Postradiation trismus and its impact on quality of life in patients with head and neck cancer

Lee, Li-Yun; Chen, Shu‐Ching; Chen, Wen‐Cheng; Huang, Bing‐Shen; Lin, Chien‐Yu

doi:10.1016/j.oooo.2014.10.003

Cited by 56 publications

(94 citation statements)

References 44 publications

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“…The absence of specific criteria for the definition of trismus and the non-homogeneous group of patients in the different studies are also some of the main reasons for the above wide variation of the prevalence of trismus in head and neck cancer patients [6,9,12,13].…”

Section: Discussion Trismusmentioning

confidence: 99%

“…Trismus was an independent and important risk factor for the worsening of quality of life in the several studies and the need for support of oral structures to prevent or manage trismus was highlighted [6,12,13,27,28]. Exercises and specific prevention programs for trismus were prospectively studied but the beneficial result was not permanent for all patients [29−32].…”

Section: Eortc Qlq Head/neck35mentioning

confidence: 99%

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Trismus and reduced quality of life in patients with oral squamous cell carcinoma, who received post-operative radiotherapy alone or combined with chemotherapy

Galitis

Droukas

Tzakis

et al. 2017

Forum of Clinical Oncology

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Background Patients, who receive radiotherapy (RT) for head and neck cancer, develop chronic functional abnormalities and survive with reduced quality of life. Purpose We aimed to study patients with oral cancer, who received post-operative radiotherapy or chemoradiotherapy. Patients Ten patients (mean age 63.8 years) were included. Methods Oral mucositis, pain and xerostomia, maximum mouth opening (MMO) and functional abnormalities before and after RT were recorded. The 35 mm MMO or less was accepted as trismus. Patients completed the EORTC QLQ C-30 and Head/Neck35 questionnaires. Results Mean RT dose was 64.3 Gray. Six patients received chemoradiotherapy. Severe mucositis, pain and xerostomia were recorded in 6 and 5 patients respectively. MMO was reduced in all patients. The mean MMO (34 mm) reached the level of trismus. The total number of symptoms increased from 3.1 to 6.3 in C-30 and from 3.1 to 8.8 per patient in the H/N35. Severe fatigue, pain, limitations at work, weakness, sad feelings, family problems, sleeping problems, anorexia, financial difficulties, tense/irritable, constipation, nausea, vomiting and depression were most often reported with C-30. Most patients reported low to moderate quality of life. Severe oral, jaw and neck pain, swallowing problems, taste alterations, sticky saliva, dry mouth, coarseness, dental problems, feeling sick and reduced interest in life/sex were the most common symptoms reported with N/H35. Conclusions The observed trismus, 2- to 3-fold increase of symptoms and poorer quality of life highlighted the need for support of oral cancer patients, who receive postoperative radiotherapy or chemoradiotherapy.

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Section: Discussion Trismusmentioning

confidence: 99%

Section: Eortc Qlq Head/neck35mentioning

confidence: 99%

Trismus and reduced quality of life in patients with oral squamous cell carcinoma, who received post-operative radiotherapy alone or combined with chemotherapy

Galitis

Droukas

Tzakis

et al. 2017

Forum of Clinical Oncology

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“…Swallowing impairment has been documented to adversely affect quality of life, mental well being, and psychosocial function in various patient populations including Parkinson’s disease [17], multiple sclerosis [14, 18], and head and neck cancer [19, 20]. Although the physiologic impact of dysphagia in ALS has been described in the literature [2–4, 13], its impact on quality of life and mental well being is yet to be as well defined.…”

Section: Introductionmentioning

confidence: 99%

Defining Swallowing-Related Quality of Life Profiles in Individuals with Amyotrophic Lateral Sclerosis

