title: Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head-and-neck malignancies.
abstract: OBJECTIVE
  To study the risk, outcomes, and costs of radiation-induced oral mucositis (OM) among patients receiving radiotherapy (RT) to head and neck primary cancers.
  
  
  METHODS
  A retrospective cohort consisting of 204 consecutive head-and-neck cancer patients who received RT with or without chemotherapy during 2002 was formed; their records were reviewed for clinical and resource use information. Patients who had received prior therapy, had second primary cancers, or received palliative radiation therapy were excluded. The risk of OM was analyzed by multiple variable logistic regression. The cost of care was computed from the provider's perspective in 2006 U.S. dollars and compared among patients with and without OM.
  
  
  RESULTS
  Oral mucositis occurred in 91% of patients; in 66% it was severe (Grade 3-4). Oral mucositis was more common among patients with oral cavity or oropharynx primaries (odds ratio [OR], 44.5; 95% confidence interval [CI], 5.2 to >100; p < 0.001), those who received chemotherapy (OR = 7.8; 95% CI, 1.5-41.6; p = 0.02), and those who were treated with altered fractionation schedules (OR = 6.3; 95% CI, 1.1-35.1; p = 0.03). Patients with OM were significantly more likely to have severe pain (54% vs. 6%; p < 0.001) and a weight loss of > or =5% (60% vs. 17%; p < 0.001). Oral mucositis was associated with an incremental cost of $1700-$6000, depending on the grade.
  
  
  CONCLUSIONS
  Head-and-neck RT causes OM in virtually all patients. Oral mucositis is associated with severe pain, significant weight loss, increased resource use, and excess cost. Preventive strategies are needed.
authors.affiliation: Section of Health Services Research, Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. lelting@mdanderson.org
authors.forename: Linda S
authors.initials: LS
authors.lastname: Elting
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Cooksley
authors.forename: Mark S
authors.initials: MS
authors.lastname: Chambers
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000009:adverse effects; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D004435:Eating; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000191:economics / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D013280:Stomatitis / Q000191:economics / Q000209:etiology / Q000628:therapy
chemical_list: D000970:Antineoplastic Agents