title: Patient-reported measurements of oral mucositis in head and neck cancer patients treated with radiotherapy with or without chemotherapy: demonstration of increased frequency, severity, resistance to palliation, and impact on quality of life.
abstract: BACKGROUND
  The risk, severity, and patient-reported outcomes of radiation-induced mucositis among head and neck cancer patients were prospectively estimated.
  
  
  METHODS
  A validated, patient-reported questionnaire (OMDQ), the FACT quality of life (QOL), and the Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scales were used to measure mucositis (reported as mouth and throat soreness), daily functioning, and use of analgesics. Patients were studied before radiotherapy (RT), daily during RT, and for 4 weeks after RT.
  
  
  RESULTS
  Contrary to previous reports, the risk of mucositis was virtually identical in the 126 patients with oral cavity or oropharynx tumors (99% overall; 85% grade 3-4) compared with 65 patients with tumors of the larynx or hypopharynx (98% overall; 77% grade 3-4). The mean QOL score decreased significantly during RT, from 85.1 at baseline to 69.0 at Week 6, corresponding with the peak of mucositis severity. The mean functional status score decreased by 33% from 18.3 at baseline to 12.3 at Week 6. The impact of mucositis on QOL was proportional to its severity, although even a score of 1 or 2 (mild or moderate) was associated with a significant reduction in QOL (from 93.6 at baseline to 74.7 at Week 6). Despite increases in analgesic use from 34% at baseline to 80% at Week 6, mean mucositis scores exceeded 2.5 at Week 6.
  
  
  CONCLUSIONS
  Mucositis occurs among virtually all patients who are undergoing radiation treatment of head and neck cancers. The detrimental effects on QOL and functional status are significant, and opioid analgesia provides inadequate relief. Preventive rather than symptom palliation measures are needed.
authors.affiliation: Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. lelting@mdanderson.org
authors.forename: Linda S
authors.initials: LS
authors.lastname: Elting
authors.forename: Dorothy M
authors.initials: DM
authors.lastname: Keefe
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Sonis
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
authors.forename: F K L
authors.initials: FK
authors.lastname: Spijkervet
authors.forename: Andrei
authors.initials: A
authors.lastname: Barasch
authors.forename: Roy B
authors.initials: RB
authors.lastname: Tishler
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Canty
authors.forename: Mahesh K
authors.initials: MK
authors.lastname: Kudrimoti
authors.forename: Montserrat
authors.initials: M
authors.lastname: Vera-Llonch
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017281:Cost of Illness; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects*; D013280:Stomatitis / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid; D000970:Antineoplastic Agents