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American Head & Neck Society
July 21-25, 2012
Metro Toronto Convention Centre
Toronto, ON, Canada


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ORAL MUCOSITIS IN HEAD AND NECK CANCER PATIENTS UNDERGOING RADIOTHERAPY RECORDED BY THE USE OF A PATIENT REPORTED ORAL MUCOSITIS SCALE (PROMS) QUESTIONNAIRE.

Presentation: P020
Topic: Larynx/Oral Cavity
Type: Poster
Date: Sunday - Tuesday, July 22 - 24, 2012
Session: Designated Poster viewing times
Authors: Anne M Gussgard, DDS, Robert Wood, DDS PhD, Michael Glogauer, DDS PhD, Andrew Hope, MD, Asbjorn Jokstad, DDS PhD, Howard Tenenbaum, DDS PhD
Institution(s): University of Toronto Faculty of Dentistry & Princess Margaret Hospital, Toronto, Canada

Background
Extensive resources have been spent to find meaningful tools for measuring oral mucositis (OM). A growing consensus is arising that OM should include a standardized instrument, or a combination of instruments that measure physical, functional and patient-perception factors.

Objective:
To evaluate the feasibility of using a patient-reported-oral mucositis scale (PROMS) to complement common clinician-determined assessments of OM in patients receiving radiotherapy for head and neck malignancy.

Hypothesis of study
The relative magnitude of OM assessed by using two commonly used clinician-determined tools, NCI-CTCAE v.3 and the OMAS scale, correlates with patient-reported OM experience as determined using a PROMS questionnaires.

Materials and Methods
50 patients with head and neck cancer receiving radiotherapy were examined before treatment and twice weekly during 6-7 weeks of therapy and post-therapy. Oral mucositis (OM) signs were evaluated using NCI-CTCAE v.3, OMAS criteria and Total VAS-OMAS score. The patient’s OM experience was recorded using PROMS-questionnaires. This questionnaire consists of 10 questions using a previously validated VAS scale. The protocol was approved by the Research Ethics Boards of the University Health Network (#09-0231-CE) and University of Toronto (# 24171) and was conducted at the Princess Margaret Hospital, Toronto. The PROMS data were subjected to Spearman rank correlations versus the clinician-determined data.

Results
Thirty-three participants completed all stages of the study. They reported that the PROMS questionnaire was easy to use. Significant correlations (p<.001) were seen between PROMS scores and clinical indicators of OM at a group level, although on an individual level large variations were seen. Two components of the PROMS instrument, i.e., “Change of Taste” and “Difficulties eating hard foods”, were more affected by OM than the remaining components of this instrument. Moreover, participants reported these two functions were substantially affected 6 weeks after treatment cessation.

• The patient experience of OM using the PROMS aggregate score demonstrates good correlations on the group level over all time points with the clinician-determined scales. (Spearman’s Rho 0.65 - 0.78, p<0.001).
• The patient experience of OM using the PROMS aggregate score demonstrates poor to good correlations on the group level at different time points with the clinician-determined scales. (Spearman’s Rho 0.12 - 0.70, p< 0.001).
• The patient experience of OM using the individual components of the PROMS assessment tool demonstrates fair to good correlations on the group level over all time points with the clinician-determined scales. (Spearman’s Rho 0.30 - 0.77, p< 0.001).
• The patient experience of OM using the individual components of the PROMS assessment tool demonstrates poor to very good correlations on the individual level over all time points with the clinician-determined scales. (Spearman’s Rho 0.06– 1.00, p< 0.001).

Conclusion: The current findings indicating good correlations between the PROMS questionnaire and common clinical assessment tools adding novel dimensions to currently available methods of assessments used for quantification of OM. Patient-reported OM-scores might reflect the OM experience more meaningfully than clinical assessments.
 

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