Xerostomia after radiotherapy and its effect on quality of life in head and neck cancer patients

Kerman Neuroscience Research Center, Kerman, Iran.
Archives of Iranian medicine (Impact Factor: 1.11). 04/2012; 15(4):214-8.
Source: PubMed


Xerostomia is one of the one complications following radiotherapy that can affect quality of life (QoL). This study aims to assess the severity of xerostomia in patients with head and neck cancers after radiotherapy and its effect on QoL.
In this longitudinal prospective study, the severity of xerostomia and related QoL were was assessed in 63 head and neck cancer patients who referred to the Radiotherapy Ward. Patients completed a xerostomia questionnaire (XQ) at the beginning, and 2, 4, and 6 weeks after treatment over a period of 6 months. Additionally, unstimulated saliva was collected using the spitting method at all 4 visits.
QoL significantly worsened with increased time (P = 0.0001); meanwhile, the severity of xerostomia increased significantly (P = 0.0001). However, there was no significant change in the amount of saliva at these 4 time points (P = 0.23). Regression analysis showed that with each milliliter decrease in saliva secretion, the QoL score decreased 2.25%. With one score increase in xerostomia, from the QoL mean score there was a 1.65% decrease.
The decrease in saliva and xerostomia that resulted from radiotherapy plays an important role in worsening QoL among patients who undergo radiotherapy for head and neck cancers. Although the amount of saliva has a significant association with QoL, the xerostomia score which shows subjects' general feeling also independently impacts QoL. In future studies, we recommend patient assessments for periods longer than 6 months.

