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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

Oral mucositis ulceration score and PROMS scale VAS values recorded on the last radiotherapy session of the 7 weeks cancer therapy period.The horizontal axis shows the observed number of intra-oral sites with ulceration (max = 9). The vertical axis indicates the accumulated OMAS score of the ulcerations (max = 27). The boxes show the individual participants’ PROMS scale VAS values for: Pain—Difficulty eating hard food—Aggregated PROMS average. Higher VAS-values denote more impairment of oral functions (max VAS = 100).
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pone.0129001.g005: Oral mucositis ulceration score and PROMS scale VAS values recorded on the last radiotherapy session of the 7 weeks cancer therapy period.The horizontal axis shows the observed number of intra-oral sites with ulceration (max = 9). The vertical axis indicates the accumulated OMAS score of the ulcerations (max = 27). The boxes show the individual participants’ PROMS scale VAS values for: Pain—Difficulty eating hard food—Aggregated PROMS average. Higher VAS-values denote more impairment of oral functions (max VAS = 100).

Mentions: The majority of participants experienced visually manifest ulceration in two to four sites (Fig 5). One participant had OMAS score 3, i.e., more than 3 cm2 in one site, while two participants suffered from OM in all 9 intra-oral sites and of these two, one had the maximum OMAS score of 3 in all nine sites (i.e., OMAS score 27, Fig 5). Both reported relatively medium mouth pain and average PROMS scale values (VAS 37–55), but severe (VAS = 100) impairment of eating hard foods.


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)

Oral mucositis ulceration score and PROMS scale VAS values recorded on the last radiotherapy session of the 7 weeks cancer therapy period.The horizontal axis shows the observed number of intra-oral sites with ulceration (max = 9). The vertical axis indicates the accumulated OMAS score of the ulcerations (max = 27). The boxes show the individual participants’ PROMS scale VAS values for: Pain—Difficulty eating hard food—Aggregated PROMS average. Higher VAS-values denote more impairment of oral functions (max VAS = 100).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0129001.g005: Oral mucositis ulceration score and PROMS scale VAS values recorded on the last radiotherapy session of the 7 weeks cancer therapy period.The horizontal axis shows the observed number of intra-oral sites with ulceration (max = 9). The vertical axis indicates the accumulated OMAS score of the ulcerations (max = 27). The boxes show the individual participants’ PROMS scale VAS values for: Pain—Difficulty eating hard food—Aggregated PROMS average. Higher VAS-values denote more impairment of oral functions (max VAS = 100).
Mentions: The majority of participants experienced visually manifest ulceration in two to four sites (Fig 5). One participant had OMAS score 3, i.e., more than 3 cm2 in one site, while two participants suffered from OM in all 9 intra-oral sites and of these two, one had the maximum OMAS score of 3 in all nine sites (i.e., OMAS score 27, Fig 5). Both reported relatively medium mouth pain and average PROMS scale values (VAS 37–55), but severe (VAS = 100) impairment of eating hard foods.

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