Symptom distress and interference among cancer patients with osteoradionecrosis of jaw: A cross-sectional study

Abstract

Objective Osteoradionecrosis of the jaws (ORNJ) is among the most serious oral complications of head and neck cancer treatment with radiation therapy. This study aimed to examine the level of symptom distress and interference of ORNJ in head and neck cancer patients in China. Methods A cross-sectional study was conducted to profile patient reported symptom severity. Ninety-five hospitalized ORNJ patients were recruited. Participants completed the MD Anderson Symptom Inventory–Head and Neck Module-Chinese version. Results The percentage of participants who reported that they experienced at least one type of symptom was 97.9%, and 85.2% patients reported interference. The 10 most severe symptoms were as follows: limited mouth opening, problem with teeth/gums, difficulty swallowing/chewing, dry mouth, oral malodor, difficulty with voice/speech, dental ulcer, tinnitus/ear obstruction, skin pain/burning/rash, and difficulty hearing. The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy. The interference of patients positively correlated with core symptoms ( r = 0.612), head and neck symptoms ( r = 0.709), and ORNJ symptoms ( r = 0.440) ( P < 0.01). The longer time to the onset of ORNJ after radiotherapy was positively and significantly correlated with symptom distress ( r = 0.479, P < 0.001), and mouth opening correlated negatively with symptom distress ( r = −0.298, P = 0.003). Conclusions ORNJ patients suffered mainly from limited mouth opening and other maxillofacial symptoms. The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy. ORNJ patients commonly had symptom distress, which influenced their quality of life.

Patients' experience and perceived concerns regarding obtaining and taking prescriptions for head and neck osteoradionecrosis

“…In this survey, tonsillar and base of tongue tumours accounted for a combined 64% of primary tumour sites. Patients with ORN report problems with pain, trismus, and swallowing (2,3). In this survey, patients mentioned Speech and Language Therapists (SALT) having a positive intervention on their dysphagia.…”

“…The prevalence of which being between 5-15%, with the mandibular body being the commonest site affected following external beam radiotherapy (1). ORN can have a profound impact on health-related quality of life with issues often attributed to difficulties with trismus, pain, chewing, speaking, swallowing, and psychosocial wellbeing (2)(3)(4). Rates of ORN are likely to rise due to increasing incidence of oral and oropharyngeal cancer, frequent use of radiotherapy and chemoradiotherapy particularly in the Human Papilloma Virus positive groups (HPV), and growing numbers of long-term survivors (5,6).…”

“…One previous study (15) looked at the effect of a self-prepared liquid formulation of pentoxifylline on its tolerance profile, with over 11% reporting varying side effects (nausea, malaise, vomiting). Although evidence exists regarding side-effects, there is a lack on patient experience in terms of administration, obtaining the prescriptions, use of 'quadruple therapy', and compliance with multiple medication in the setting of pre-existing functional difficulties, such as, pain and trismus (2,3). Anecdotally, Nurse Specialists, Pharmacists, and clinicians at the Regional Centre have had feedback from patients regarding difficulties with their medical management, hence the aim of this study was to seek the patient experience in obtaining their prescriptions, difficulties in taking them and possible side effects, to help guide care.…”

Health related quality of life and patient concerns in patients with osteoradionecrosis

“…Patients with ORN report various problems such as dysphagia, dentition, and activity limitations, (7) also trismus and a range of symptom distress including problems with teeth/gums, dry mouth, oral malodour, tinnitus/ear obstruction/difficulty hearing. (9) Previous papers reporting HRQOL following reconstructive surgery for ORN, although with small patient numbers, tend to support the benefit of surgical intervention on QOL. (2,3,5,8) However, in an earlier series, HRQOL was relatively poor after composite resection for NOTANI grade III disease; the long-term side effects of radiotherapy affects many different domains that are not improved by radical surgery such as speech, swallowing, appearance, chewing, shoulder.…”

“…(1) Although modern radiotherapy techniques might reduce the risk, the number of ORN patients is expected to rise as more patients are treated with primary or adjuvant radiotherapy or chemoradiotherapy and with increasing life expectancy. The number of papers reporting health-related quality of life (HRQOL) following ORN are relatively few, (2)(3)(4)(5)(6)(7)(8)(9) however they highlight the detrimental impact on HRQOL. Surgical management of ORN is complex.…”