Oral symptoms and functional outcome related to oral and oropharyngeal cancer

Jolanda I Kamstra, Harriet Jager-Wittenaar, Pieter U Dijkstra, Paulien M Huisman, Rob P van Oort, Bernard F A M van der Laan, Jan L N Roodenburg, Jolanda I Kamstra, Harriet Jager-Wittenaar, Pieter U Dijkstra, Paulien M Huisman, Rob P van Oort, Bernard F A M van der Laan, Jan L N Roodenburg

Abstract

Purpose: This study aimed to assess: (1) oral symptoms of patients treated for oral or oropharyngeal cancer; (2) how patients rank the burden of oral symptoms; (3) the impact of the tumor, the treatment, and oral symptoms on functional outcome.

Methods: Eighty-nine patients treated for oral or oropharyngeal cancer were asked about their oral symptoms related to mouth opening, dental status, oral sensory function, tongue mobility, salivary function, and pain. They were asked to rank these oral symptoms according to the degree of burden experienced. The Mandibular Function Impairment Questionnaire (MFIQ) was used to assess functional outcome. In a multivariate linear regression analyses, variables related to MFIQ scores (p≤0.10) were entered as predictors with MFIQ score as the outcome.

Results: Lack of saliva (52%), restricted mouth opening (48%), and restricted tongue mobility (46%) were the most frequently reported oral symptoms. Lack of saliva was most frequently (32%) ranked as the most burdensome oral symptom. For radiated patients, an inability to wear a dental prosthesis, a T3 or T4 stage, and a higher age were predictive of MFIQ scores. For non-radiated patients, a restricted mouth opening, an inability to wear a dental prosthesis, restricted tongue mobility, and surgery of the mandible were predictive of MFIQ scores.

Conclusions: Lack of saliva was not only the most frequently reported oral symptom after treatment for oral or oropharyngeal cancer, but also the most burdensome. Functional outcome is strongly influenced by an inability to wear a dental prosthesis in both radiated and non-radiated patients.

Figures

Fig. 1
Fig. 1
Clinical model of factors influencing mandibular functioning. Within this study, a clinical model of factors influencing mandibular functioning was hypothesized and analyzed: (1) Tumor characteristics determine treatment modalities (extent of surgery, dose of radiotherapy, etc.). (2) Besides anti-tumor effects, treatments also induce adverse effects, resulting in oral symptoms. (3) These oral symptoms may result in restrictions in mandibular functioning. (4, 5) However, it is possible that some tumor characteristics or treatment characteristics influence mandibular functioning directly without actually resulting in specific oral symptoms. (6) Finally, tumor characteristics may induce oral symptoms directly

