Curative intent radiotherapy (RT), adjuvant or definitive, is required in 70% of Head and Neck Cancer (HNC) diagnoses1. Severe on-treatment toxicities including radiation mucositis are common, especially with concurrent chemotherapy. If not managed effectively, toxicity can lead to malnutrition, morbidity and poorer disease outcomes2. Weight loss (WL) is a surrogate for nutritional status and an independent predictor of overall and disease-specific survival, local tumour control, quality of life and late complications2-8. As such symptom control and nutritional management represents a clinical need to be improved. Several topical and systemic therapies are available to alleviate mucositis-related symptoms but their optimal combination is unknown9-12.
To assess the introduction of a standardised on-treatment radiation mucositis pain management protocol in a HNC Oncology Unit in a large tertiary hospital.
Prospective data was collected pre and post protocol introduction. Primary endpoint was WL from start of RT - 12 weeks following RT. Secondary endpoints were WL from diagnosis, WL during RT, oral mucositis, pain scores, unplanned hospital admissions, enterostomy use and treatment delays. Data was collected throughout treatment, 1 and 3 months post RT.
At preliminary analysis, 74 and 69 patients were enrolled pre and post-protocol, respectively. Groups were not statistically different in demographic, tumour and treatment characteristics. Median percentage WL from start - 12wks post RT improved between groups (12.3% vs. 8.7%) as has median percentage WL on-treatment (9.5% vs. 7.7%). No significant difference in admission rate or median length of stay was noted. Updated results will be presented.
Introduction of a standardised mucositis symptom control pathway for HNC patients receiving curative intent RT has reduced WL and other markers of patient morbidity. Further analysis will be completed to determine the extent to which the protocol influences outcomes. Quality of life analysis and refinement of analgesia pathways continue.