title: Changes and predictors of radiation-induced oral mucositis in patients with oral cavity cancer during active treatment.
abstract: OBJECTIVE
  Radiation-induced oral mucositis (OM) is the most debilitating side effect of radiation treatment in oral cavity cancer. The purpose of the study was to investigate change of prevalence of severe OM, OM-related symptoms, and predictors in oral cavity cancer patients during active treatment.
  
  
  METHODS
  Longitudinal study design with repeated measures was used. Patients with oral cavity cancer were recruited from a head and neck outpatient radiation department at a major medical center in Taiwan. Patients' OM-related symptoms were measured at three time points. Patients' oral mucosa was assessed at nine time points. Generalized estimating equations (GEE) were used to analyze the predictive factors of prevalence of severe OM and OM-related symptoms.
  
  
  RESULTS
  Patients reported highest prevalence of severe OM at T5 (5 weeks after beginning RT) and T6 (6 weeks after beginning radiation therapy, RT), with the combined chemotherapy and RT (CCRT) patients reporting a higher prevalence than those receiving RT alone. The peak of OM-related symptoms was at T8 (8 week after beginning RT), with primary symptoms of mouth pain, mouth dryness, eating difficulties, swallowing difficulties, and taste change. Patients with CCRT, a higher cumulative radiation dose, smoking, and lower body mass index (BMI) were at high risk to develop severe OM. OM-related symptoms were predicted by type of treatment, cumulative radiation dose, and smoking.
  
  
  CONCLUSIONS
  Patients with oral cavity cancer suffer from OM and OM-related symptoms during aggressive RT or CCRT. Patient-specific oral care and emotional support are needed to relieve distressful OM-related symptoms during active treatment.
authors.affiliation: Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Head and Neck Oncology Group, Chang Gung Medical Foundation, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan. Electronic address: shuching@gw.cgust.edu.tw.
authors.forename: Shu-Ching
authors.initials: SC
authors.lastname: Chen
authors.affiliation: School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Yeur-Hur
authors.initials: YH
authors.lastname: Lai
authors.affiliation: Department of Radiation Oncology, Chang Gung Medical Foundation, Chang Gung Memorial Hospital at LinKou and Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Head and Neck Oncology Group, Chang Gung Medical Foundation, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan.
authors.forename: Bing-Shen
authors.initials: BS
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, Chang Gung Medical Foundation, Chang Gung Memorial Hospital at LinKou and Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Head and Neck Oncology Group, Chang Gung Medical Foundation, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan.
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Lin
authors.affiliation: Department of Radiation Oncology, Chang Gung Medical Foundation, Chang Gung Memorial Hospital at LinKou and Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Head and Neck Oncology Group, Chang Gung Medical Foundation, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan.
authors.forename: Kang-Hsing
authors.initials: KH
authors.lastname: Fan
authors.affiliation: Department of Radiation Oncology, Chang Gung Medical Foundation, Chang Gung Memorial Hospital at LinKou and Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Head and Neck Oncology Group, Chang Gung Medical Foundation, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan.
authors.forename: Joseph Tung-Chien
authors.initials: JT
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000209:etiology*; D005260:Female; D005544:Forecasting; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000150:complications* / Q000532:radiotherapy*; D015995:Prevalence; D011832:Radiation Injuries / Q000209:etiology* / Q000523:psychology*; D013280:Stomatitis / Q000209:etiology* / Q000523:psychology*; D013624:Taiwan
keywords: Depression; Oral cavity cancer; Oral mucositis; Radiation; Symptom