et al. 2016

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Although it is known that dysphagia contributes to significant malnutrition, pneumonia, and mortality in amyotrophic lateral sclerosis (ALS), it remains unclear how swallowing impairment impacts quality of life in this vulnerable patient population. The aim of the current study was to (1) delineate swallow-related quality of life (SR-QOL) profiles in individuals with ALS and (2) evaluate relationships between SR-QOL, degree of swallowing impairment, and ALS global disease progression. Eighty-one ALS patients underwent a standardized videofluoroscopic swallow study and completed the swallowing quality of life (SWAL-QOL) instrument and ALS functional rating scale-revised (ALSFRS-R). Penetration Aspiration Scale (PAS) scores were derived by a blinded rater. Correlation analyses and a between groups ANOVA (safe vs. penetrators vs. aspirators) were performed. Mean SWAL-QOL score for this cohort was 75.94 indicating a moderate degree of SR-QOL impairment with fatigue, eating duration, and communication representing the most affected domains. Correlations were revealed between the SWAL-QOL and (1) PAS (r = −0.39, p < 0.001) and (2) ALSFRS-R (r = 0.23, p < 0.05). Mean (SD) SWAL-QOL scores for safe versus penetrator versus aspirator groups were 81.2 (2.3) versus 77 (3.4) versus 58.7 (5.9), respectively, with a main effect observed [F(2,78) = 9.71, p < 0.001]. Post hoc testing revealed lower SWAL-QOL scores for aspirators versus safe swallowers (p < 0.001) and aspirators versus penetrators (p < 0.001). Overall, SR-QOL was moderately reduced in this cohort of ALS patients and profoundly impacted in ALS aspirators and individuals with advanced disease. These findings highlight the importance of early multidisciplinary intervention to not only avoid malnutrition, weight loss, and pulmonary sequelae but also the associated reduced QOL seen in these individuals.

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“…It can be caused by tumor infiltrating the muscle of mastication, their nerves, and the temporomandibular joint or as a complication of surgery or radiation therapy (Ichimura and Tanaka, 1993; Stubblefield et al, 2010). Trismus may cause difficulty in many aspects of daily living, such as impaired speech, difficulty eating, difficulty in maintaining proper oral hygiene and receiving dental intervention, thereby affecting the patient’s quality of life (Louise Kent et al, 2008; Lee et al, 2015; Weber et al, 2010; Pauli et al, 2013). …”

Section: Introductionmentioning

confidence: 99%

Objective assessment of trismus in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT)

Owosho

Ramalho

Rosenberg

et al. 2016

Journal of Cranio-Maxillofacial Surgery

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Purpose The aim of this study was to estimate the incidence of trismus in oral and oropharyngeal cancer patients (OOPC) treated with intensity-modulated radiation therapy (IMRT) and to identify the role of risk factors in patients who developed trismus. Materials and Methods A retrospective cohort study of OOPC treated with IMRT in our institution from 2009 through 2014 was performed. Patients eligible for this study had pre-RT and post-RT maximal inter-incisal opening (MIO) measurements at 6 – 48 months post-RT, treated with high-dose radiation (≥60 Gy) and pre-RT MIO ≥ 36 mm. A descriptive analysis to identify the incidence of trismus, with trismus stated as MIO ≤ 35 mm at or after 6 months post-RT measurement was performed. The role of risk factors such as age, gender, tumor site, tumor size (T), tumor stage, pre-RT MIO measurements and radiation dose to the tumor were assessed using Fisher exact test and the radiation doses to the ipsilateral muscles of mastication in patients who developed trismus were assessed by matching with control (non-trismus) patients using Wilcoxon Signed Rank test. Results The study consisted of 54 patients with a median age of 55 years and 81% were males. The median follow-up time was 10 months. The incidence of trismus was 14.8%. Patients with pre-RT MIO measurements ≤40 mm were at risk of developing trismus (P<0.001). In trismus patients, the average mean radiation dose to the masseter and medial pterygoid muscles was numerically higher but not significantly different (P=0.08; P=0.22, respectively) to matched control patients. Age, gender, radiation dose to the tumor, tumor site, size (T) and stage were also found to be not significant. Conclusion Pre-RT MIO measurement was a significant risk factor for the development of trismus. However, this is a non-modifiable factor. Limiting radiation dose to the muscles of mastication could prevent this complication.

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Postradiation trismus and its impact on quality of life in patients with head and neck cancer

Cited by 56 publications

References 44 publications

Trismus and reduced quality of life in patients with oral squamous cell carcinoma, who received post-operative radiotherapy alone or combined with chemotherapy

Trismus and reduced quality of life in patients with oral squamous cell carcinoma, who received post-operative radiotherapy alone or combined with chemotherapy

Defining Swallowing-Related Quality of Life Profiles in Individuals with Amyotrophic Lateral Sclerosis

Objective assessment of trismus in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT)

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