Alleviation of dry mouth by saliva substitutes improved swallowing ability and clinical nutritional status of post-radiotherapy head and neck cancer patients: a randomized controlled trial

Abstract

The aim of this study is to investigate the effect of an edible saliva substitute, oral moisturizing jelly (OMJ), and a topical saliva gel (GC) on dry mouth, swallowing ability, and nutritional status in post-radiotherapy head and neck cancer patients. Methods Sixty-two post-radiation head and neck cancer patients with xerostomia completed a blinded randomized controlled trial. They were advised to swallow OMJ (n = 31) or apply GC orally (n = 31) for 2 months. Outcome measures were assessed at baseline, 1, and 2 months, including subjective and objective dry mouth (Challcombe) scores, subjective swallowing problem scores (EAT-10), water swallowing time, clinical nutritional status (PG-SGA), body weight, and dietary intake. Results After 1 and 2 months of interventions, subjective and objective dry mouth scores, subjective swallowing problem scores, swallowing times, and clinical nutritional status in both groups were significantly improved (p < 0.0001). Compared to GC, OMJ group had higher percent improvement in all outcome measures (p < 0.001) except swallowing time and clinical nutritional status. Interestingly, subjective dry mouth scores were significantly correlated with subjective swallowing problem scores (r = 0.5321, p < 0.0001). Conclusions Continuous uses of saliva substitutes (OMJ or GC) for at least a month improved signs and symptoms of dry mouth and enhanced swallowing ability. An edible saliva substitute was superior to a topical saliva gel for alleviating dry mouth and swallow problems. These lead to improved clinical nutritional status. Thus, palliation of dry mouth may be critical to support nutrition of post-radiotherapy head and neck cancer patients. Clinical trial registry Clinicaltrials.gov NCT03035825 Keywords Dysphagia. Xerostomia. Saliva substitute. Nutritional status. Head and neck cancer. Radiation therapy Abbreviations BIA Bioelectrical impedance assessment BMI Body mass index EAT-10 Eating Assessment Tool OMJ Oral moisturizing jelly PG-SGA Patient Generate-Subjective Global Assessment WST Water swallowing test Electronic supplementary material The online version of this article (

Evaluation of the salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation

“…These complications influence the appetite and intake of these patients, which can lead to inadequate levels of energy and nutrients, causing malnutrition. One study showed that dry mouth was the most important factor associated with weight loss in cancer survivors after completion of RT ( 22 ). This malnutrition can lead to interruption in treatment with impaired prognosis, as well as a negative impact on the quality of life of these patients.…”

Efficacy of gel-based artificial saliva on Candida colonization and saliva properties in xerostomic post-radiotherapy head and neck cancer patients: a randomized controlled trial

“…This was a secondary analysis of a single-blinded randomized controlled trial conducted as previously described [ 26 ]. The study was performed according to the Declaration of Helsinki and ICH-GCP.…”

“…The trial included 72 post-radiotherapy head and neck cancer patients with xerostomic problems ( N = 37 for OMJ and 35 for GC (control) groups) [ 26 ]. However, in this study, we analyzed data from a subpopulation of 56 who could provide saliva samples at all time points.…”

“…This report was a secondary analysis of a single-blinded randomized controlled trial in xerostomic post-radiotherapy head and neck cancer patients [ 26 ]. We previously published that continuous use of OMJ for a month improved signs and symptoms of dry mouth, and increased swallowing ability [ 26 ].…”

“…This report was a secondary analysis of a single-blinded randomized controlled trial in xerostomic post-radiotherapy head and neck cancer patients [ 26 ]. We previously published that continuous use of OMJ for a month improved signs and symptoms of dry mouth, and increased swallowing ability [ 26 ]. In this study, we aimed to analyze the effects of OMJ, in comparison with a commercially available gel-based artificial saliva (GC dry mouth gel), on salivary flow rates, saliva pH, and buffering capacity as well as Candida colonization in xerostomic post-radiotherapy head and neck cancer patients.…”