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Daily Time of Radiation Treatment Is Associated with Subsequent Oral Mucositis Severity during Radiotherapy in Head and Neck Cancer Patients.

Authors
  • Gu, Fangyi1
  • Farrugia, Mark K2
  • Duncan, William D3
  • Feng, Yingdong4
  • Hutson, Alan D4
  • Schlecht, Nicolas F5
  • Repasky, Elizabeth A6
  • Antoch, Marina P7
  • Miller, Austin4
  • Platek, Alexis2, 3
  • Platek, Mary E5, 2, 8
  • Iovoli, Austin J3
  • Singh, Anurag K9
  • 1 Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York. [email protected] [email protected]
  • 2 Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
  • 3 University at Buffalo, The State University of New York, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York.
  • 4 Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
  • 5 Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
  • 6 Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
  • 7 Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
  • 8 D'Youville College, Buffalo, New York.
  • 9 Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York. [email protected] [email protected]
Type
Published Article
Journal
Cancer Epidemiology Biomarkers & Prevention
Publisher
American Association for Cancer Research
Publication Date
May 01, 2020
Volume
29
Issue
5
Pages
949–955
Identifiers
DOI: 10.1158/1055-9965.EPI-19-0961
PMID: 32098893
Source
Medline
Language
English
License
Unknown

Abstract

Limited treatment options are available for oral mucositis, a common, debilitating complication of cancer therapy. We examined the association between daily delivery time of radiotherapy and the severity of oral mucositis in patients with head and neck cancer. We used electronic medical records of 190 patients with head and neck squamous cell carcinoma who completed radiotherapy, with or without concurrent chemotherapy, at Roswell Park Comprehensive Cancer Center (Buffalo, NY) between 2015 and 2017. Throughout a 7-week treatment course, patient mouth and throat soreness (MTS) was self-reported weekly using a validated oral mucositis questionnaire, with responses 0 (no) to 4 (extreme). Average treatment times from day 1 until the day before each mucositis survey were categorized into seven groups. Multivariable-adjusted marginal average scores (LSmeans) were estimated for the repeated- and maximum-MTS, using a linear-mixed model and generalized-linear model, respectively. Radiation treatment time was significantly associated with oral mucositis severity using both repeated-MTS (n = 1,156; P = 0.02) and maximum-MTS (n = 190; P = 0.04), with consistent patterns. The severity was lowest for patients treated during 8:30 to <9:30 am (LSmeans for maximum-MTS = 2.24; SE = 0.15), increased at later treatment times and peaked at early afternoon (11:30 am to <3:00 pm, LSmeans = 2.66-2.71; SEs = 0.16/0.17), and then decreased substantially after 3 pm. We report a significant association between radiation treatment time and oral mucositis severity in patients with head and neck cancer. Although additional studies are needed, these data suggest a potential simple treatment time solution to limit severity of oral mucositis during radiotherapy without increasing cost. ©2020 American Association for Cancer Research.

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