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Martins AFL, Morais MO, de Sousa-Neto SS, de Jesus APG, Nogueira TE, Valadares MC, Freitas NMA, Batista AC, Leles CR, Mendonça EF. Photobiomodulation reduces the impact of radiotherapy on oral health-related quality of life due to mucositis-related symptoms in head and neck cancer patients. Lasers Med Sci 2020; 36:903-912. [PMID: 33113075 DOI: 10.1007/s10103-020-03167-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
To assess the effectiveness of photobiomodulation therapy (PBMT) in the oral health-related quality of life (OHRQoL) of patients with head and neck cancer undergoing radiotherapy (RT), using the Oral Health Impact Profile-14 (OHIP-14) and the Patient-Reported Oral Mucositis (OM) Symptoms Scale (PROMS), and to correlate OM degree with the PROMS and OHIP-14 scores. Forty-eight patients undergoing RT for head and neck cancer were randomly assigned into two groups: PBMT group (n = 25)-daily PBMT associated with a preventive oral care program (POCP); and control group (n = 23)-receiving POCP exclusively. OHRQoL was assessed using the PROMS and OHIP-14 questionnaires. OM degrees were classified according to the World Health Organization and the National Cancer Institute scales. Assessments were performed at the 1st, 7th, 14th, 21st, and 30th RT sessions. PBMT was effective in preventing and treating severe OM. Both groups showed increased OHRQoL impacts throughout the RT sessions; however, higher impacts were observed in the control group, mainly at the final stage of treatment (21st and 30th RT sessions). Significant correlations were found between the severity of OM and PROMS scores in the total sample and the control group at all RT periods. PROMS and OM scores were positive correlated at 14th, 21st, and 30th RT sessions in the control group, suggesting that this instrument is useful in classifying OM. PBMT was effective in treating and preventing severe OM and OM-related symptoms, and with consequent positive impacts in OHRQoL in head and neck patients undergoing RT. The PROMS scale was helpful instrument for assessment of the severity of OM. Brazilian Clinical Trials database (ReBEC - RBR-5h4y4n), registered in Aug, 24th 2017.
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Affiliation(s)
- Allisson Filipe Lopes Martins
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Marília Oliveira Morais
- Hospital de Câncer Araújo Jorge, R. 239, 206 - Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Sebastião Silvério de Sousa-Neto
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Ana Paula Gonçalves de Jesus
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Tulio Eduardo Nogueira
- Departamento de Prevenção e Reabilitação Oral da Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Marize Campos Valadares
- Laboratório de Farmacologia e Toxicologia Celuular, Faculdade de Farmácia, Universidade Federal de Goiás, 5ª Avenida Esquina com Rua 240, s/n, Setor Universitário, Goiânia, Goiás, 74605-170, Brazil
| | - Nilceana Maya Aires Freitas
- Departamento de Radioterapia, Hospital de Câncer Araújo Jorge, R. 239, 206-Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Aline Carvalho Batista
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Cláudio Rodrigues Leles
- Departamento de Prevenção e Reabilitação Oral da Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Elismauro Francisco Mendonça
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil.
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Martins AFL, Nogueira TE, Morais MO, Oton-Leite AF, Valadares MC, Batista AC, Freitas NMA, Leles CR, Mendonça EF. Effect of photobiomodulation on the severity of oral mucositis and molecular changes in head and neck cancer patients undergoing radiotherapy: a study protocol for a cost-effectiveness randomized clinical trial. Trials 2019; 20:97. [PMID: 30709370 PMCID: PMC6359861 DOI: 10.1186/s13063-019-3196-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/14/2019] [Indexed: 01/28/2023] Open
Abstract
Background Oral mucositis (OM) is the most frequent and debilitating acute side effect associated with head and neck cancer (HNC) treatment. When present, severe OM negatively impacts the quality of life of patients undergoing HNC treatment. Photobiomodulation is a well-consolidated and effective therapy for the treatment and prevention of severe OM, and is associated with a cost reduction of the cancer treatment. Although an increase in the quality of life and a reduction in the severity of OM are well described, there is no study on cost-effectiveness for this approach considering the quality of life as a primary outcome. In addition, little is known about the photobiomodulation effects on salivary inflammatory mediators. Thus, this study aimed to assess the cost-effectiveness of the photobiomodulation therapy for the prevention and control of severe OM and its influence on the salivary inflammatory mediators. Methods/design This randomized, double-blind clinical trial will include 50 HNC patients undergoing radiotherapy or chemoradiotherapy. The participants will be randomized into two groups: intervention group (photobiomodulation) and control group (preventive oral care protocol). OM (clinical assessment), saliva (assessment of collected samples) and quality of life (Oral Health Impact Profile-14 and Patient-Reported Oral Mucositis Symptoms questionnaires) will be assessed at the 1st, 7th, 14th, 21st and 30th radiotherapy sessions. Oxidative stress and inflammatory cytokine levels will be measured in the saliva samples of all participants. The costs are identified, measured and evaluated considering the radiotherapy time interval. The incremental cost-effectiveness ratio will be estimated. The study will be conducted according to the Brazilian public health system perspective. Discussion Photobiomodulation is an effective therapy that reduces the cost associated with OM treatment. However, little is known about its cost-effectiveness, mainly when quality of life is the effectiveness measure. Additionally, this therapy is not supported by the Brazilian public health system. Therefore, this study widens the knowledge about the safety of and strengthens evidence for the use of photobiomodulation therapy, providing information for public policy-makers and also for dental care professionals. This study is strongly encouraged due to its clinical relevance and the possibility of incorporating new technology into public health systems. Trial registration Brazilian Registry of Clinical Trials—ReBEC, RBR-5h4y4n. Registered on 13 June 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3196-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allisson Filipe Lopes Martins
- Department of Oral Pathology, Dentistry Faculty, Federal University of Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Túlio Eduardo Nogueira
- Department of Prevention and Oral Rehabilitation, Dentistry Faculty, Federal University of Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Marília Oliveira Morais
- Department of Stomatology, Araujo Jorge Cancer Hospital , R. 239, 206-Setor Universitário, Goiânia, Goiás, CEP 74175-120, Brazil
| | - Angélica Ferreira Oton-Leite
- Department of Stomatology, Araujo Jorge Cancer Hospital , R. 239, 206-Setor Universitário, Goiânia, Goiás, CEP 74175-120, Brazil
| | - Marize Campos Valadares
- Department of Pharmacology and Cellular Toxicology, Pharmacy Faculty, Federal University of Goiás, 5ª Avenida Esquina com Rua 240, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-170, Brazil
| | - Aline Carvalho Batista
- Department of Oral Pathology, Dentistry Faculty, Federal University of Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Nilceana Maya Aires Freitas
- Department of Radiotherapy, Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiânia, Goiás, CEP 74175-120, Brazil
| | - Cláudio Rodrigues Leles
- Department of Prevention and Oral Rehabilitation, Dentistry Faculty, Federal University of Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Elismauro Francisco Mendonça
- Department of Oral Pathology, Dentistry Faculty, Federal University of Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil.
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