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Head and neck cancer patients who undergo intensity-modulated radiation therapy (IMRT) are going to develop a side effect called mucositis or dry mouth. Well…not all patients but 98.6% of patients who undergo IMRT.
Mucositis is a common side effect of cancer treatment, particularly for patients undergoing radiation therapy and chemotherapy for head and neck cancer. It occurs due to damage to the mucous membranes lining the digestive tract, including the mouth, throat, and gastrointestinal tract. Here’s how it typically develops in head and neck cancer patients:
As a cancer survivor who has struggled with this side effect since radiation to my neck in 1994, believe me that mucositis is a serious, painful side effect that can cause serious long-term damage to your health.
The bad news is that your oncologist may or may not prepare you for this side effects. The second study linked and excerpted below explains that conventional oncology’s mucositis treatment plan is to either give gabapentin ahead of time or wait for the patient to come to their oncologist once mucositis develops.
The good news is that there are several therapies shown to reduce and possibly heal mucositis.
I include myself in this group. I am not a head and neck cancer survivor but did undergo radiation to my lower neck (C5).
If you have been diagnosed with head and neck cancer and radiation is part of your treatment plan, consider evidence-based non-conventional therapies before, during and after IMRT therapy.
To learn more about evidence-based, non-conventional therapies for mucositis-
Have you been diagnosed with head and neck cancer? Have you already undergone radiation therapy and are experiencing dry mouth? Let me know- David.PeopleBeatingCancer@gmail.com
Thanks,
David Emerson
“Many patients with head and neck cancer develop oral mucositis after intensity-modulated radiation therapy (IMRT), according to a single-center study published in JAMA Network Open.
The study also showed that most cases of oral mucositis were severe, and increasing severity of mucositis was associated with a greater likelihood of feeding tube placement, hospitalization, and opiate use…
The study included 576 patients who underwent definitive or adjuvant IMRT during 2015-2022…
Nearly all patients (98.6%) had oral mucositis, and 62.5% developed severe oral mucositis. By the final week of IMRT,
Overall, 20.8% of patients required hospitalization. Hospitalizations occurred a median of 35 days from the start of IMRT, and the median length of stay was 4 days. The proportion of patients who required hospitalization was 25.0% in those who had severe mucositis and 13.9% in those who did not (P =.001).
The proportion of patients using opiates was 12.2% at the start of IMRT and 50.9% by the end of treatment. The proportion of patients using opiates was 63% among those who had severe mucositis and 35% among those who did not (P <.001).
“These findings suggest that oral mucositis continues to cause morbidity in patients with head and neck cancer, contributing to worse quality of life and financial effects,” the researchers concluded.”
“Management of OM varies greatly at different institutions. Our institutional standard strongly emphasizes oral hygiene, hydration, and nutrition at the start of treatment and uses prescription medications when necessary as patients develop worsening OM symptoms.16
For OM pain control, we prescribe all eligible patients prophylactic gabapentin and recommend alternating between over-the-counter acetaminophen and nonsteroidal anti-inflammatory drugs before prescribing opioids. The use of prophylactic gabapentin is controversial, with multiple studies34–38 showing it can reduce and delay opioid use in patients with HNC, while a placebo-controlled randomized clinical trial39found it to have no pain control benefit.
Consistent with prior reports,4–6 we found severity of OM to be associated with opiate use. Patient pain control continues to worsen during treatment despite opioid prescriptions, indicating better solutions are still desperately needed…”