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.