Author: Andrea S. Blevins Primeau, PhD, MBA
Many patients with head and neck cancer develop oral mucositis after intensity-modulated radiation therapy (IMRT), according to a single-center study published in JAMA Network Open.
The study also showed that most cases of oral mucositis were severe, and increasing severity of mucositis was associated with a greater likelihood of feeding tube placement, hospitalization, and opiate use.
The study included 576 patients who underwent definitive or adjuvant IMRT during 2015-2022. The Oral Mucositis Weekly Questionnaire-Head and Neck Cancer survey was used to categorize the severity of mucositis and throat soreness.
Nearly all patients (98.6%) had oral mucositis, and 62.5% developed severe oral mucositis. By the final week of IMRT, 48.6% of patients had difficulty drinking, 56.8% had difficulty swallowing, and 69.4% had difficulty eating. Most patients (76.8%) were consuming a pureed diet and/or had a feeding tube by the end of IMRT.
The median time to placing a feeding tube was 32 days from starting IMRT. The proportion of patients with nonprophylactic feeding tube placement was 16.4% of those with severe oral mucositis and 5.6% of those without severe mucositis (P <.001). Overall, 20.8% of patients required hospitalization. Hospitalizations occurred a median of 35 days from the start of IMRT, and the median length of stay was 4 days. The proportion of patients who required hospitalization was 25.0% in those who had severe mucositis and 13.9% in those who did not (P =.001). The proportion of patients using opiates was 12.2% at the start of IMRT and 50.9% by the end of treatment. The proportion of patients using opiates was 63% among those who had severe mucositis and 35% among those who did not (P <.001). “These findings suggest that oral mucositis continues to cause morbidity in patients with head and neck cancer, contributing to worse quality of life and financial effects,” the researchers concluded.
Iovoli AJ, Turecki L, Qui ML, et al. Severe oral mucositis after intensity-modulated radiation therapy for head and neck cancer. JAMA Netw Open. Published online October 11, 2023. doi:10.1001/jamanetworkopen.2023.37265