Assessment of the quality of life in complex medical rehabilitation of patients at the stage of chemoradiotherapy for head and neck cancer

Abstract

BACKGROUND: At the stage of chemoradiotherapy of malignant neoplasms of the head and neck, in 90% of cases, the development of radiation dermatitis and mucositis is observed. The resulting acute radiation reactions negatively affect not only the quality of life of the patient, but also the planned treatment. A multidisciplinary approach with the inclusion of basic treatment, physical therapy, physical factors, psychological correction, and nutritional support is an effective strategy for improving the patient's quality of life at this stage of treatment. AIM: To assess the quality of life of patients in complex medical rehabilitation who underwent chemoradiotherapy for malignant neoplasms of the head and neck. MATERIALS AND METHODS: An interventional prospective randomized study was conducted with the participation of 60 patients with malignant neoplasms of the oral cavity, larynx, oropharynx, larynx undergoing chemoradiotherapy. The main group (n=30) received a course of medical rehabilitation: exposure to low-temperature argon plasma, general magnetic therapy, physical therapy, training on the support reaction on a barefoot platform, nutritional support and classes with a medical psychologist. In patients of the comparison group (n=30), plasma exposure was not included in the rehabilitation course. The effect of chemoradiotherapy for head and neck cancer on the patient's quality of life was assessed by the severity of pain syndrome, physical functioning, and limitations of daily activities using Visual Analogue Scale (VAS), Hospital Anxiety and Depression Scale (HADS) techniques, a questionnaire developed by C.D. Spielberger and adapted by Y.L. Khanin, the SF-36 questionnaire. RESULTS: After a course of chemoradiotherapy, patients began to complain of pain, burning in the mouth, complaints of dry mouth, pain when swallowing, eating, limited mouth opening, redness and peeling of the skin, voice changes, difficulty falling asleep, frequent awakenings at night, embarrassment of one’s appearance. In patients of both groups, there was a decrease in the level of reactive and personal anxiety, the increased level of anxiety and depression decreased by the end of the course of chemoradiotherapy with a decrease in indicators after 6 months. Despite the increase in pain intensity during chemoradiation treatment, an increase in vital activity indicator was recorded, as well as an indicator of self-assessment of one’s health by the end of the course of chemoradiation treatment. CONCLUSION: The resulting radiation mucositis and epidermitis at the stage of chemoradiotherapy for head and neck cancer lead to physical and psychological limitations, worsening the patient's quality of life, which determines the need to accompany this stage of treatment with comprehensive medical rehabilitation. The study of the dynamics of the parameters of the quality of life of patients is the basis for the selection of individual rehabilitation treatment programs.