 and p=.05) or between score 2 and 3 (p=.001 and p=.02).Mouth pain increased more upon transition of OMAS score anywhere in the mouth from 1 to 2 compared to 0 to 1 (p=.05).

View Article: PubMed Central - PubMed

Affiliation: Princess Margaret Cancer Centre, Toronto, Ontario, Canada.

ABSTRACT

Background: Self-reported pain and impairment of oral functions varies markedly and often in spite of extensive oral mucositis (OM). The aim of the current study was to appraise how patient-reported debilitation caused by OM is influenced by the extent and possibly location of the OM lesions.

Methods: Patients with head and neck cancer undergoing radiotherapy were examined before treatment, twice weekly during 6-7 weeks of therapy, and 3-4 weeks after therapy completion. OM signs of 33 participants were evaluated using the Oral Mucositis Assessment Scale (OMAS), while OM symptoms were recorded using Patient-Reported Oral Mucositis Symptom (PROMS)-questionnaires. Changes in OM experience as a function of OM signs was undertaken by comparing the aggregated and individual PROMS scale values at the point of transition of OMAS ulceration scores between 0 to 1, 1 to 2 and 2 to 3, respectively in the nine intra-oral locations designated in the OMAS. ANOVA with pairwise contrasts using the LSD procedure was applied for comparisons of mean changes of PROMS scale values for the participants who experienced an OMAS score of 2 or more during therapy (n=24).

Results: Impairment of eating hard foods was more when the OMAS score for ulceration anywhere in the mouth or in the soft palate changed from 1 to 2, compared to between score 0 and 1 (p=.002 and p=.05) or between score 2 and 3 (p=.001 and p=.02). Mouth pain increased more upon transition of OMAS score anywhere in the mouth from 1 to 2 compared to 0 to 1 (p=.05).

Conclusion: The relationship between patient-reported impairment of oral function and pain caused by OM ulceration is not linear, but rather curvilinear. Our findings should prompt investigators of future interventional trials to consider using a less severe outcome than maximum OM scores as the primary study outcome.

No MeSH data available.


Related in: MedlinePlus

Development of oral mucositis ulceration in the soft palate.In this participant, the first sign of ulceration developed during the 3rd week of radiotherapy on the uvula (upper centre picture). The size of the ulceration increased over the subsequent weeks 4 (upper right picture), 5 (bottom left picture) and 6 (bottom right picture). A common challenge in the clinic examination is that pain and impaired control of pharyngeal and extrinsic tongue muscles caused by the oral mucositis often counteracts a clear visual examination of the back of the mouth and throat.
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pone.0129001.g001: Development of oral mucositis ulceration in the soft palate.In this participant, the first sign of ulceration developed during the 3rd week of radiotherapy on the uvula (upper centre picture). The size of the ulceration increased over the subsequent weeks 4 (upper right picture), 5 (bottom left picture) and 6 (bottom right picture). A common challenge in the clinic examination is that pain and impaired control of pharyngeal and extrinsic tongue muscles caused by the oral mucositis often counteracts a clear visual examination of the back of the mouth and throat.

Mentions: The current investigator group recently appraised the merits of adopting a new patient-reported oral mucositis experience instrument named PROMS (Patient-Reported Oral Mucositis Symptom) [19] in a cohort of H&N cancer patients [20]. The main purpose of this observational study was to elucidate whether the OM that affected the study participants during the course of their radiotherapy correlated with signs of OM. The investigators undertook detailed intra-oral examinations that included clinical scoring of OM according to the Oral Mucositis Assessment Scale (OMAS) protocol [21] twice per week while the participants underwent radiotherapy (Fig 1). Upon applying Spearman rank correlation tests in repeated-measures mixed linear models between the PROMS scale values and three different clinician-based scores at various time points while the patients underwent radiotherapy it was apparent that the patient experiences of OM correlated well with the scoring tools on a group basis [20]. However an intriguing observation in the investigation was that some participants reported hardly any mouth pain, in spite of visual manifestation of large and often confluent areas of ulcerations of the intraoral mucosa, and vice versa. These observations led the current investigator team to explore how the participants’ self-reported mouth pain was associated with the intraoral location and extent of OM lesions. The working hypothesis was that the advent of patient-reported debilitation due to OM was influenced by the extent and possibly location of the OM lesions.


Symptoms Reported by Head and Neck Cancer Patients during Radiotherapy and Association with Mucosal Ulceration Site and Size: An Observational Study.

