Effect of an Oral Care Protocol on the Physical Symptoms and Quality of Life in Patients with Head and Neck Cancer Treated with Concurrent Radiotherapy and Chemotherapy

Autor: LIN,YA-WEN, 林雅雯
Rok vydání: 2019
Druh dokumentu: 學位論文 ; thesis
Popis: 107
The incidence of head and neck cancer is the fourth highest among men with cancer in Taiwan. Surgery and concurrent radiochemotherapy are the main treatments and oral mucositis is one of the most common side effects. The purpose of this study was to develop a continuous, bidirectional interactive oral care intervention, and to investigate its effects on the physical symptoms of oral mucositis and oral pain, as well as on the quality of life in patients with head and neck cancer undergoing concurrent radiochemotherapy. A quasi-experimental longitudinal study design was conducted in the outpatient department of a radiation oncology clinic at a medical center in northern Taiwan from July 2017 to May 2018. Based on different treatment periods, thirty-two patients in the control group was first selected to receive general routine oral care; then thirty-one patients in the experimental group was selected to receive additional individual oral care programs. The study collected data on oral mucositis, oral pain and quality of life at eight time points during and after concurrent radiochemotherapy. The data were analyzed using one-way repeated measures ANOVA, two-way repeated measures ANOVA, and two-way repeated measures ANCOVA with SPSS 22.0 software. The results of the study showed that, overall, the patients with head and neck cancer experienced non-linear changes in oral mucositis, oral pain, and quality of life. Most of them gradually increased to the highest severity at the end of treatment followed by a decline. However, the levels of severity in most outcome variables at one month after treatment were still never returned to the initial treatment level. In addition, after an additional oral care intervention was implemented, the following results were observed: (1) A statistical difference was not found between 2 groups measured by the World Health Organization (WHO) mucositis grading system scale. However, the increasing score using the Oral Assessment Guide (OAG) was significantly lower in experimental group during the traumatic phase (i.e. treatment period) but declined at a slower rate during the repair phase (one-month period following the end of the treatment) when compared to the control group. (2) There was no significant different between two groups during the traumatic phase, but declined at a slower rate in experimental group during the repair phase. (3) During the traumatic phase, the experimental group experienced better quality of life (lower scores in pain, dry mouth, and discomfort felling) than the control group; and in terms of life quality related olfactory and taste sensation abnormalities, the severity increased in the control group but flatted in the experimental group. During the repair phase, the severity of life quality related dry mouth and saliva viscosities in the experimental group was significantly alleviated compared to the control group. Besides, from the start of the treatment till the fifth week after, the quality of life in sexual life was also better in the experimental group than in the control group. Compared to traditional approach that utilizes leaflet-based guidance, the investigated oral care intervention can better meet patients’ needs. It is recommended to adjust the content of the intervention, such as incorporating telephone interviews during the initial guidance period to ensure patients’ correct implementation, emphasizing the impact of poor oral care to increase patients’ motivation to engage in self-care. This oral care program, if further extended to the routine care of clinical patients, will benefit more patients with head and neck cancer who receive treatment and improve the overall quality of care.
Databáze: Networked Digital Library of Theses & Dissertations
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