One of the major side effects of radical radiation therapy for head and neck malignancies is xerostomia, or dryness of the mouth. There is no clearly effective treatment for this condition, but we have observed that patients in our practice believe that their symptoms improve significantly when using two "over-the-counter" oral comfort products - Biotene (toothpaste, mouthwash and chewing gum) and Oralbalance gel. We decided to study these agents in a formal phase II study to evaluate their usefulness in patients with postirradiation xerostomia. Twenty-eight patients with post-irradiation xerostomia were entered on the study. All had biopsy-proven carcinoma of the nasopharynx, oropharynx, oral cavity, hypopharynx or larynx, and had received primary radiotherapy with curative intent (> or =50 Gy in 20 fractions) more than 4 months before study entry. More than 75% of both parotid glands were included in the primary radiation field. There was no clinical evidence of recurrent disease. Patients were provided with a 2-month supply of Biotene mouthwash, toothpaste, chewing gum and Oralbalance gel. Response was evaluated 1 and 2 months after study entry using a patient-completed visual analogue scale to assess the severity of xerostomia and its effects on quality of life. For analysis, the scored baseline was subtracted from the later scores to assess change. Patients with an increase of 10 mm from their baseline score on the visual analogue scale were classified as having responded to the treatment intervention, and those with an increase of > or =25 mm from their baseline score were classified as having experienced a major improvement in their symptoms. After 2 months of treatment, 15 patients (54%) reported an improvement in intraoral dryness and 10 of these patients (36%) reported a major improvement. Similar proportions of patients (46% some improvement, 25% major improvement) reported an improvement in their ability to eat normally. Seventeen patients (61%) reported an improvement in oral discomfort, and 12 of these (43%) had a major improvement in their symptoms. The results of this study suggest that the use of Biotene (mouthwash, toothpaste and chewing gum) and Oralbalance gel can improve many of the symptoms of radiation-induced xerostomia. A placebo effect could account for many of the observed improvements in symptoms, and in order to assess the role of these agents in the management of patients with postirradiation xerostomia a randomised phase III study is needed.

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Traditionally, patient education is based on two myths : 1) increases in patients' knowledge lead to changes in behavior and 2) changes in behavior (exercise, pain management techniques) improve health status (pain, disability, depression). There it little evidence in the arthritis patient education literature that changes in knowledge or behavior improve patients' health status. In fact, little association has been found between these changes and improved health status. Explanation:The mechanism by which patient education improves arthritis may be more psychological (giving patients a sense of control) than behavioral. For example, strong associations have been shown between improved self-efficacy for controlling arthritis symptoms and health status. Therefore, arthritis patient education programs should be designed with an emphasis on giving patients a sense of control rather than on increasing knowledge or the practice of new behaviors. Patient eduction: Selection of'patient educational strategiesE. Seydel, E. Taal*, H. Rasker**. *University of Twente; **Medisch Spectrum Twente, Department of Psychology, P.O. Box 217, 7500 AE Enschede, The Netherlands.In the last few years patient education on rheumatology is a tremendous growing field of research. It is receiving more interest from behavioral scientists, physicians, nurses, policy makers, and other people who want their patients to become more informed about their conditions, to use self-management strategies, and to prevent disability. In shaping patient education health professionals are often guided by implicit criteria, vague assumptions or by trial and error. Some of them tend to equate patient education with such information dissemination techniques as teaching, and distribution of instructional pamphlets. However, instructional techniques to increase patients' knowledge is not sufficient to change behavior. There is a growing evidence, that if patient education succeeds in influencing behavior, this will not automatically result in better self-management or better health status. Self-management is defined as a process whereby a patient functions on his/her own behalf in health enhancing behavior, disease detection and treatment'. Self-efficacy seems to be an important moderator in enhancing self-management and refers to the expectation of a person that the can perform a given behavior successfully. We suggest the use of a more systematic and encompassing paradigm based on the self-efficacy concept. This concept has been successfully applied to a broad range of clinical problems, including a.o. chronic illness and health promotion. To facilitate the shaping of a patient education program based on the self-efficacy paradigm, we will present a model of patient education analysis and a set of criteria for developing and evaluating patient education programs. Some of the criteria are (1) a firm problem analysis (2) the encouragement of client responsibility, (3) full disclosure of information pertaining to the illness, (4) training of the patient in decisi...