Date of Award

12-2022

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Dr. Shafquat Rozi

Second Advisor

Dr. Farhan Raza Khan

Third Advisor

Dr. Sohail Awan

Department

Community Health Sciences

Abstract

Introduction: Patients after completing their treatment for HNC, are often functionally challenged by the acute and chronic complications in the oral cavity i.e. oral pain, mouth soreness, oral dryness, alteration in the sense of taste, limited tongue movements, speech disturbances, mouth opening and swallowing difficulties due to the aggressive nature of the treatment thereby restricting their food intake, social activity and economic growth, negatively influencing their OHRQoL therefore overall QoL It is important to assess their OHRQoL so that the symptoms commonly and severely affecting these patients can be identified either to modify the existing interventions or to develop strategies to minimize these complications and improving their overall survival.
Objective: This study aims to assess the OHRQoL in patients with head and neck cancer after completion of cancer treatment and to assess the relationship between OHRQoL and clinical parameters such as oral hygiene status and oral mucositis in patients with head and neck cancer within one year after completing their cancer treatment.
Methodology: Cross-sectional study was performed to assess the oral health related quality of life and its associated factors in head and neck cancer survivors coming for their routinely follow up at the ENT and dental clinics of Aga Khan University Hospital. All the potential adult HNC patients who had completed their cancer treatment within the last 12 months, having at least one molar and one incisor in each quadrant and consented to participate were interviewed and examined for oral hygiene status using OHI- simplified and oral mucositis grade using WHO oral mucositis scale at one point in time. Mean OHRQoL score was calculated using EORTC QLQ H&N-35 tool, which was assessed for association with the oral clinical parameters i.e. oral hygiene status and oral mucositis and sociodemographic and treatment related factors on STATA version -16 using Multi Linear Regression Model.
Results: Majority of the study participants were below 52 years (51.9%) married (74.6%), and had an educational level of above matriculation (58.2%). Most participants (58.3%) had stage 3 cancers at the time of diagnosis and 79.7% of the participants received concurrent radiotherapy along with surgery, 60.7% of them were briefed about the oral complications of cancer treatment prior to start of the treatment, majority of the participants 54.4% were not given instructions related to oral hygiene maintenance during and after the cancer treatment by the consulting physician or dental hygienist. 26.58% of the participants had poor oral hygiene status. All the study participants reported presence of varying degree of oral mucositis, 83.54% of them had moderate to severe oral mucositis. The results of the study showed an overall higher mean score for OHRQoL of 25.02 ±15.86, with difficulty in mouth opening, dry mouth because of salivary dysfunction among the most affected domain with highest symptoms scores in the study population. The least affected domain was of senses with the lowest symptom score of 9.9 ± 9.4. We found a significant interaction between oral mucositis and use of fluoride toothpaste which indicated that the estimated mean of OHRQoL was 12.8 ± 7.31units lower for patients who were using fluoride toothpaste having moderate to severe oral mucositis, furthermore, the estimated mean score of OHRQoL was (30.5 ± 4.64, CI -39.8 -- -21.3) lower in respondents with poor oral hygiene status than in participants with good oral hygiene status. BMI, marital status, monthly income and gender were among other significant predicting factors of OHRQoL (p-value < 0.05)
Conclusion: High mean score for OHRQoL was observed for the head and neck cancer patients coming for their routine follow up within one-year post cancer treatment, suggesting poor oral health due to oral complications caused by the cancer treatment. Therefore, it is important evaluate and modify the current treatment modalities and to introduce oral care program for HNC patients who are higher risk of oral consequences of cancer and its treatment to improve their OHRQoL thereby enhancing their overall QoL.

First Page

1

Last Page

108

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