Relation of mucous membrane alterations to oral intake during the first year after treatment for head and neck cancer

Abstract

Background Acute oral mucositis is associated with pain and impaired swallowing. Little information is available on the effects of chronic mucositis on swallowing. Methods Sixty patients treated for cancer of the head and neck were examined during the first year after their cancer treatment. Oral mucosa was rated with the Oral Mucositis Assessment Scale. Stimulated whole-mouth saliva, oral pain rating, percent of oral intake, and 2 subscales of the Performance Status Scale for Head and Neck (PSS-HN) cancer were also collected. Results Mucositis scores and pain ratings decreased over time while functional measures of eating improved over time. Reduction in chronic mucositis was correlated with improved oral intake and diet. Conclusion Lack of association with pain was attributed to the absence of ulcerations. Continued impairment of oral intake during the first year posttreatment may be related to oral mucosal changes and other factors.

Experiences of Pain: A Longitudinal, Qualitative Study of Patients with Head and Neck Cancer Recently Treated with Radiotherapy

“…The results agree with several studies reporting function-related mucositis pain, tumor pain, and breakthrough pain as very common in cancer patients (Bhatnagar, et al, 2010;Epstein, et al, 2010;Pauloski, et al, 2011). In two studies, as in ours, this pain was clearly and primarily linked to RT-induced mucositis (Cheng & Lee, 2011;Rose-Ped, et al, 2002).…”

Pathophysiology of Radiation-Induced Dysphagia in Head and Neck Cancer

“…In cases where dysphagia is present, it is often attributed to an array of functional characteristics, such as reduced retraction of base of tongue, poor epiglottic retroflexion, reduced laryngeal elevation, delay in pharyngeal transit, and/or poor coordination of swallowing muscles [23,22]. In many cases, these functional characteristics are accompanied by oral mucositis, causing continuous pain, resulting in difficulty with oral eating, malnutrition, and/or weight loss [24–26]; systemic fatigue and nausea may also play a role diminishing motivation to eat [27]. Of note, mucositis is also strongly related to other cofactors including smoking, infection, oral hygiene, and nutritional status [17,28].…”

“…The mechanism that causes the transformation from fibrosis to atrophy is not well-understood; it is possibly related to fragmentation or degeneration of muscle fibers and/or mechanism of disuse atrophy [73]. It is well known that oral intake declines during radiotherapy for HNSCC [24]. Therefore, muscle disuse likely plays a role in development of swallowing muscle impairments after radiation.…”

A hyaluronic acid-based compound inhibits fibroblast senescence induced by oxidative stress in vitro and prevents oral mucositis in vivo

“…The pathogenesis of oral mucositis is currently the subject of intense debate. Because the disease peaks near the completion of treatment, approximately 7–9 weeks after initiation of radiotherapy, and usually resolves between 2 and 10 weeks after the end of treatment (Pauloski et al, ), it is reasonable to speculate that slowly appearing but long lasting changes take place in the oral mucosa, in addition to the acute toxicity associated with apoptosis of keratinocytes (Talwar et al, ). Further, mucosal alteration causing impaired oral intake often persists long into the first year after cancer treatment when the impact of oral mucositis would be expected to have dissipated (Pauloski et al, ).…”