Linda Elting receives research funds from Amgen and MGI and is an advisory board member for Endo and NPS Pharmaceuticals.
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
Version of Record online: 30 OCT 2008
Copyright © 2008 American Cancer Society
Volume 113, Issue 10, pages 2704–2713, 15 November 2008
How to Cite
Elting, L. S., Keefe, D. M., Sonis, S. T., Garden, A. S., Spijkervet, F. K. L., Barasch, A., Tishler, R. B., Canty, T. P., Kudrimoti, M. K., Vera-Llonch, M. and for the Burden of Illness Head and Neck Writing Committee (2008), Patient-reported measurements of oral mucositis in head and neck cancer patients treated with radiotherapy with or without chemotherapy . Cancer, 113: 2704–2713. doi: 10.1002/cncr.23898
Andy Trotti has received consulting fees from Amgen.
Presented in part at the 43rd Annual Meeting of the American Society of Clinical Oncology, Chicago, Illinois, June 1-5, 2007 and at the 49th Annual Meeting of the American Society for Therapeutic Radiology Oncology, Los Angeles, California, October 28-November 1, 2007.
Members of the BOI Head and Neck Writing Committee include A. Barasch, M. Brennan, G. Calais, T. Canty, L. S. Elting, J. Epstein, P. Feyer, A. Garden, S. M. Grunberg, D. M. Keefe, M. Kudrimoti, A. Molassiotis, G. Oster, J. E. Raber-Durlacher, C. Schultz, S. T. Sonis, F. Spijkervet, R. Tishler, A. Trotti, M. Vera-Llonch
The principal investigators and institutions who participated in the study are as follows: D. Brachman and T. Canty, Arizona Oncology Services Foundation; T. Meiller, University of Maryland; P. Harari and C. Schultz, University of Wisconsin; B. Murphy, Vanderbilt-Ingram Cancer Center; D. Peterson, University of Connecticut; P. Silberstein, Creighton University Medical Center; T. Bolek, Tallahassee Memorial Hospital; P. Jacquin, Cookeville Regional Medical Center; P. Randolph, Washington Cancer Institute; J. Rothman, Regional Cancer Center of Erie Pennsylvania; S. Katz, Willis-Knighton Cancer Center; A. Barsevick, Fox Chase Cancer Center; V. Alberola, Hospital Arnau of Vilanova of Valencia; L. Licitra, Tumor Institute of Milan; S. Selva-Nayagam, Royal Adelaide Hospital Cancer Center; A. Garden, M. D. Anderson Cancer Center, F. Spijkervet, University of Groningen; A. Barasch, University of Alabama Medical Center; R. Tishler, Harvard-Farber Cancer Center; M. Brennan, Carolinas Medical Center; A. Molassiotis, University of Manchester; M. Kudrimoti, University of Kentucky; G. Calais, Henry S. Kaplan Center; A. Trotti, Moffitt Cancer Center; P. Feyer, Vivantes Clinics Berlin, Neukolln, Germany; J. Epstein, University of Illinois at Chicago; S. M. Grunberg, University of Vermont; J. Raber-Durlacher; Leids University Medical Center, Amsterdam; B. Koczwara, Flinders Medical Center.
- Issue online: 3 NOV 2008
- Version of Record online: 30 OCT 2008
- Manuscript Accepted: 1 JUL 2008
- Manuscript Revised: 20 JUN 2008
- Manuscript Received: 4 APR 2008
- Amgen, Thousand Oaks, California
- radiation therapy;
- head and neck cancer;
- patient-reported outcomes;
- quality of life
The risk, severity, and patient-reported outcomes of radiation-induced mucositis among head and neck cancer patients were prospectively estimated.
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.
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.
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. Cancer 2008. © 2008 American Cancer Society.