Abstract
BackgroundPain due to oral mucositis (OM) is a major problem during concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma (NPC) patients.MethodsWe enrolled 56 NPC patients receiving CCRT and allocated them into two groups: moderate pain group (n = 27) and a severe pain group (n = 29) according to the degree of pain reported (moderate = numerical rating scale (NRS) score 4–6 or severe = NRS score 7–10) at initiation of controlled-release oxycodone (CRO) treatment.ResultsTotal dose of CRO was significantly higher in severe pain patients than in moderate pain patients (791.60 ± 332.449 mg vs. 587.27 ± 194.940 mg; P = 0.015). Moderate pain patients had significantly better quality of life (P = 0.037), lower weight loss (P = 0.030) and more active CCRT response (90.9% vs. 64.0%; P = 0.041). Although 24-h pain control rate was comparable in the two groups (85.2% vs. 86.2%; P = 0.508), the moderate pain group score eventually stabilized at ~ 2 vs. 3 in the severe pain group (P < 0.001); the titration time to reach bearable pain (NRS ≤ 3) was also significantly shorter in moderate pain patients (2.45 ± 0.60 days vs. 3.60 ± 1.98 days; P = 0.012). Incidence of adverse events was comparable in both groups.ConclusionsThe study findings suggest that early introduction of low-dose CRO at the moderate pain stage could help reduce the total dose required, provide better pain control, improve quality of life, and enhance CCRT response.
Highlights
Nasopharyngeal carcinoma (NPC) is usually (> 70%) diagnosed at a locoregionally advanced stage [1,2,3], when the standard treatment is concurrent chemoradiotherapy (CCRT) [4]
The study population was comprised of nasopharyngeal carcinoma (NPC) patients without distant metastasis receiving CCRT at Sun Yat-Sen University Cancer Center in China between May 19, 2015, and January 23, 2018
9 patients were excluded from the full analysis: 3 because they violated the eligibility criteria (change to another analgesic (n = 2), refusal to accept controlled-release oxycodone (CRO) after relief of pain (n = 1)) and 6 because they had serious AEs
Summary
Nasopharyngeal carcinoma (NPC) is usually (> 70%) diagnosed at a locoregionally advanced stage [1,2,3], when the standard treatment is concurrent chemoradiotherapy (CCRT) [4]. About 85%–100% of patients receiving chemoradiotherapy for head-and-neck cancer develop oral mucositis (OM) [5,6,7]. Pain due to oral mucositis (OM) is a major problem during concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma (NPC) patients. Methods We enrolled 56 NPC patients receiving CCRT and allocated them into two groups: moderate pain group (n = 27) and a severe pain group (n = 29) according to the degree of pain reported (moderate = numerical rating scale (NRS) score 4–6 or severe = NRS score 7–10) at initiation of controlled-release oxycodone (CRO) treatment
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