Dissertations / Theses on the topic 'Oral mucositis; radiotherapy; head and neck cancer'

Neste estudo clínico verificaram-se os efeitos do laser em baixa intensidade na prevenção e tratamento da mucosite oral radio e/ou radioquimioinduzida. Foram selecionados 31 pacientes portadores de câncer em cabeça e pescoço a serem submetidos à radioterapia ou a radioterapia em associação a quimioterapia, os quais foram distribuídos aleatoriamente em três grupos: grupo 1 (controle) tratamento medicamentoso; grupo 2 tratamento medicamentoso e laserterapia diária, a partir do início da ulceração referente à mucosite grau 2 e grupo 3 tratamento medicamentoso e laserterapia diária a ser iniciada imediatamente antes do início da radioterapia. Os parâmetros de irradiação foram: comprimento de onda de 660nm, potência de 100mW, modo de operação contínuo, aplicação pontual, energia de 2J por ponto em 30 pontos pré-determinados, sendo o tempo utilizado de 20s por ponto. O grupo controle recebeu tratamento medicamentoso que consistia no uso de um conjunto de medidas preventivas e terapêuticas para abordagem dos efeitos adversos agudos radioinduzidos. Os resultados foram avaliados, quanto à ocorrência, graus e escore de dor associados à mucosite oral, perda de massa corpórea, uso de sonda nasogástrica, necessidade de internação e interrupção do tratamento oncológico decorrentes da mucosite oral. Os resultados indicam que o protocolo de aplicação do laser em sua forma preventiva é o mais efetivo na prevenção e tratamento da mucosite oral e que seu uso diário contribuiu para o alívio da sintomatologia dolorosa colaborando para melhora da qualidade de vida do paciente oncológico.
In this clinical study verified the effects of low intensity laser in the prevention and treatment of oral mucositis radio and/or chemical induced. Thirty one patients with head and neck cancer were selected before being submitted to cancer exclusive radiotherapy or radio and associated chemotherapy. The patients were distributed into three randomly groups as follows: group 1- (control) conventional medicine treatment; group 2 conventional medicine treatment and daily lasertherapy as soon as grade two oral mucositis appeared; group 3 conventional medicine treatment and daily lasertherapy to be initiated immediately before radiotherapy sessions.The irradiation parameters were: wavelength of 660nm, potency of 100mW, continuous mode, punctual application, 2J energy on thirty pre-determined 30 points, with 20s of exposure per point. The control group received medical treatment which consisted in using a set of preventive and therapeutic approach for acute radiation-induced adverse effects. Results were evaluated observing occurrence and grade of oral mucositis, score of pain, loss of body mass, use of nasogastric sound line, internment and interruption of oncologic treatment due to oral mucositis. The results showed that the preventive protocol as used was the most effective in prevention and treatment of oral mucositis and that its daily application contributed in relieving the painful symptomatology so collaborating to maintain and/or bettering the life quality of oncologic patients.

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária
O cancro de cabeça e pescoço representa cerca de 10% dos tumores malignos a nível mundial, e anualmente são diagnosticados sensivelmente 500.000 novos casos em todo o mundo. A nível nacional, o cancro de cabeça e pescoço é uma neoplasia maligna relativamente frequente, sendo responsável por uma taxa de mortalidade elevada. No ano de 2005 e 2006 foram registados 10286 doentes no RORENO, e destes, 1240 eram referentes à cavidade oral e pescoço, sendo as principais localizações na glândula tiroideia, seguida da laringe, esófago, boca (que inclui a gengiva, o pavimento da boca, palato e o trígono retromolar), língua, amígdala, lábio, hipofaringe, nasofaringe, orofaringe e glândulas salivares. Não só o cancro oral produz alterações na cavidade oral, bem como a terapia utilizada para o tratamento dos diversos tipos de neoplasias. A radioterapia é uma das formas terapêuticas utilizada para o tratamento das neoplasias da cabeça e pescoço, porém apesar da sua eficácia esta modalidade terapêutica também promove alguns efeitos adversos, tais como a mucosite, xerostomia, dermatite, disfagia, disgeusia, infecções secundárias, cárie por radiação, trismo, necrose de tecido mole e osteorradionecrose. Estes efeitos colaterais decorrentes da radioterapia estão relacionados com a dose de radiação, a forma de administração, a extensão e a localização da área a ser irradiada, bem como a qualidade e poder de penetração da radiação e dos factores individuais do paciente. Deste modo, os danos da radiação podem manifestar-se gradualmente ao longo de muitos meses ou anos após o terminar do tratamento e/ou ocorrer meses depois do termino da terapia antitumoral. As complicações do cancro de cabeça e pescoço encontram-se entre as mais devastadoras a curto e a longo prazo, por afectarem as actividades humanas mais básicas, tais como alimentar-se e comunicar-se. Assim, é de grande importância que o Médico Dentista, a fim de minimizar os transtornos decorrentes da terapia antitumoral, examine o paciente antes de iniciar o tratamento antineoplásico, e inicie um programa de higiene oral e seja instruído sobre a importância desta higienização no decurso do tratamento oncológico. Assim sendo, é necessário uma equipa multidisciplinar, do qual o Médico Dentista faça parte, de modo a tornar mais digna a vida dos pacientes com este tipo de patologia, ou mesmo prevenir tais complicações surgidas devido à terapêutica. The head and neck cancer represents about 10% of malignant tumors worldwide, and are diagnosed annually substantially 500,000 new cases worldwide. Nationally, the head and neck cancer is a relatively common malignancy, accounting for a high mortality rate. In 2005 and 2006 were 10286 registered patients in RORENO, and of these, 1240 were related to the oral cavity and neck, and the main locations in the thyroid gland, followed by the larynx, esophagus, mouth (including gum, floor of mouth, palate and retromolar trigone), tongue, tonsil, lip, hypopharynx, nasopharynx, oropharynx and salivary glands. Not only oral cancer produces changes in the oral cavity as well as the therapy used for treating various types of neoplasms. Radiation therapy is one way used for the therapeutic treatment of cancers of head and neck, but despite its efficacy, this type of treatment also promotes some adverse effects, such as mucositis, xerostomia, dermatitis, dysphagia, dysgeusia, secondary infections, caries by radiation, trismus, soft tissue necrosis and osteoradionecrosis. These side effects resulting from radiotherapy are related to the radiation dose, the administration form, the extent and location of the area to be irradiated, and the quality and and the penetrating power of the radiation and the individual factors of the patient. This way, the radiation damage may occur gradually over many months or years after the end of the treatment and / or occur months after the end of antitumor therapy. Complications of head and neck cancers are among the most devastating in the short and long term, to affect the most basic human activities such as eating and communicating. Thus, it is very important that the dentist, in order to minimize the problems caused antitumor therapy, examine the patient before starting their treatment, and initiate a program of oral hygiene and instructed on the importance of hygiene during the cancer treatment. Therefore, it is necessary a multidisciplinary team, of which the dentist is an essential part, to make more worthy the life of patients with this type of pathology, or even prevent such complications arising due to therapy.

