The Effects of Multidimensional Individualized Clinical Management (MDICM) in Radiotherapy for Patients with Head and Neck Cancer: A Pilot Study

Abstract

<h3>Purpose/Objective(s)</h3> Radiotherapy (RT) is an important modality for HNC patients. However, RT is prone to radiation mucosal injury, followed by malnutrition, and often accompanied by psychological changes, which may affect the quality of life of patients. This study aims to observe the effects of <b>MDICM</b> on the course of RT in HNC patients. <h3>Materials/Methods</h3> Between January 2021 and November 2021, a total of 90 HNC and nasopharyngeal carcinoma (NPC) patients who received postoperative RT/radical RT consecutively at our center were included in this study. The first 50 cases were assigned to the control group and the whole course of radiotherapy was managed according to the conventional clinical management pathway. The latter 40 patients were assigned to the study group, and accept <b>MDICM</b> in four dimensions: nutrition, psychology, living habits, and symptoms. Patient-Generated Subjective Global Assessment (PG-SGA) was used to assess nutritional status Oral mucositis was graded according to RTOG toxicity criteria. Anxiety scale (PHQ-9), Depression screening scale (GAD-7), and Quality of life scale (QoL-C30) were used to assess anxiety, depression and quality of life. Data were collected before (within 1 week before RT), during (RT 20 times), and after RT (1 month after RT), respectively. <h3>Results</h3> Baseline information (age, disease distribution, nutritional status, anxiety and depression, etc.) was not significantly different between the two groups. During RT, the proportion of moderate-to-severe malnutrition (according to PG-SGA score) was significantly less in the study group than that in the control group (12.0% vs. 50.0%, P = 0.0000). The incidence of severe oral mucositis (G3-4) was significantly less in the study group than that in the control group (4.0% vs. 32.5%, P = 0.019); WHO Nausea and vomiting (0-4), he incidence of nausea and vomiting was significantly less in the research group than in the control group (10.0% vs. 12.5%, 30.0% vs. 42.5%, P = 0.003). In the study group, anxiety and depression were alleviated significantly (PHQ-9 scores, median 15.1 <i>vs</i> 17.2, <i>p</i> = 0.000; GAD-7 scores, median 13.2 <i>vs</i> 17.1 <i>p</i> = 0.000), and the quality of life was improved (QoL-C30 scores, median 5.8 vs 7.2, <i>p</i> = 0.000). <h3>Conclusion</h3> Multidimensional individualized clinical management can significantly improve the radiotherapy treatment experience at nutritional, symptomatic, and psychological levels and the quality of life in HNC patients.