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Radiation-Induced Xerostomia in Chinese Patients with Head and Neck Cancer – An Explorative and Interventional study
Jönköping University, School of Health and Welfare, HHJ. ADULT.
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Radiation-induced xerostomia is a common oral complication of patients with head and neck cancer (HNC) undergoing radiotherapy (RT). This can lead to a series of functional oral disorders, particularly dental caries, and ultimately negatively affect their oral health and health-related quality of life (HRQoL).

Aims: The overall aim of this thesis was to understand the living experience of radiation-induced xerostomia and to determine the effects of an integrated supportive program based on multicomponent oral care strategies in Chinese patients with HNC.

Methods: A qualitative descriptive study was conducted to describe how patients (13 men and 7 women) with HNC experienced radiation-induced xerostomia (Ⅰ). A cross-sectional study of patients (n=80) with HNC was conducted to accomplish the validation of the Chinese version of the xerostomia questionnaire (XQ) (Ⅱ). A randomized controlled trial (n=79) was conducted to determine the effect of an integrated supportive program (with a combination of face-to-face health education and coaching sections) on xerostomia, saliva characteristics (Ⅲ), oral health, and HRQoL (IV).

Results: Five categories emerged from the manifest content of the interviews: communication problems, physical problems, psychosocial problems, treatment problems, and relief strategies. The meaning underlying these categories formed a theme, which was the latent content of the interview: Due to lack of information regarding xerostomia, patients had to find their own ways to deal with the problem (Ⅰ). The Chinese version of XQ was a unidimensional scale (1-factor solution explained 75.6 of the total variance) and had good psychometric properties with excellent internal consistency (Cronbach’s α of 0.95), test-retest reliability (intraclass correlation coefficient of 0.92), and good criterion-related validity and content validity (Ⅱ). The integrated supportive program showed significant inter-group differences in xerostomia (P=0.046), unstimulated saliva flow rate (P=0.035), plaque index (P=0.038), Oral Health Impact Profile-14 (P=0.002), and Functional Assessment Cancer Therapy-Head & Neck (P=0.001) over the 12-month follow-up, with better outcomes in the intervention group (Ⅲ & Ⅳ).

Conclusion: This thesis contributes knowledge regarding the experiences of living with xerostomia from a patient perspective, noting that xerostomia has a profound impact on a patient's physical, psychological, and social quality of life. There is lack of assessment tools for xerostomia in the Chinese population, and the Chinese version of XQ proved to be a valid and simple self-administered tool to measure and monitor the xerostomia level in patients with HNC. The integrated supportive program with multicomponent oral care strategies demonstrated positive effects on relieving xerostomia, increasing unstimulated saliva flow rate, and improving their oral health and HRQoL. These findings provide a basis for improvement in the management of xerostomia and oral health of Chinese patients with HNC through the integration of oral care in nursing.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2021. , p. 98
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 108
Keywords [en]
Head and neck cancer, Xerostomia, Integrated supportive program
National Category
Nursing Cancer and Oncology
Identifiers
URN: urn:nbn:se:hj:diva-54724ISBN: 978-91-88669-07-0 (print)OAI: oai:DiVA.org:hj-54724DiVA, id: diva2:1596981
Public defence
2021-10-22, Digital, School of Health and Welfare, Jönköping, 10:00 (English)
Opponent
Supervisors
Available from: 2021-09-23 Created: 2021-09-23 Last updated: 2022-04-07Bibliographically approved
List of papers
1. Experiences of xerostomia after radiotherapy in patients with head and neck cancer: A qualitative study
Open this publication in new window or tab >>Experiences of xerostomia after radiotherapy in patients with head and neck cancer: A qualitative study
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2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 1-2, p. e100-e108Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: To describe the experiences of radiation-induced xerostomia in patients with head and neck cancer.

BACKGROUND: Xerostomia is the most commonly occurring complication during and following radiotherapy. It can persist for several months or years and can have a significant impact on patients' quality of life.

DESIGN: This was a qualitative descriptive study.

METHODS: Semi-structured interviews were conducted with a sample of 20 participants. Inductive content analysis was used to analyse the qualitative data.

RESULTS: Analysis of the manifest content identified five categories: communication problems, physical problems, psychosocial problems, treatment problems and relief strategies. The latent content was formulated into a theme: due to lack of information from professionals, the patients had to find their own solutions for their problems.

CONCLUSIONS: Xerostomia is not only a biophysical symptom but also has a profound effect on the emotional, intellectual and sociocultural dimensions of life. The majority of patients continued to suffer from xerostomia and its associated symptoms after radiotherapy, in part, because of a lack of professional support, including the inability of nurses to provide oral health care.

