Quantification of very late xerostomia in head and neck cancer patients after irradiation

• Published in: Laryngoscope investigative otolaryngology Vol. 7; no. 4; pp. 1018 - 1024
• Main Authors: Blitzer, Grace C., Rogus‐Pulia, Nicole M., Paz, Cristina, Nickel, Kwangok P., Cannaday, Vanessa L., Kelm‐Nelson, Cynthia A., Sudakaran, Sailendharan, Chappell, Richard J., Glazer, Tiffany, Kimple, Randall J.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.08.2022; Wiley
• Subjects: Cancer therapies; Clinical trials; COVID-19; Dysphagia; Enrollments; Head & neck cancer; head and neck cancer; Head and Neck, and Tumor Biology; Mouth; Original Research; Patients; Polymerase chain reaction; Quality of life; Questionnaires; Radiation therapy; Tongue; xerostomia; United States > US; xerostomia; head and neck cancer; quality of life; radiation therapy
• ISSN: 2378-8038; 2378-8038
• DOI: 10.1002/lio2.864

Objective Radiation therapy (RT) for head and neck cancer (HNC) can result in severe xerostomia, or the subjective feeling of dry mouth. Characterizing xerostomia is critical to designing future clinical trials investigating how to improve HNC patients' quality of life (QoL). Few studies have investigated the very late (>5 years post‐RT) effects of RT for HNC. We undertook preliminary studies quantifying very late xerostomia. Methods Six adults who underwent RT for HNC at least 5 years prior and reported xerostomia were enrolled. Five healthy adults without a self‐reported history of HNC or xerostomia were enrolled as controls. All participants completed three validated surveys to measure xerostomia‐related QoL. Salivary production rates were measured and compositional analysis of the saliva and oral microbiome was completed. Results The QoL survey scores for the HNC participants were significantly worse as compared to the control participants. The HNC participants produced less unstimulated saliva (p = .02) but not less stimulated saliva. The median salivary mucin significantly higher in HNC participants than in control participants (p = .02). There was no significant difference between the pH, amylase, or total protein. Microbiome analysis revealed alpha diversity to be significantly lower in the HNC participants. Conclusion In the survivors of HNC who suffer from late toxicities, multiple means of measuring toxicity may be useful. We found that in patients with radiation‐induced xerostomia over 5 years after therapy, not only were the QoL surveys significantly worse, as expected, but other measurements such as mucin and oral microbiome diversity were also significantly different. Level of evidence 3. We undertook preliminary studies quantifying xerostomia as a very late toxicity of radiation in HNC patients for use in a planned clinical trial. We found salivary quality of life surveys to differ significantly even 5 or more years after radiation, as did certain salivary compositional analyses. In the survivors of HNC who suffer from late toxicities, multiple means of measuring toxicity may be useful.