Despite Treatment Advances, Oral Mucositis Continues to Plague Patients With Head and Neck Cancer

Despite Treatment Advances, Oral Mucositis Continues to Plague Patients With Head and Neck Cancer

Findings from a cohort study of patients with head and neck cancer (HNC) suggest that severe oral mucositis continues to be a common adverse event in this population. Findings were published in JAMA Network Open.

In this single-institution study, 98.6% (n = 568) of patients who underwent definitive or adjuvant intensity-modulated RT (IMRT) for primary HNC between February 9, 2015, and May 2022, developed some degree of oral mucositis, and 62.5% (n = 360) of these patients developed severe oral mucositis.

A total of 576 patients were included in this analysis. The median patient age was 62.5 years (IQR, 53.6-69.1) and 78.3% (n = 451) were male. Most patients were White (88.4%).

Most patients (80.6%) also received concurrent chemotherapy.

Quality-of-Life Parameters

Patients were assessed for mouth and soreness (MTS) scores during radiotherapy through the Oral Mucositis Weekly Questionnaire–Head and Neck Cancer survey.

Patients who had higher MTS scores were more likely to require a feeding tube (P = .001); the rate of feeding tube utilization with MTS scores 0, 1, 2, 3, and 4, respectively, was 0%, 3.6%, 6.6, 14.7%, and 21.6%.

They were also more likely to be hospitalized (P = .02) or require opiate use (P < .001). The rates for these 2 parameters, respectively, were 12.5%, 10.7%, 15.1%, 23.9%, and 28.4%; and 0%, 19.6%, 42.8%, 61.4%, and 64.8%.

Lastly, those with high oral mucositis severity were most likely to experience weight loss (P < .001). Across MTS scores 0, 1, 2, 3, and 4, the median weight loss was –0.7 kg (IQR, –1.7 to –0.4), 3.9 kg (IQR, 1.1-6.1), 5.0 kg (IQR, 2.2-7.7), 4.7 kg (IQR, 2.1-7.7), and 7.7 kg (IQR, 2.8-10.6).

Practice Implications

As the study authors explain, oral mucositis is debilitating. Patients with oral mucositis experience painful inflammation and ulceration of the mucosal membranes in the mouth and throat. In turn, speaking, swallowing, and eating becomes uncomfortable and even painful. As shown above, these patients are more likely to turn to opioids, require a feeding tube, lose weight during treatment, or require hospitalization.

Previous studies have assessed the relationship between oral mucositis severity and quality of life outcomes however, these assessments were predominantly in the era of less precise 3-dimentional conformal radiotherapy planning and less frequent concurrent chemotherapy use. Before embarking on this study, investigators had hypothesized that the routine use of IMRT—which is better at sparing normal structures than previous radiotherapy techniques—might help mitigate some of the effects of oral mucositis. IMRT has also been shown to reduce some other quality-of-life domains, like xerostomia and dysphagia.

However, this study showed that even with these more precise strategies, oral mucositis continues to be a problem.

“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,” study authors concluded. “Improvements in oral mucositis prevention and management are needed.”

Reference

Iovoli AJ, Turecki L, Qiu ML, et al. Severe oral mucositis after intensity-modulated radiation therapy for head and neck cancer. JAMA Netw Open. 2023;6(10):e2337265. Published 2023 Oct 2. doi:10.1001/jamanetworkopen.2023.37265