The Effect of Educational-Care Intervention on the Severity of Mucositis Related to Radiotherapy in Patients with Head and Neck Cancers

Abstract

Background: Radiation therapy-induced oral mucositis is a significant acute side effect in patients with head and neck cancer. Severe mucositis can negatively impact the patient's treatment plan and decrease survival rates. Objectives: This study aimed to evaluate the effect of educational and care interventions on the severity of oral mucositis in patients undergoing radiation therapy for head and neck cancer. Methods: This study was conducted on head and neck cancer patients referred to the chemotherapy and radiotherapy departments of Khatam Al-Anbia and Ali Ibn Abi Talib Hospitals, affiliated with Zahedan University of Medical Sciences, in 2023. A total of 60 participants were selected through convenience sampling and randomly divided into intervention and control groups. Initially, patients in both groups were examined for oral and dental conditions. Oral health was assessed using the Decayed, Missing, and Filled Teeth (DMFT) Index and the Community Periodontal Index of Treatment Needs (CPITN), based on the global WHO standard. The condition of oral mucositis was evaluated upon entry into the study to confirm eligibility. The intervention group received a comprehensive oral and dental care program during their chemotherapy sessions, which consisted of three 45 - 60-minute sessions. In contrast, the control group received routine training. Recognizing the importance of dental health, dental check-ups were performed again before radiotherapy using the DMFT Index, followed by continued monitoring during the radiotherapy period and at the end of radiotherapy to ensure the patients' teeth remained in good condition. At the conclusion of the radiotherapy, the severity of oral mucositis was assessed. Data analysis was performed using SPSS version 27 software, employing paired t-tests, independent t-tests, Fisher’s exact test, Mann-Whitney U, and chi-square tests. A significance level of less than 0.05 was considered statistically significant. Results: An initial examination of oral and dental conditions was conducted using the DMFT Index (Tooth Decay Index) and CPITN Index (Gingival Inflammation Index). Analysis with the independent t-test and Fisher's exact test showed no statistically significant differences between the intervention and control groups (P > 0.46 and P > 0.31, respectively). At the start of radiotherapy, the mean ± standard deviation of the DMFT Index was 16.53 ± 7.56 in the intervention group and 15.13 ± 7.07 in the control group. The independent t-test revealed no significant statistical difference between the two groups (P > 0.46). However, by the end of radiotherapy, a significant difference in the severity of mucositis was observed between the two groups, as determined by the Mann–Whitney U test (P < 0.001). Conclusions: This study underscores the critical role of a collaborative treatment team, including dentists, nurses, and oncologists, in the prevention and management of oral mucositis in patients. By fostering a multidisciplinary approach to patient care, treatment effectiveness, survival rates, and the quality of life for patients can be significantly improved.