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Radiation-induced trismus in head and neck cancer patients
338 Abstracts Conclusions: The study suggests that iTRAQ combined with LC-MS/MS may be useful for salivary cancer biomarker discovery.
RADIATION-INDUCED TRISMUS IN HEAD AND NECK CANCER PATIENTS. M.L. Kent,1 M.T. Brennan,1 J.L. Noll,1 P.C. Fox,1 S.H. Burri,2 J.C. Hunter,3P.B. Lockhart.1 1Department of Oral Medicine, 2Southeast Radiation Oncology, 3Department of Otolaryngology, Carolinas Medical Center, Charlotte, NC. Objectives: To determine the prevalence of trismus in patients who had received curative doses of radiation therapy (RT) for head and neck cancer; and secondarily, to assesss if quality of life factors (e.g., opening, chewing, oral/facial pain) were influenced by trismus. We hypothesized that trismus is a common side effect of curative doses of radiation therapy in the head and neck cancer population. Methods: We enrolled patients who had received a curative dose of RT for head and neck cancers (ⱖ 55Gy) that involved the area of the masseter and/or pterygoid muscles. After conducting a limited oral exam, we measured maximum vertical dimension (MVD). Trismus was defined as MVD ⬍35 mm and/or by report of pain with opening. A Common Toxicity Criteria (CTC) Version 3.0 score for trismus was ascertained. Questions were asked regarding facial/oral pain and difficulty opening. Student’s t-test was utilized for continuous variables, and the chi-square test or Fisher exact test was used for dichotomous variables. Results: A total of 30 patients (21 male), mean age 55 (⫾11.5), were enrolled in the study. Fourteen (46%) patients met the criteria for trismus. MVD in the trismus group measured 28.1 mm (⫾ 8.5), and 42.6 mm (⫾ 6.1) in the non-trismus group (p⫽0.0001). Duration of time from completion of RT in the trismus group was 7.6 months (⫾ 9.2), and 25 months (⫾ 36.3) in the non-trismus group (p⫽0.09). There was no significant difference between the trismus and non-trismus groups who had a previous surgical resection. The trismus group reported higher levels of difficulty opening than the non-trismus group; 2.7 (⫾ 1.0) vs. 1.2 (⫾ 0.4), respectively (p⫽0.0002). Pain with chewing was scored as 1.5 (⫾ 0.5) in the trismus group, and 1 (⫾ 0) in the non-trismus group (p⫽0.006). Reports of burning, shooting, or shock-like pains in the mouth or face were no significantly different in the trismus group: 1.6 (⫾ 0.9) vs the non-trismus group 1.2 (⫾ 0.6) (p⫽0.21). The CTC score was significantly higher in the trismus group, 1.7 (⫾ 0.4), than the non-trismus group, 0.6 (⫾ 0.7) (p⫽0.0002). The oral examinations did not reveal differences in clinical caries, and there was no dental infection noted in any of the enrolled subjects. Conclusions: A high prevalence of trismus (47%) was found in the current cohort of cancer patients following ⱖ55Gy to the masseter and/or pterygoid muscles. Patients who experienced trismus had a greater negative impact on quality of life than those without trismus. Supported by: This study was funded by the Department of Oral Medicine of the Carolinas Medical Center in Charlotte, NC.
