Relationship of Oral Hygiene and Oral Mucositis with Concurrent Chemo-Radiotherapy in Head and Neck Cancers

Main Article Content

Sana Shafique
Hajra Siddique
Rida Gul Rahim
Husna Maab Haroon

Abstract

Background: Oral mucositis is a common and debilitating side effect of concurrent chemoradiotherapy for head and neck cancers, significantly affecting patient quality of life and treatment continuity. Previous studies have highlighted the potential role of oral hygiene in mitigating the severity of mucositis, yet standardized care protocols remain underexplored.


Objective: To investigate the relationship between oral hygiene and the incidence and severity of oral mucositis in patients undergoing concurrent chemoradiotherapy for head and neck cancers.


Methods: A prospective observational study was conducted over six months at the Oncology Department of Combined Military Hospital, Rawalpindi, with a sample size of 100 patients. Patients aged 18-70 years with histopathologically confirmed head and neck cancers and an ECOG performance status of 2 or less were included. Oral hygiene was assessed using a standardized scale, and mucositis was graded post-therapy using the CTCAE version 5.0 criteria. Data were analyzed using SPSS version 25 with Chi-square tests and ordinal logistic regression.


Results: The study found that 44% of patients with poor oral hygiene developed moderate to severe mucositis (grades 2 and 3), compared to 24% with grade 2 and 5% with grade 3 mucositis in the good oral hygiene group. The difference in mucositis severity between the two groups was statistically significant (P < 0.01).


Conclusion: The maintenance of good oral hygiene is significantly associated with a lower severity of mucositis in patients receiving concurrent chemoradiotherapy for head and neck cancers. This association suggests that standardized oral care protocols should be an integral part of cancer treatment to improve patient outcomes.

Article Details

How to Cite
Shafique, S., Siddique, H., Rahim, R. G., & Haroon, H. M. (2024). Relationship of Oral Hygiene and Oral Mucositis with Concurrent Chemo-Radiotherapy in Head and Neck Cancers. Journal of Health and Rehabilitation Research, 4(1), 1209–1213. https://doi.org/10.61919/jhrr.v4i1.624
Section
Articles
Author Biographies

Sana Shafique, Combined Military Hospital (CMH) Rawalpindi Pakistan.

MBBS Resident FCPS Radiation Oncology, Combined Military Hospital (CMH), Rawalpindi, Pakistan.

Hajra Siddique, Armed Forces Institute of Dentistry (AFID) Rawalpindi Pakistan.

BDS, Dental Officer, Armed Forces Institute of Dentistry (AFID), Rawalpindi, Pakistan.

Rida Gul Rahim, School of Dentistry Islamabad Pakistan.

BDS, Medical Officer, School of Dentistry, Islamabad, Pakistan.

Husna Maab Haroon, Armed Forces Institute of Dentistry (AFID) Rawalpindi Pakistan.

BDS, RDS, Dental Surgeon, Armed Forces Institute of Dentistry (AFID), Rawalpindi, Pakistan.

References

Das SM, Roy N, Singh D, Sardar PK, Das S. A Comparative Prospective Study Between Conventional Chemo-Radiotherapy and Pure Accelerated Radiotherapy With Concurrent Chemotherapy for the Treatment of Locally Advanced Head and Neck Cancer. Cureus. 2023;15(7).

Bottaro, Larsen B, Madhur. 基因的改变NIH Public Access. Bone. 2008;23(1):1–7.

Parmar A, Macluskey M, N MG, Di C, Am G, Je C, et al. cancer : chemotherapy ( Review ). 2021;

Maria OM, Eliopoulos N, Muanza T. Radiation-Induced Oral Mucositis. Front Oncol. 2017;7(MAY).

Pandya JA, Srikant N, Boaz K, Manaktala N, Kapila SN, Yinti SR. Post-radiation changes in oral tissues - An analysis of cancer irradiation cases. South Asian J Cancer. 2014;3(3):159–62.

Bonomi M, Batt K. Supportive management of mucositis and metabolic derangements in head and neck cancer patients. Cancers (Basel). 2015;7(3):1743–57.

Saedi HS, Gerami H, Soltanipour S, Habibi AF, Mirhosseyni M, Montazeri S, et al. Frequency of chemoradiotherapy-induced mucositis and related risk factors in patients with the head-and-neck cancers: A survey in the North of Iran. Dent Res J (Isfahan). 2019;16(5):354–9.

