Assessment of onset and progression of chemoradiotherapy induced oral complications in head and neck cancer patients - A prospective study

Abstract

Background: Patients with head and neck cancer (HNC) undergoing chemoradiotherapy (CRT) are susceptible to acute oral complications that have deleterious effects on oral health, reducing the patients' quality of life. Aim: To assess the onset and progression of oral complications in head and neck cancer patients undergoing chemoradiotherapy. Materials and Method: This was a prospective study conducted among 40 patients with HNC undergoing CRT. Oral complications onset and grades of severity at different time points on a weekly basis for six weeks were assessed. Weekly pairwise comparisons of oral complications was done using the Friedman one-way repeated measure analysis of variance (ANOVA). The Chi-squared test was done in oral candidiasis to determine the significance between groups (P < 0.05). Results: Among 40 HNC patients who completed CRT and showed oral complications, 27 (67.5%) were males and 13 (32.5%) females, with peak age of 51–60 years (40%). All the oral complications had onset first noticed in the second week of CRT except dysphagia that occurred in the first week. A statistically significant difference in oral complications grading during week 1 to week 6 with P < 0.001 was present. All the patients had oral mucositis (OM), xerostomia, and dysgeusia observed in the fourth week, and dysphagia in fifth week. Severity in grading was noticed in the sixth week for all the complications. Candida albicans were more predominantly found in the later weeks as the dose of CRT increased (P < 0.001). Conclusion: In our study, a majority of oral complications had onset by second week of CRT and disease severity progressed in the sixth week of CRT. Awareness of the nature of oral complications by clinicians will aid in developing novel strategies and management in the near future that may help to improve the quality of life of the patient with HNC undergoing CRT.