References

    1. Chambers MS, Garden AS, Kies MS, Martin JW. Radiation-induced xerostomia in patients with head and neck cancer: pathogenesis, impact on quality of life, and management. Head Neck. 2004;26:796–807. doi: 10.1002/hed.20045.
    1. Finlay PM, Dawson F, Robertson AG, Soutar DS. An evaluation of functional outcome after surgery and radiotherapy for intraoral cancer. Br J Oral Maxillofac Surg. 1992;30:14–17. doi: 10.1016/0266-4356(92)90130-B.
    1. Vissink A, Jansma J, Burlage FR, Coppes RP. Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med. 2003;14:199–212. doi: 10.1177/154411130301400305.
    1. Konstantinovic VS. Quality of life after surgical excision followed by radiotherapy for cancer of the tongue and floor of the mouth: evaluation of 78 patients. J Craniomaxillofac Surg. 1999;27:192–197.
    1. Malone JP, Stephens JA, Grecula JC, Rhoades CA, Ghaheri BA, Schuller DE. Disease control, survival, and functional outcome after multimodal treatment for advanced-stage tongue base cancer. Head Neck. 2004;26:561–572. doi: 10.1002/hed.20012.
    1. Rogers SN, Lowe D, Brown JS, Vaughan ED. The University of Washington head and neck cancer measure as a predictor of outcome following primary surgery for oral cancer. Head Neck. 1999;21:394–401. doi: 10.1002/(SICI)1097-0347(199908)21:5<394::AID-HED3>;2-Q.
    1. Rogers SN, Lowe D, Fisher SE, Brown JS, Vaughan ED. Health-related quality of life and clinical function after primary surgery for oral cancer. Br J Oral Maxillofac Surg. 2002;40:11–18. doi: 10.1054/bjom.2001.0706.
    1. Zuydam AC, Lowe D, Brown JS, Vaughan ED, Rogers SN. Predictors of speech and swallowing function following primary surgery for oral and oropharyngeal cancer. Clin Otolaryngol. 2005;30:428–437. doi: 10.1111/j.1365-2273.2005.01061.x.
    1. Scott B, Butterworth C, Lowe D, Rogers SN. Factors associated with restricted mouth opening and its relationship to health-related quality of life in patients attending a Maxillofacial Oncology clinic. Oral Oncol. 2008;44(5):430–8. doi: 10.1016/j.oraloncology.2007.06.015.
    1. Teoh KH, Patel S, Hwang F, Huryn JM, Verbel D, Zlotolow IM. Prosthetic intervention in the era of microvascular reconstruction of the mandible–a retrospective analysis of functional outcome. Int J Prosthodont. 2005;18:42–54.
    1. Logemann JA, Smith CH, Pauloski BR, Rademaker AW, Lazarus CL, Colangelo LA, Mittal B, MacCracken E, Gaziano J, Stachowiak L, Newman LA. Effects of xerostomia on perception and performance of swallow function. Head Neck. 2001;23:317–321. doi: 10.1002/hed.1037.
    1. List MA, Stracks J, Colangelo L, Butler P, Ganzenko N, Lundy D, Sullivan P, Haraf D, Kies M, Goodwin W, Vokes EE. How do head and neck cancer patients prioritize treatment outcomes before initiating treatment? J Clin Oncol. 2000;18:877–884.
    1. List MA, Rutherford JL, Stracks J, Pauloski BR, Logemann JA, Lundy D, Sullivan P, Goodwin W, Kies M, Vokes EE. Prioritizing treatment outcomes: head and neck cancer patients versus nonpatients. Head Neck. 2004;26:163–170. doi: 10.1002/hed.10367.
    1. Stegenga B, de Bont LGM, de Leeuw R, Boering G. Assessment of mandibular function impairment associated with temporomandibular joint osteoarthrosis and internal derangement. J Orofac Pain. 1993;7:183–195.
    1. Dijkstra PU, Huisman PM, Roodenburg JLN. Criteria for trismus in head and neck oncology. Int J Oral Maxillofac Surg. 2006;35:337–342. doi: 10.1016/j.ijom.2005.08.001.
    1. Fricton JR, Look JO, Schiffman E, Swift J. Long-term study of temporomandibular joint surgery with alloplastic implants compared with nonimplant surgery and nonsurgical rehabilitation for painful temporomandibular joint disc displacement. J Oral Maxillofac Surg. 2002;60:1400–1411. doi: 10.1053/joms.2002.36091.
    1. Pereira LJ, Steenks MH, de Wijer A, Speksnijder CM, van der Bilt A. Masticatory function in subacute TMD patients before and after treatment. J Oral Rehabil. 2009;36:391–402. doi: 10.1111/j.1365-2842.2008.01920.x.
    1. Politi M, Sembronio S, Robiony M, Costa F, Toro C, Undt G. High condylectomy and disc repositioning compared to arthroscopic lysis, lavage, and capsular stretch for the treatment of chronic closed lock of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:27–33. doi: 10.1016/j.tripleo.2006.01.008.
    1. Dirix P, Nuyts S, Vander Poorten V, Delaere P, Van den Bogaert W. Efficacy of the BioXtra dry mouth care system in the treatment of radiotherapy-induced xerostomia. Support Care Cancer. 2007;15:1429–1436. doi: 10.1007/s00520-006-0210-y.
    1. Bensadoun RJ, Riesenbeck D, Lockhart PB, Elting LS, Spijkervet FK, Brennan MT (2010) A systematic review of trismus induced by cancer therapies in head and neck cancer patients. Support Care Cancer
    1. Pauloski BR. Rehabilitation of dysphagia following head and neck cancer. Phys Med Rehabil Clin N Am. 2008;19:889–928.
    1. Atkinson JC, Fox PC. Salivary gland dysfunction. Clin Geriatr Med. 1992;8:499–511.
    1. Kreeft AM, van der Molen L, Hilgers FJ, Balm AJ. Speech and swallowing after surgical treatment of advanced oral and oropharyngeal carcinoma: a systematic review of the literature. Eur Arch Otorhinolaryngol. 2009;266:1687–1698. doi: 10.1007/s00405-009-1089-2.
    1. Scott B, D'Souza J, Perinparajah N, Lowe D, Rogers SN (2010) Longitudinal evaluation of restricted mouth opening (trismus) in patients following primary surgery for oral and oropharyngeal squamous cell carcinoma. Br J Oral Maxillofac Surg (in press)
    1. Van Cann EM, Dom M, Koole R, Merkx MA, Stoelinga PJ. Health related quality of life after mandibular resection for oral and oropharyngeal squamous cell carcinoma. Oral Oncol. 2005;41:687–693. doi: 10.1016/j.oraloncology.2005.03.001.
    1. Goldstein M, Maxymiw WG, Cummings BJ, Wood RE. The effects of antitumor irradiation on mandibular opening and mobility: a prospective study of 58 patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88:365–373. doi: 10.1016/S1079-2104(99)70044-2.
    1. Wang CJ, Huang EY, Hsu HC, Chen HC, Fang FM, Hsiung CY. The degree and time-course assessment of radiation-induced trismus occurring after radiotherapy for nasopharyngeal cancer. Laryngoscope. 2005;115:1458–1460. doi: 10.1097/01.mlg.0000171019.80351.46.
    1. Hsiung CY, Huang EY, Ting HM, Huang HY. Intensity-modulated radiotherapy for nasopharyngeal carcinoma: the reduction of radiation-induced trismus. Br J Radiol. 2008;81:809–814. doi: 10.1259/bjr/17942449.
    1. Dijkstra PU, Sterken MW, Pater R, Spijkervet FKL, Roodenburg JLN. Exercise therapy for trismus in head and neck cancer. Oral Oncol. 2006;43:389–394. doi: 10.1016/j.oraloncology.2006.04.003.
    1. Buchbinder D, Currivan RB, Kaplan AJ, Urken ML. Mobilization regimens for the prevention of jaw hypomobility in the radiated patient: a comparison of three techniques. J Oral Maxillofac Surg. 1993;51:863–867. doi: 10.1016/S0278-2391(10)80104-1.
    1. Logemann JA, Rademaker AW, Pauloski BR, Kahrilas PJ. Effects of postural change on aspiration in head and neck surgical patients. Otolaryngol Head Neck Surg. 1994;110:222–227.
    1. Logemann JA, Pauloski BR, Rademaker AW, Colangelo L. Speech and swallowing rehabilitation for head and neck cancer patients. Oncology (Williston Park) 1997;11:651–656.
    1. Rasley A, Logemann JA, Kahrilas PJ, Rademaker AW, Pauloski BR, Dodds WJ. Prevention of barium aspiration during videofluoroscopic swalling studies: value of change in posture. Am J Radiol. 1993;160:1005–1009.

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