ORAL AND PHARYNGEAL CANCER: QUALITATIVE PATIENT PERCEPTIONS: CAUSES, DIAGNOSIS, AND OUTCOMES. L.L. Patton, R.P. Strauss, J.R. Elter, J.H. Southerland, J.C. Garner, T.G. Francis. University of North Carolina, Chapel Hill, NC; SciMetrika, LLC, Research Tri-
OOOOE September 2006 angle Park, NC; Veterans Affairs Medical Center, Durham, NC. Oral and pharyngeal cancer (OPC) diagnosis and care present unique sets of challenges for patients. The psychosocial and cultural beliefs of OPC patients are an area that has not received sufficient attention from caregivers, even though these patient perceptions may influence patient care seeking and early diagnosis, treatment compliance, and cancer outcomes. Objectives: The purpose of this pilot study was to qualitatively explore newly diagnosed OPC patient perceptions regarding oral cancer that may have an impact on diagnosis and treatment outcomes. Methods: A convenience sample of newly diagnosed OPC patients undergoing staging evaluation/treatment at the University of North Carolina Hospitals (n⫽46) and the Veterans Affairs Medical Center, Durham, NC (n⫽31) were enrolled. In addition to obtaining patient risk behaviors and sociodemographic data from personal interviews, four open-ended questions were asked as follows: 1. (causes) Do you have any ideas why you got oral cancer? 2. (diagnosis-awareness) What made you aware or know you had an oral cancer? 3. (diagnosis/care-delay) What things might have delayed you in getting care for your oral cancer? 4. (outcomes) What do you think will happen over time to your oral cancer? Responses to open-ended questions were qualitatively analyzed for themes. Characteristics of the initial 77 patients include: 79% male; 62% white; age range 21-83 years with 26% age 65 and older; 66% high school education or less; 79% current or former smokers; and 38% report having had a drinking problem. Results: Regarding causes: Approximately half had no idea why they got oral cancer. Some were still searching for answers. Approximately a third had a correct understanding of their personal risks: for example smoking, drinking, or transplant immunosuppressants. Some held misinformation: cancer caused by false teeth, dental treatment, hot spicy foods, dental infections. Regarding diagnosis-awareness: Although approximately a third of patients had their cancer initially identified by a physician or dentist on routine exam or other symptom-driven exam, most patients self-diagnosed or were suspicious and sought care as a result of a head and neck sign (growth/lump/swelling) or symptom (pain and burning). Regarding diagnosis/care-delay: While approximately a third felt nothing delayed their care, many reported influencing factors including: a lack of awareness of the importance of their diagnosis, difficulty with scheduling and conflicting obligations, fear, cost and insurance issues, and professional delay. Regarding outcomes: Although some expressed uncertainty about the future and the possibility of recurrence, over two-thirds were optimistic that their cancer would be cured. Many relied on their faith. Few were pessimistic, anticipating death, suffering and disfigurement. Conclusions: Among newly diagnosed OPC patients in NC with significant smoking and drinking behaviors, most were unable to explain why they got cancer, yet were optimistic about a cure. Diagnosis was symptom-driven for most, with elements of denial and fear influencing delay, rather than a result of routine examination. Increased opportunities for opportunistic screening and enhanced public awareness of signs and symptoms of OPC are important for early diagnosis and prompt care. Supported by: NIH R21 DE14413 and CDC Prevention Research Center Oral Health Network Small Grant 6405-277LO-B.
RADIATION-INDUCED TRISMUS IN HEAD AND NECK CANCER PATIENTS. M.L. Kent,1 M.T. Brennan,1 J.L. Noll,1 P.C. Fox,1 S.H. Burri,2 J.C. Hunter,3P.B. Lockhart.1 1Department of Oral Medicine, 2Southeast Radiation Oncology, 3Department of Otolaryngology, Carolinas Medical Center, Charlotte, NC. Objectives: To determine the prevalence of trismus in patients who had received curative doses of radiation therapy (RT) for head and neck cancer; and secondarily, to assesss if quality of life factors (e.g., opening, chewing, oral/facial pain) were influenced by trismus. We hypothesized that trismus is a common side effect of curative doses of radiation therapy in the head and neck cancer population. Methods: We enrolled patients who had received a curative dose of RT for head and neck cancers (ⱖ 55Gy) that involved the area of the masseter and/or pterygoid muscles. After conducting a limited oral exam, we measured maximum vertical dimension (MVD). Trismus was defined as MVD ⬍35 mm and/or by report of pain with opening. A Common Toxicity Criteria (CTC) Version 3.0 score for trismus was ascertained. Questions were asked regarding facial/oral pain and difficulty opening. Student’s t-test was utilized for continuous variables, and the chi-square test or Fisher exact test was used for dichotomous variables. Results: A total of 30 patients (21 male), mean age 55 (⫾11.5), were enrolled in the study. Fourteen (46%) patients met the criteria for trismus. MVD in the trismus group measured 28.1 mm (⫾ 8.5), and 42.6 mm (⫾ 6.1) in the non-trismus group (p⫽0.0001). Duration of time from completion of RT in the trismus group was 7.6 months (⫾ 9.2), and 25 months (⫾ 36.3) in the non-trismus group (p⫽0.09). There was no significant difference between the trismus and non-trismus groups who had a previous surgical resection. The trismus group reported higher levels of difficulty opening than the non-trismus group; 2.7 (⫾ 1.0) vs. 1.2 (⫾ 0.4), respectively (p⫽0.0002). Pain with chewing was scored as 1.5 (⫾ 0.5) in the trismus group, and 1 (⫾ 0) in the non-trismus group (p⫽0.006). Reports of burning, shooting, or shock-like pains in the mouth or face were no significantly different in the trismus group: 1.6 (⫾ 0.9) vs the non-trismus group 1.2 (⫾ 0.6) (p⫽0.21). The CTC score was significantly higher in the trismus group, 1.7 (⫾ 0.4), than the non-trismus group, 0.6 (⫾ 0.7) (p⫽0.0002). The oral examinations did not reveal differences in clinical caries, and there was no dental infection noted in any of the enrolled subjects. Conclusions: A high prevalence of trismus (47%) was found in the current cohort of cancer patients following ⱖ55Gy to the masseter and/or pterygoid muscles. Patients who experienced trismus had a greater negative impact on quality of life than those without trismus. Supported by: This study was funded by the Department of Oral Medicine of the Carolinas Medical Center in Charlotte, NC.