RELEVANCE TO CLINICAL PRACTICE: Nurses need to be knowledgeable about the effects of radiotherapy on oral mucosa and about appropriate interventions. The healthcare system requires a symptom management platform for radiation-induced complications, to help patients, their families and healthcare professionals obtain information about self-care, treatments and relief strategies.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
cancer, content analysis, oncology nursing, oral care, qualitative study
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-38615 (URN)10.1111/jocn.13879 (DOI)000418871000019 ()28514511 (PubMedID)2-s2.0-85021822353 (Scopus ID)HHJADULTIS, HHJARNIS (Local ID)HHJADULTIS, HHJARNIS (Archive number)HHJADULTIS, HHJARNIS (OAI)
Available from: 2018-01-19 Created: 2018-01-19 Last updated: 2021-09-23Bibliographically approved
2. Assessment of Radiation-Induced Xerostomia: Validation of the Xerostomia Questionnaire in Chinese Patients With Head and Neck Cancer
Open this publication in new window or tab >>Assessment of Radiation-Induced Xerostomia: Validation of the Xerostomia Questionnaire in Chinese Patients With Head and Neck Cancer
Show others...
2021 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 44, no 2, p. E68-E75Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Xerostomia is a common complication in patients with head and neck cancer (HNC) during and after radiotherapy. The lack of a simply-administered and well-validated self-reported instrument has hampered the assessment and management of xerostomia for research and clinical purposes in China. OBJECTIVE: This study aimed to evaluate the content validity and psychometric properties of the Xerostomia Questionnaire (XQ) in Chinese patients with HNC undergoing radiotherapy. METHODS: This psychometric evaluation study enrolled 80 patients and was conducted in 2 stages: translation and evaluation of content validity and psychometric evaluation. Cognitive interviews (n = 10) were conducted using the Participant Interview Form. The psychometric evaluation (n = 80) included score distribution, homogeneity (interitem and item-total correlations), factor structure (exploratory factor analysis), internal consistency (Cronbach's α), criterion-related validity (person correlation), and test-retest reliability (intraclass correlations). RESULTS: Content validity was supported by cognitive interviews. The factor analysis resulted in a 1-factor solution with strong factor loadings (0.84-0.91) that explained 75.6% of the total variance. The internal consistency was excellent, with a Cronbach's α of .95. The XQ correlated strongly with other measures of xerostomia (0.70-0.80), which supports criterion-related validity. The test-retest reliability was excellent (intraclass correlation coefficient = 0.92). CONCLUSIONS: The result provides evidence for the validity and reliability of the XQ in a sample of Chinese patients with HNC. IMPLICATIONS FOR PRACTICE: The XQ can be used in both clinical practice and research as a valuable tool to screen for problems with xerostomia, monitor the xerostomia level, and evaluate the effects of treatment and interventions among patients with HNC.

Place, publisher, year, edition, pages
Wolters Kluwer, 2021
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-52035 (URN)10.1097/NCC.0000000000000751 (DOI)000626002200002 ()31633565 (PubMedID)2-s2.0-85102153510 (Scopus ID)
Available from: 2021-03-17 Created: 2021-03-17 Last updated: 2021-09-23Bibliographically approved
3. The effects of an integrated supportive program on xerostomia and salivary characteristics in patients with head and neck cancer undergoing radiotherapy: a randomized controlled trial
Open this publication in new window or tab >>The effects of an integrated supportive program on xerostomia and salivary characteristics in patients with head and neck cancer undergoing radiotherapy: a randomized controlled trial
(English)Manuscript (preprint) (Other academic)
National Category
Nursing Cancer and Oncology
Identifiers
urn:nbn:se:hj:diva-54720 (URN)
Note

Submitted to journal.

Available from: 2021-09-23 Created: 2021-09-23 Last updated: 2021-09-23
4. The effects of an integrated supportive program on oral health and quality of life in patients with head and neck cancer undergoing radiotherapy: a randomized controlled trial
Open this publication in new window or tab >>The effects of an integrated supportive program on oral health and quality of life in patients with head and neck cancer undergoing radiotherapy: a randomized controlled trial
(English)Manuscript (preprint) (Other academic)
National Category
Nursing Cancer and Oncology
Identifiers
urn:nbn:se:hj:diva-54721 (URN)
Note

Submitted to journal.

Available from: 2021-09-23 Created: 2021-09-23 Last updated: 2021-09-23

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