Determination of acute complications of head and neck radiotherapy, their impact on treatment and quality of life
Abstract
Radiotherapy is in common use for managing head and neck cancer
(HNC). As much as it has proven benefits, it also has many adverse
side effects. These side effects may lead to treatment interruption
and a deterioration of the quality of life (QoL) of patients.
Objectives: The aim of this study was to determine the range of
acute morbidity among patients undergoing radiotherapy for head
and neck cancer (HNC) at Kenyatta National Hospital (KNH), as a
consequence of ionizing radiation; and their impact on treatment
and quality of life (QoL).
Design: A descriptive cross-sectional nospttai based study.
Setting: Radiotherapy department of the Kenyatta National
Hospital (KNH).
Material and methods: A total of 64 patients were recruited
among whom 26 patients were evaluated for pattern of occurrence
of side effects, incidence of treatment interruption and the number
of rest days during the interruption. The other 38 patients who had
completed treatment had evaluation of their QoL. Data regarding
acute side effects was obtained using a standardized form. A
standardized head and neck radiotherapy questionnaire was utilised
to collect data for evaluating QoL. This instrument was a
modification of the head and neck radiotherapy questionnaire
(HNRQ) developed by the McMaster University. In evaluating QoL
eight questions were asked to cover symptoms related to the
domains of pain, skin reactions, taste, saliva, chewing, speech,
swallowing and psychosocial issues. The results were analyzed
using the Statistical Package for Social Sciences (SPSS) 11 (SPSS
Inc. Chicago, Illinois, USA). The Fischer's exact test was used to
test for significance of association among variables. The variables
were age, gender, site of tumour and treament interruption.
Results: Twenty six patients (16 male and 10 female) aged
between 21-70 years (mean= 49.6 yrs; SD±15.44) were evaluated
for acute side effects of radiotherapy. Xerostomia (96.8%),
mucositis (88.5%), skin reactions (88.5%) and odynophagia
(84.5%) were found to have been the most frequently occurring
side effects. Half the patients had to have their treatment
interrupted due to severity of side effects. The cumulative radiation
dose received at the time of interruption ranged from 22 to 58Gys.
The number of rest-days during the interruption ranged from 4-30
days.
Thirty eight patients (28 male and to female) aged 21-69 years
(mean 47; SD±13.39) who had completed radiation therapy were
evaluated to determine their QoL. Altered taste (96.6%), mouth
sores and pain (79.4%), dryness of the mouth (71.1%) and
difficulty in swallowing (71.1%) were found to have been the most
debilitating domains of the QoL measured. Nineteen (50%) of the
patients were found to have had a good QoL with the remainder
exhibiting a poor QoL. In this group 16 patients (42.1%) had had
treatment interrupted due to severity of side effects.
In conclusion the severity of acute side effects resulted in treatment
interruption for about half the patients who underwent head and
neck radiotherapy at KNH. This may have grave consequences in
terms of tumour control and hence overall patient survival. There
was also a significant erosion in the QoL of patients who had
completed radiotherapy which calls for measures to be taken to
ameliorate the situation. It is, therefore, recommended that specific
HNC treatment protocols be revised and implemented within the
guidelines of Total Quality Management (TQM).
Studies should be conducted to determine the long-term QoL of
post-radiotherapy patients and its effect on patient survival and also
to determine the effect of frequent treatment interruption on
tumour control at KNH. It is also recommended that the delivery
system for radiotherapy at KNH should be upgraded and that a
study similar to the present one should be done using a larger
sample size.
Citation
Degree of Master of Dental Surgery in Oral and Maxillofacial SurgeryPublisher
University of Nairobi School of Dental Sciences
Description
A dissertation submitted to the
University of Nairobi in partial
fulfillment for the award of the Degree
of Master of Dental Surgery in Oral and
Maxillofacial Surgery