Ito H, Itasaka S, Sakanaka K, Araki N, Mizowaki T, Hiraoka M. Long-term complications of definitive chemoradiotherapy for esophageal cancer using the classical method. J Radiat Res. 2017;58(1):106–13.

Lalla R V., Sonis ST, Peterson DE. Management of Oral Mucositis in Patients Who Have Cancer. Dent Clin North Am. 2008;52(1):61–77.

Gamal A, Abd El Mabood S, Shalan H, Mansour A. Extended oral care can prevent oral mucositis in immunocompromised acute lymphoblastic leukemia ghildren. Int J Cancer Biomed Res. 2022;6(1):11–7.

Evaristo L, Volpato R, Cruvinel Silva T, Oliveira TM, Sakai VT, Andrade MA, et al. Radiation therapy and chemotherapy-induced oral mucositis Summary [Internet]. Vol. 73, BRAZILIAN JOURNAL OF OTORHINOLARYNGOLOGY. Available from: http://www.rborl.org.br/Telephone:

Pai R, Ongole R, Banerjee S, Prasad K, George L, George A, et al. Oral Care Protocol for Chemotherapy- and Radiation Therapy-Induced Oral Complications in Cancer Patients: Study Protocol. Asia-Pacific J Oncol Nurs. 2019 Oct 1;6(4):417–23.

The Oral Management of Oncology Patients Requiring Radiotherapy, Chemotherapy and / or Bone Marrow Transplantation Clinical Guidelines. 2018.

Jayeeta Burman, Aparajita Dasgupta, Rajarshi Banerjee, Sembagamuthu Sembiah, Lina Bandyopadhyay BP. A Study on Oral Hygiene among Students of a Secondary School in Harinavi, South 24 Parganas, West Bengal. 2023;(July):19–21.

Arora C, Sharma N, Kapoor A, Pandya TN. A comparative study of the treatment outcome of moderately accelerated radiation fractionation (with concurrent chemotherapy in daily dosing) to conventional chemo-radiotherapy in locally advanced head and neck cancers: Supportive in a resource constrained environment. Indian Journal of Cancer. 2023:10.4103.

Costa IB, Tomazelli KB, Grando LJ, Simões A, Melo Júnior JTd, Mituuti CT. Management of hypopharyngeal mucositis in patients undergoing chemoradiotherapy in the head and neck region and its impact on swallowing: an integrative literature review. Audiology-Communication Research. 2023;28:e2793.

Kayikci EE, Yildirim D, Kocatepe V, Can G. The Effect of Coffee in the Prevention of Oral Mucositis Associated with Head and Neck Radiotherapy. Florence Nightingale Journal of Nursing. 2023;31(2):105.

Liu M, An R, Wu Z, Dai L, Zeng Q, Chen W. The Trajectory of Oral Mucositis in Head and Neck Cancer Patients Undergoing Radiotherapy and its Influencing Factors. Ear, Nose & Throat Journal. 2024:01455613241228211.

Namuangchan Y, Chailertwanich O, Susinsamphan S, Supakalin N, Supaadirek C, Krusun S, et al. Prophylaxis of oral mucositis with iodine solution during concurrent Chemoradiation of head and neck cancer: preliminary results of a double-blind, randomized controlled trial. Asian Pacific Journal of Cancer Prevention: APJCP. 2023;24(7):2445.

Nicol AJ, Ching JC, Tam VC, Liu KC, Leung VW, Cai J, et al. Predictive Factors for Chemoradiation-Induced Oral Mucositis and Dysphagia in Head and Neck Cancer: A Scoping Review. Cancers. 2023;15(23):5705.

Uttam AK, Yadav AK, Jalota S, Singh R, Malik S, Arya AK. A prospective randomized comparative study to evaluate the effect of palliative hypo-fractionated radiotherapy with concurrent chemotherapy versus hypo-fractionated radiotherapy alone in advanced and unresectable head and neck cancer with no metastasis. ecancermedicalscience. 2023;17.

Yoshida K, Watanabe S, Hoshino N, Pak K, Hidaka N, Konno N, et al. Hospital pharmacist interventions for the management of oral mucositis in patients with head and neck cancer receiving chemoradiotherapy: a multicenter, prospective cohort study. Supportive Care in Cancer. 2023;31(5):316.