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

Aroonwan Lam-Ubol,Dunyaporn Trachootham,Sumalee Nuchit,Orapin Chokchaitam,Sineepat Talungchit,On-Ong Mungkung,Wannaporn Paemuang,Tippawan Pongcharoen

doi:10.1007/s00520-019-05132-1

Aroonwan Lam-Ubol, Dunyaporn Trachootham + Show 6 more

Open Access

https://doi.org/10.1007/s00520-019-05132-1

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Abstract

PurposeThe 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.MethodsSixty-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.ResultsAfter 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).ConclusionsContinuous 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 registryClinicaltrials.gov NCT03035825

Highlights

Saliva plays a critical role in chewing, swallowing, and taste perception [1]
A previous study showed that xerostomia was the most important factor associated with weight loss in cancer survivors after completion of radiotherapy [7]
This study was aimed to investigate the effect of an edible saliva substitute oral moisturizing jelly (OMJ) on dry mouth, swallowing ability, and nutritional status of post-radiation head and neck cancer patients with xerostomia, in comparison with that of a commercially available saliva gel (GC) giving topically

Summary

Introduction

Saliva plays a critical role in chewing, swallowing, and taste perception [1]. a decrease in the quantity and quality of saliva (hyposalivation) could result in swallowing difficulty (dysphagia), reduced intake, and malnutrition [2]. Head and neck cancer patients received radiotherapy exceeding 60 Grey (Gy) often had xerostomia together with dysphagia even after the cancer is remitted [3, 4] These complications influence the patient’s appetite, food preference, and dietary intake. Commercially available saliva substitutes are not recommended to be swallowed [12] Their side effects especially allergic reactions (rash; swelling of the mouth, face, lips, or tongue) have been reported [12]. This study was aimed to investigate the effect of an edible saliva substitute OMJ on dry mouth, swallowing ability, and nutritional status of post-radiation head and neck cancer patients with xerostomia, in comparison with that of a commercially available saliva gel (GC) giving topically

Methods

Objective dry mouth score

Objective swallowing ability score

Results

Discussion

Compliance with ethical standards