Comparsion of Two Nasopharyngeal Carcinoma Treatments on Oral Mucositis and Related Side Effects

• Main Authors: Pin-Rong Chen, 陳品蓉
• Other Authors: Hsiu-Fang Hsieh
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/92390713851533919522

碩士 === 輔英科技大學 === 護理系碩士班 === 104 === After chemotherapy or radiotherapy, 80 to 90 percent of patients with nasopharyngeal carcinoma suffer from oral mucositis. As the severity of oral symptoms and mucositis progress, the problems of incidence of disease, pain, malnutrition, local or systemic infection, prolonged hospitalization, increased medical cost, and quality of life emerge gradually. We evaluated the difference of oral symptoms and mucositis of providing concurrent chemoradiotherapy compared with induction chemotherapy followed by radiotherapy, and investigate the correlated factors of oral mucositis and prediction of occurrence of severe mucositis. A retrospective case-control study was performed, and collected 206 patients with diagnosis of nasopharygneal carcinoma at a medical center in southern Taiwan from November 2007 to November 2012. We designed a structured collecting chart to register the data of demography, treatment methods, laboratory test values, oral mucosal changes and oral symptoms. The data collection was administered to both groups of patients to investigate the correlated factors of oral mucositis and prediction of occurrence of severe mucositis. Oral mucosal changes were evaluated at 2 (T1), 4, 6, 8 and 10 weeks (T5) after treatment start, and oral symptoms were evaluated at 2(T1), 4, 6, 8 weeks and 6 months (T5) after treatment start, retrospectively. The stastical analysis was performed using SPSS 22.0, including descriptive statistics, chi-square test, Fisher’s exact test, Pearson correlation and linear regression analysis. Comparing with the “induction chemoradiotherapy” group and “concurrent chemoradiotherapy” group, the results reveal: (1) We quantified the severity of oral mucositis as grade 1 to 5, by chi-square test and Fisher’s exact test, the oral mucositis has higher grade. The average grade and its standard deviation were T1(1.3±0.49), T2(1.8±0.28), T3(2.4±0.42), T4(2.6±0.21) and T5(1.5±0.35), retrospectively. (2) Using NCI 3.0 to evaluate oral condition and analysed by linear regression analysis, the mucositis progress at 6 weeks after treatment (28% of the variance) and show high level at 8 weeks after treatment in oral assessment guide (71% of the variance). (3) By Pearson correlation, the total dose of radiation therapy (r=-0.239; p<0.05) and neutropenia (r=0.013/0.039; p<0.05) are correlated factor of oral mucositis in “concurrent chemoradiotherapy” group. (4) At last, the analysis of oral symptoms after treatment for 6 months, there are higher occurrence rate in “concurrent chemoradiotherapy” group with significant difference of dysgeusia (4th week and 6th week; p<0.01), trismus (6th week to 32nd week; p<0.005), dysphagia (6th week and 8th week; p<0.05), pain (4th week to 8th week; p<0.05) and hoarseness (2nd week to 8th week; p<0.01), retrospectively. Therefore, patients of “concurrent chemoradiotherapy” group have higher oral mucositis severity especially in the patients with correlated risk foctor as leukopenia and total dose of radiation therapy, and the patients have more limitation in functions of taste, swallowing and deglutition. The study results can offer oncology nurse an instructive evidence to design oral mucositis screen method and accurate evaluation for preventing malnutrition risk in cancer patients. In order to offer patients and families appropriate plan and preparation in the future, help patient regain health and life quality, and improve nursing care quality and streghthen nursing profession.