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Oral health-related quality of life after radiation therapy for head and neck cancer: the OraRad study

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Abstract

Purpose

Head and neck cancer (HNC) treatment results in morbidity impacting quality of life (QOL) in survivorship. This analysis evaluated changes in oral health-related QOL (OH-QOL) up to 2 years after curative intent radiation therapy (RT) for HNC patients and factors associated with these changes.

Methods

572 HNC patients participated in a multicenter, prospective observational study (OraRad). Data collected included sociodemographic, tumor, and treatment variables. Ten single-item questions and 2 composite scales of swallowing problems and senses problems (taste and smell) from a standard QOL instrument were assessed before RT and at 6-month intervals after RT.

Results

The most persistently impacted OH-QOL variables at 24 months included: dry mouth; sticky saliva, and senses problems. These measures were most elevated at the 6-month visit. Aspects of swallowing were most impacted by oropharyngeal tumor site, chemotherapy, and non-Hispanic ethnicity. Problems with senses and dry mouth were worse with older age. Dry mouth and sticky saliva increased more among men and those with oropharyngeal cancer, nodal involvement, and use of chemotherapy. Problems with mouth opening were increased by chemotherapy and were more common among non-White and Hispanic individuals. A 1000 cGy increase in RT dose was associated with a clinically meaningful change in difficulty swallowing solid food, dry mouth, sticky saliva, sense of taste, and senses problems.

Conclusions

Demographic, tumor, and treatment variables impacted OH-QOL for HNC patients up to 2 years after RT. Dry mouth is the most intense and sustained toxicity of RT that negatively impacts OH-QOL of HNC survivors.

ClinicalTrials.gov Identifier

NCT02057510; first posted February 7, 2014.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors acknowledge the time and commitment of study subjects who participated in this longitudinal study and the efforts of the site study coordinators and examiners.

Funding

This work was supported by the National Institute of Dental and Craniofacial Research, Grant/Award Number: 1U01DE022939.

Author information

Authors and Affiliations

  1. Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, CB 7450, USA

    Lauren L. Patton

  2. Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN, 55414, USA

    Erika S. Helgeson

  3. Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA

    Michael T. Brennan

  4. Department of Otolaryngology/Head and Neck Surgery, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA

    Michael T. Brennan

  5. Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, 1620 Tremont Street, 3rd Floor, Boston, MA, 02120, USA

    Nathaniel S. Treister

  6. Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA, 02115, USA

    Nathaniel S. Treister

  7. Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 South 40Th Street, Philadelphia, PA, 19104, USA

    Thomas P. Sollecito

  8. Division of Oral Medicine, University of Pennsylvania Health System, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Thomas P. Sollecito

  9. Department of Oral & Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, New York, NY, 10010, USA

    Brian L. Schmidt

  10. Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Alexander Lin

  11. Department of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive, CB 7512, Chapel Hill, NC, 27599-7512, USA

    Bhishamjit S. Chera

  12. Department of Radiation Oncology, Hollings Cancer Center, Medical University South Carolina, 169 Ashley Ave. MSC 318, Charleston, SC, 29425, USA

    Bhishamjit S. Chera

  13. Section of Oral Medicine, MC3912, University of Connecticut Health, 263 Farmington Avenue, Farmington, CT, 06030-3912, USA

    Rajesh V. Lalla

Authors
  1. Lauren L. Patton
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  2. Erika S. Helgeson
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  3. Michael T. Brennan
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  4. Nathaniel S. Treister
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  7. Alexander Lin
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  9. Rajesh V. Lalla
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Contributions

All authors contributed to the study conception and design. Data collection was performed by Michael Brennan, Rajesh Lalla, Thomas Sollecito, Nathaniel Treister, Brian Schmidt, Alexander Lin, Bhishamjit Chera and Lauren Patton. Data analysis was performed by Erika Helgeson. The first draft of the manuscript was written by Lauren Patton and Erika Helgeson and all authors commented on versions of the manuscript. Figures and tables were prepared by Erika Helgeson. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Lauren L. Patton.

Ethics declarations

Ethics approval and consent to participate

This study was performed in line with the principles of the Declaration of Helsinki. This is an observational study. Approval was granted by the Ethics Committees of each participating enrolling University prior to enrolling patients at each respective University site. UNC Biomedical IRB# 15–2192 approved 12/7/2015. Informed consent was obtained from all individual participants included in the study.

Permissions

Dr. Rajesh Lalla obtained permission from EORTC for academic use of EORTC-QLQ (H&N35) questions and scales on 11/21/2012.

Consent for publication

No individual person’s data is identifiable; consent to participate in this observational study included consent for publication of individual person’s data as collective datasets.

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

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Patton, L.L., Helgeson, E.S., Brennan, M.T. et al. Oral health-related quality of life after radiation therapy for head and neck cancer: the OraRad study. Support Care Cancer 31, 286 (2023). https://doi.org/10.1007/s00520-023-07750-2

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