Abstract
Formål
At vurdere mundåbning, nakkebevægelighed, tungebevægelighed, vævsstramhed, smerte, ødem og helbredsrelateret livskvalitet (HRQOL) ved påbegyndelse af strålebehandling hos patienter med cancer cavi oris og cancer oropharyngis.
Baggrund
Behandlingen af hoved-hals kræft er enten operation, stråleterapi/kemoterapi eller en kombination heraf. Senfølgerne af strålebehandling er lymfødem, fibrosedannelse i underhud, muskler og led, og som følge heraf nedsat mundåbning, tunge-, og nakkebevægelighed. Sygdommen og dens behandling har ved flere undersøgelser vist sig at påvirke HRQOL. Der er imidlertid kun foretaget få undersøgelser af funktion inden påbegyndelse af behandling, og der mangler således viden om dette.
Metode
I undersøgelsen deltog 81 patienter med cancer cavi oris og cancer oropharyngis. Deltagerne gennemgik ved start af stråleterapibehandling følgende undersøgelser: Måling af mundåbning målt i cm, aktiv cervical bevægelighed målt i grader, registrering af smerte ved visuel analog skala, ansigts- og hals ødem vurderet ved palpation, tungebevægelighed, stramhed i væv udtrykt ved Likert skala samt HRQOL ved hjælp af EORTC QLQ-C30 og H&N35.
Resultater
Undersøgelsen viste, at 15% af deltagerne havde trismus (cut-off < 3,5cm), 33% havde nedsat tungebevægelighed og 18% havde nedsat cervical lateral flexion, 17% havde nedsat cervical rotation og 18% havde ødem. Funktions scorer i forbindelse med HRQOL var generelt lavere og symptomscorer var højere sammenlignet med normdata. Patienter med cancer cavi oris, tumorstørrelse T3-T4 samt co-morbiditet, havde en højere grad af nedsat tungebevægelighed, dårligere fysisk funktion og en højere grad af problemer (versus patien-ter med cancer oropharyngis, T1-T2 tumorer og ingen co-morbiditet).
Konklusion
Ved påbegyndelse af behandling er der en række funktionelle problemer hos patienter med cancer cavi oris og cancer oropharyngis samt påvirket HRQOL i form af dårli-gere funktion og højere grad af symptomer sammenlignet med norm-data.
ABSTRACT
Pretreatment values concerning functional status and quality of life in patients suffering from cancer of the oral cavity and oropharynx.
Purpose
To assess pretreatment values of mouthopening, cervical range of motion, tongue-movement, tissue tightness, pain, oedema, and health related quality of life (HRQOL) in patients suffering from Head and Neck Cancer.
Background
The treatment of head and neck cancer is either surgery, radiothera-py/chemotherapy or a combination of these. Adverse events from radiotherapy is lymphoe-dema, fibrosis of the skin, muscles and joints leading to reduced mouthopening, tongue movement and cervical range of motion. The disease and its treatment has in several studies revealed an impact on HRQOL. There is however very few studies concerning the assess-ment of pretreatment functional status, and knowledge is sparse.
Method
In all 81 patients suffering from Head and Neck Cancer participated. The partici-pants underwent following examinations: measurement of mouthopening in cm, cervical range of motion measured in degrees, pain measurement by visual analogue scale, facial and neck oedema assessed by palpation, tongue movement, tissue tightness by Likert scale and HRQOL by EORTC QLQ-C30 , H&N35.
Results
Before treatment 15% of the participants had trismus (cut-off <3,5cm), 33% had decreased tongue movement, 18% had decreased cervical lateral flexion, 17% had decreased cervical rotation and 18% had oedema in the head and neck region. HRQOL functional scores were generally lower and the symptom scores were higher compared to normdata. Patients diagnosed with cancer of the oral cavity, tumor size T3-T4 and co-morbidity had a higher degree of decreased tongue movement and had worse physical functioning and a higher degree of problems (versus patients with oropharynx cancer, tumor size T1-T2 and without co-morbidity).
Conclusion
Patients suffering from cancer of the oral cavity and oropharynx seems to be having a wide range of HRQOL and functional deficits before treatment.