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Available from: Shahla Kakoei,
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    • "The patients’ whole resting saliva was collected and measured precisely before and after every course of medication by two experts: one oral medicine specialist and one student of dentistry who was trained in this procedure. The resting saliva secretion was measured using spitting methods19 and levels of lower than 0.01 mL reflected dysfunction of salivary glands. The patients were not informed about the prescribed drugs as dictated by the single-blind research design. "
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    ABSTRACT: Background and aims. Xerostomia is one of the most common complications of head and neck radiotherapy. The aim of this study was to evaluate and compare the efficacy of pilocarpine and bromhexine in improving radiotherapy-induced xerostomia and its associated symptoms. Materials and methods. In this single-blind, randomized crossover study, pilocarpine and bromhexine tablets were used by twenty-five patients suffered from xerostomia, with a medical history of head and neck radiotherapy. At step A, the patients were treated with pilocarpine for 2 weeks. In addition, they were asked to take bromhexine for 2 weeks with a one-week washout period. At step B, the inverse process was conducted (first bromhexine, then pilocarpine). Whole resting saliva was collected from patients before and after receiving each medication by precise measurements. Then, efficacy of the two drugs in the treatment of xerostomia and its related oral complications was evaluated using questionnaires by Dichotomous format. The results were statistically analyzed using t-student and Fisher’s exact and chi-squared tests. Statistical significance was set at P<0.05. Results. The difference between saliva secretion rates before and after medications was not significant for bromhexine users at two steps of the study (P=0.35); however, it was significant for pilocarpine users (P=0.0001). Users of both drugs showed significant differences in improvement of xerostomia, chewing, swallowing, tasting and mouth burning. Conclusion. Pilocarpine is probably more effective in improving xerostomia and its associated problems compared with bromhexine, although the use of the latter was also shown to ease some of the consequences of radiotherapy in the head and neck region.
    05/2013; 7(2):86-90. DOI:10.5681/joddd.2013.015
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    • "Whole-mouth salivary function has been shown to be related to quality of life (QoL) [9,10] and has been used to compare different treatment strategies in clinical oncology trials. Kakoei et al. [11] have shown that the decrease in saliva and xerostomia resulting from RT can negatively affect QoL for patients who undergo RT. Several prospective studies conducted over the past decade have reported the RT dose constraints to allow preservation of parotid gland function based on salivary flow measurements or salivary gland scintigraphy [10,12-14]. "
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    ABSTRACT: Background: With advances in modern radiotherapy (RT), many patients with head and neck (HN) cancer can be effectively cured. However, xerostomia is a common complication in patients after RT for HN cancer. The purpose of this study was to use the Lyman-Kutcher-Burman (LKB) model to derive parameters for the normal tissue complication probability (NTCP) for xerostomia based on scintigraphy assessments and quality of life (QoL) questionnaires. We performed validation tests of the Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) guidelines against prospectively collected QoL and salivary scintigraphic data. Methods: Thirty-one patients with HN cancer were enrolled. Salivary excretion factors (SEFs) measured by scintigraphy and QoL data from self-reported questionnaires were used for NTCP modeling to describe the incidence of grade 3+ xerostomia. The NTCP parameters estimated from the QoL and SEF datasets were compared. Model performance was assessed using Pearson's chi-squared test, Nagelkerke's R2, the area under the receiver operating characteristic curve, and the Hosmer-Lemeshow test. The negative predictive value (NPV) was checked for the rate of correctly predicting the lack of incidence. Pearson's chi-squared test was used to test the goodness of fit and association. Results: Using the LKB NTCP model and assuming n=1, the dose for uniform irradiation of the whole or partial volume of the parotid gland that results in 50% probability of a complication (TD50) and the slope of the dose-response curve (m) were determined from the QoL and SEF datasets, respectively. The NTCP-fitted parameters for local disease were TD50=43.6 Gy and m=0.18 with the SEF data, and TD50=44.1 Gy and m=0.11 with the QoL data. The rate of grade 3+ xerostomia for treatment plans meeting the QUANTEC guidelines was specifically predicted, with a NPV of 100%, using either the QoL or SEF dataset. Conclusions: Our study shows the agreement between the NTCP parameter modeling based on SEF and QoL data, which gave a NPV of 100% with each dataset, and the QUANTEC guidelines, thus validating the cut-off values of 20 and 25 Gy. Based on these results, we believe that the QUANTEC 25/20-Gy spared-gland mean-dose guidelines are clinically useful for avoiding xerostomia in the HN cohort.
    BMC Cancer 12/2012; 12(1):567. DOI:10.1186/1471-2407-12-567 · 3.36 Impact Factor
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    ABSTRACT: Older persons are at risk of chronic diseases of the mouth, including dental infections (e.g., caries, periodontitis), tooth loss, benign mucosal lesions, and oral cancer. Another serious oral condition in this population is xerostomia (dry mouth). Xerostomia is a common finding in the elderly people mainly due to their increased use of drugs, possible radiotherapy, malnutrition, pathological situations of the salivary glands and also or simply due to age. Since there is a numerical augmentation of the third-age group worldwide, the problem of xerostomia is a matter of augmenting clinical concern. Certain factors of the saliva, such as pH Ôr/and the flow degree, can be measured directly in one dental appointment with various clinical tests in order to diagnose directly the presence and degree of xerostomia. These tests are carried out through the use of predisposed single-use kits that count the saliva flow and the microbial population of the oral cavity easily, rapidly and economically. Diagnosed xerostomia caused by underlying disease or medication use may be treated with over-the-counter saliva substitutes. The control of xerostomia may lead to control of dental caries since the main intraoral effect of xerostomia is the increased active caries index. The main location of caries in third-age patients is usually the exposed root surfaces (root caries). Effort to assess the microbial population in the mouth of the elderly is the first step to (root) caries prevention. The aim of this literature review is the discussion of the current data concerning saliva’s function, the description of parameters that control the rhythm and the degree of its flow and the tests existed for quantification and examination of its quality. The relevance of saliva with root caries in the elderly population is further discussed. Finally certain protocols are suggested in order to provide prevention or caries treatment and reduce the overall caries risk index of the elderly. Key words:Xerostomia, saliva tests, saliva floe, caries, caries risk assessment
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