Variations in Symptom Severity Patterns Among Oropharyngeal and Laryngeal Cancer Outpatients During Radiation Treatment: A Pilot Study

A qualitative descriptive study of patients' experiences of a radiation skin reaction associated with treatment for a head and neck cancer

The majority of patients receiving radiation therapy will experience a radiation skin reaction, ranging from mild erythema to severe moist desquamation. The anticipated skin reaction will vary by cancer diagnosis, dose of radiation, size of treatment field, and other treatment-and patient-related factors. Recently, research has dispelled long-held myths about avoiding skin care products prior to treatment, and the use of deodorant or antiperspirant during treatment for breast cancer and any potential for an increased skin dose with the use of skin care products. Patients no longer are restricted in using these products. Most of the research regarding skin reactions due to radiation has been conducted with women with breast cancer. No research has been found on the experience of a radiation skin reaction in patients with head and neck cancer (HNC), who often get the most severe skin reactions across all patient groups. Using the qualitative interpretive descriptive approach based on the methodological work by Thorne (1997), nine participants were interviewed about their experience of having a radiation skin reaction resulting from their treatment for HNC. Three themes emerged from the interviews, including 1) the symptom experience, 2) comparison to others, and 3) the experience of support and information. Implications include recommendations for practice and patient education.

Étude qualitative descriptive sur l’expérience des patients avec réactions cutanées induites par la radiothérapie pour un cancer de la tête et du cou

La majorité des patients recevant de la radiothérapie auront une réaction cutanée radio-induite allant d’un érythème léger à une desquamation humide étendue. Les réactions cutanées attendues varieront en fonction du diagnostic de cancer, de la dose et de la taille du champ d’irradiation ainsi que d’autres facteurs liés au traitement et au patient. Récemment, la recherche a dissipé les mythes longtemps entretenus sur les produits pour le soin de la peau qui auraient été à éviter avant le traitement, tout comme le déodorant et l’antisudorifique durant les traitements contre le cancer du sein (on craignait une surdose accrue pour la peau causée par l’utilisation de ces produits). Cette limitation a été levée. Or, la plupart des recherches sur les réactions cutanées radio-induites ont été menées auprès de femmes atteintes d’un cancer du sein; aucune n’a été trouvée sur les patients atteints de cancer de la tête et du cou, alors que de tous les groupes de patients, ce sont très souvent ceux-ci qui présentent les réactions cutanées les plus graves. Nous avons fait appel à la méthode descriptive interprétative qualitative basée sur le travail méthodologique de Thorne (1997) pour interroger neuf participants sur leurs réactions cutanées par suite de radiations pour leur cancer de la tête et du cou. Trois thèmes sont ressortis des entretiens : 1) l’expérience des symptômes; 2) la comparaison avec d’autres; 3) l’expérience du soutien et de l’information. Les implications comprennent des recommandations pour la pratique et l’éducation des patients.

Symptom patterns, physical function and quality of life among head and neck cancer patients prior to and after surgical treatment: A prospective study

PURPOSE

This study aimed to evaluate patterns of symptoms, physical function and quality of life (QoL) among patients with head and neck cancer (HNC) prior to, 3-9 days post-surgery, and one month post-surgery.

METHODS

A prospective, repeated-measures design with consecutively-identified sampling was used to recruit HNC patients undergoing surgical treatment. Data collected included demographic and clinical characteristics, symptoms by M.D. Anderson Symptom Inventory-Head and Neck Module-Chinese version (MDASI-H&N-C), physical function and QoL by Function Subscales of European Cancer Research Treatment Organization Quality of Life Core Scale (EORTC QLQ C30).

RESULTS

105 HNC patients suffered multiple symptoms prior to and after surgery. Pain, difficulty with voice/speech, disturbed sleep and problems with mucus (30.48%~91.43%) were the most prevalent symptoms prior to and post-surgery. Numbers of symptoms as well as specific symptoms, such as fatigue, dry mouth, problems with mucus, pain and disturbed sleep, were significantly associated with poor physical function (p < 0.05). Tracheostomy, feeding tube and age were also linked with poor physical function and poor QoL (p < 0.05).

CONCLUSIONS

Findings of our study underscore the importance of managing symptoms in HNC patients to ensure patients' physical function and QoL prior to and after surgical treatment. Further research should focus on developing targeted interventions for symptoms that are linked to HNC patients' poor physical function and QoL.

Evolution of the Dynamic Symptoms Model

Theories and conceptual models can be thought of as broad nets that attempt to rationalize, explain, and master a phenomenon within clinical nursing and interdisciplinary care. They can be used to guide a review of the literature and to formulate and organize research variables and relationships. Gaps in the literature can be identified and opportunities for additional research revealed (Fawcett, 2005). A variety of symptom models or theories exist, including the Theory of Symptom Management (Dodd et al., 2001), Theory of Unpleasant Symptoms (Lenz, Pugh, Milligan, Gift, & Suppe, 1997), Symptoms Experience Model (Armstrong, 2003), and Symptom Experiences in Time Theory (Henly, Kallas, Klatt, & Swenson, 2003). Most recently, the National Institute of Nursing Research identified a new National Institutes of Health Symptom Science Model to guide symptom science research (Cashion & Grady, 2015).
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