Gussgard AM, Jokstad A, Wood R, Hope AJ, Tenenbaum H - PLoS ONE (2015)

Development of oral mucositis ulceration in the soft palate.In this participant, the first sign of ulceration developed during the 3rd week of radiotherapy on the uvula (upper centre picture). The size of the ulceration increased over the subsequent weeks 4 (upper right picture), 5 (bottom left picture) and 6 (bottom right picture). A common challenge in the clinic examination is that pain and impaired control of pharyngeal and extrinsic tongue muscles caused by the oral mucositis often counteracts a clear visual examination of the back of the mouth and throat.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4465350&req=5

pone.0129001.g001: Development of oral mucositis ulceration in the soft palate.In this participant, the first sign of ulceration developed during the 3rd week of radiotherapy on the uvula (upper centre picture). The size of the ulceration increased over the subsequent weeks 4 (upper right picture), 5 (bottom left picture) and 6 (bottom right picture). A common challenge in the clinic examination is that pain and impaired control of pharyngeal and extrinsic tongue muscles caused by the oral mucositis often counteracts a clear visual examination of the back of the mouth and throat.
Mentions: The current investigator group recently appraised the merits of adopting a new patient-reported oral mucositis experience instrument named PROMS (Patient-Reported Oral Mucositis Symptom) [19] in a cohort of H&N cancer patients [20]. The main purpose of this observational study was to elucidate whether the OM that affected the study participants during the course of their radiotherapy correlated with signs of OM. The investigators undertook detailed intra-oral examinations that included clinical scoring of OM according to the Oral Mucositis Assessment Scale (OMAS) protocol [21] twice per week while the participants underwent radiotherapy (Fig 1). Upon applying Spearman rank correlation tests in repeated-measures mixed linear models between the PROMS scale values and three different clinician-based scores at various time points while the patients underwent radiotherapy it was apparent that the patient experiences of OM correlated well with the scoring tools on a group basis [20]. However an intriguing observation in the investigation was that some participants reported hardly any mouth pain, in spite of visual manifestation of large and often confluent areas of ulcerations of the intraoral mucosa, and vice versa. These observations led the current investigator team to explore how the participants’ self-reported mouth pain was associated with the intraoral location and extent of OM lesions. The working hypothesis was that the advent of patient-reported debilitation due to OM was influenced by the extent and possibly location of the OM lesions.

Bottom Line: ANOVA with pairwise contrasts using the LSD procedure was applied for comparisons of mean changes of PROMS scale values for the participants who experienced an OMAS score of 2 or more during therapy (n=24).Impairment of eating hard foods was more when the OMAS score for ulceration anywhere in the mouth or in the soft palate changed from 1 to 2, compared to between score 0 and 1 (p=.002 and p=.05) or between score 2 and 3 (p=.001 and p=.02).Mouth pain increased more upon transition of OMAS score anywhere in the mouth from 1 to 2 compared to 0 to 1 (p=.05).

View Article: PubMed Central - PubMed

Affiliation: Princess Margaret Cancer Centre, Toronto, Ontario, Canada.

ABSTRACT

Background: Self-reported pain and impairment of oral functions varies markedly and often in spite of extensive oral mucositis (OM). The aim of the current study was to appraise how patient-reported debilitation caused by OM is influenced by the extent and possibly location of the OM lesions.

Methods: Patients with head and neck cancer undergoing radiotherapy were examined before treatment, twice weekly during 6-7 weeks of therapy, and 3-4 weeks after therapy completion. OM signs of 33 participants were evaluated using the Oral Mucositis Assessment Scale (OMAS), while OM symptoms were recorded using Patient-Reported Oral Mucositis Symptom (PROMS)-questionnaires. Changes in OM experience as a function of OM signs was undertaken by comparing the aggregated and individual PROMS scale values at the point of transition of OMAS ulceration scores between 0 to 1, 1 to 2 and 2 to 3, respectively in the nine intra-oral locations designated in the OMAS. ANOVA with pairwise contrasts using the LSD procedure was applied for comparisons of mean changes of PROMS scale values for the participants who experienced an OMAS score of 2 or more during therapy (n=24).

Results: Impairment of eating hard foods was more when the OMAS score for ulceration anywhere in the mouth or in the soft palate changed from 1 to 2, compared to between score 0 and 1 (p=.002 and p=.05) or between score 2 and 3 (p=.001 and p=.02). Mouth pain increased more upon transition of OMAS score anywhere in the mouth from 1 to 2 compared to 0 to 1 (p=.05).

Conclusion: The relationship between patient-reported impairment of oral function and pain caused by OM ulceration is not linear, but rather curvilinear. Our findings should prompt investigators of future interventional trials to consider using a less severe outcome than maximum OM scores as the primary study outcome.

No MeSH data available.


Related in: MedlinePlus