ORAL AND PHARYNGEAL CANCER: QUALITATIVE PATIENT PERCEPTIONS: CAUSES, DIAGNOSIS, AND OUTCOMES. L.L. Patton, R.P. Strauss, J.R. Elter, J.H. Southerland, J.C. Garner, T.G. Francis. University of North Carolina, Chapel Hill, NC; SciMetrika, LLC, Research Tri-
OOOOE September 2006 angle Park, NC; Veterans Affairs Medical Center, Durham, NC. Oral and pharyngeal cancer (OPC) diagnosis and care present unique sets of challenges for patients. The psychosocial and cultural beliefs of OPC patients are an area that has not received sufficient attention from caregivers, even though these patient perceptions may influence patient care seeking and early diagnosis, treatment compliance, and cancer outcomes. Objectives: The purpose of this pilot study was to qualitatively explore newly diagnosed OPC patient perceptions regarding oral cancer that may have an impact on diagnosis and treatment outcomes. Methods: A convenience sample of newly diagnosed OPC patients undergoing staging evaluation/treatment at the University of North Carolina Hospitals (n⫽46) and the Veterans Affairs Medical Center, Durham, NC (n⫽31) were enrolled. In addition to obtaining patient risk behaviors and sociodemographic data from personal interviews, four open-ended questions were asked as follows: 1. (causes) Do you have any ideas why you got oral cancer? 2. (diagnosis-awareness) What made you aware or know you had an oral cancer? 3. (diagnosis/care-delay) What things might have delayed you in getting care for your oral cancer? 4. (outcomes) What do you think will happen over time to your oral cancer? Responses to open-ended questions were qualitatively analyzed for themes. Characteristics of the initial 77 patients include: 79% male; 62% white; age range 21-83 years with 26% age 65 and older; 66% high school education or less; 79% current or former smokers; and 38% report having had a drinking problem. Results: Regarding causes: Approximately half had no idea why they got oral cancer. Some were still searching for answers. Approximately a third had a correct understanding of their personal risks: for example smoking, drinking, or transplant immunosuppressants. Some held misinformation: cancer caused by false teeth, dental treatment, hot spicy foods, dental infections. Regarding diagnosis-awareness: Although approximately a third of patients had their cancer initially identified by a physician or dentist on routine exam or other symptom-driven exam, most patients self-diagnosed or were suspicious and sought care as a result of a head and neck sign (growth/lump/swelling) or symptom (pain and burning). Regarding diagnosis/care-delay: While approximately a third felt nothing delayed their care, many reported influencing factors including: a lack of awareness of the importance of their diagnosis, difficulty with scheduling and conflicting obligations, fear, cost and insurance issues, and professional delay. Regarding outcomes: Although some expressed uncertainty about the future and the possibility of recurrence, over two-thirds were optimistic that their cancer would be cured. Many relied on their faith. Few were pessimistic, anticipating death, suffering and disfigurement. Conclusions: Among newly diagnosed OPC patients in NC with significant smoking and drinking behaviors, most were unable to explain why they got cancer, yet were optimistic about a cure. Diagnosis was symptom-driven for most, with elements of denial and fear influencing delay, rather than a result of routine examination. Increased opportunities for opportunistic screening and enhanced public awareness of signs and symptoms of OPC are important for early diagnosis and prompt care. Supported by: NIH R21 DE14413 and CDC Prevention Research Center Oral Health Network Small Grant 6405-277LO-B.