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária
A terapia fotodinâmica (PDT, do inglês, photodynamic therapy) é uma opção terapêutica recente e valiosa, dirigida para a destruição das células tumorais, com potencial para ser incluída no tratamento principal de combate ao cancro, bem como adjuvante de outras terapêuticas. Atualmente é considerada uma estratégia terapêutica de sucesso, clinicamente, aprovada para o tratamento de lesões potencialmente malignas (LPM) e malignas da cavidade oral. A PDT envolve a administração de um fotossensibilizador (PS, do inglês, photosensitizer) que, por si só, não possui efeito farmacológico. Contudo, este é, posteriormente ativado por irradiação, com luz visível de comprimento de onda (λ) adequado ao local a tratar. Com a foto-ativação do PS ocorre a produção de espécies reativas de oxigénio (ROS, do inglês, reactive oxygen species) que dão inicio à morte celular. O processo está associado com a indução de uma forte reação inflamatória local, potenciando a resposta imunitária e conduzindo à destruição efetiva das células tumorais. O efeito citotóxico ocorre, apenas, no local de ativação da luz e o PS acumula-se preferencialmente nas células malignas, pelo que esta terapêutica apresenta elevada seletividade e um baixo número de efeitos secundários. No contexto clínico, a PDT é utilizada em diversas áreas da medicina como a oftalmologia, a dermatologia e a oncologia, entre outras. No entanto, a sua utilização no tratamento do cancro ainda é limitada.
Photodynamic therapy (PDT) is a new and valuable therapeutic option, directed to the destruction of tumor cells, with the potential to be included in the primary treatment to combat cancer, as well as an adjunct to other therapies. A successful therapeutic strategy, clinically approved for the treatment of premalignant lesions (LPM) and malignant oral cavity is considered currently. PDT involves the administration of a photosensitizer (PS) which, by itself, does not possess pharmacological effect. However, this is subsequently activated by irradiation with visible light of wavelength (λ) appropriate to the site to be treated. With the photo-activation of the PS occurs the production of reactive oxygen species (ROS, English, reactive oxygen species) that give beginning to cell death. The process is associated with the induction of a strong local inflammatory response, enhancing the immune response and leading to the effective destruction of tumor cells. The cytotoxic effect occurs only in the light activation site and the PS accumulates preferentially in malignant cells, whereby this treatment has high selectivity and a low number of side effects. In the clinical context, PDT is used in many areas of medicine such as ophthalmology, dermatology and oncology, among others. However, their use in cancer treatment is still limited.

Head and neck cancer is a heterogeneous group of tumours, of which certain subgroups such as cancer of the mobile tongue frequently are associated with a relatively poor prognosis due to the high risk of regional failure and mortality rates that haven’t improved in a significant way over the last 3 decades, despite advancements in both diagnostics and treatment. Today we lack means to assess the biological aggressiveness of each individual tumour, which varies largely. Treatment comprises of surgery with additional radiotherapy and medical therapies in more advanced tumours. The focus in this thesis is on molecular biomarker expression in head and neck cancer and especially in association with radiotherapy. Increased knowledge paves the way to a more individualized cancer treatment aiming for better outcome and less overtreatment and sequelae. The aims of this thesis was: To map the effects of radiotherapy in both tumour and adjacent tissue for the possible markers hyaluronan, EGFR and mast cells. To investigate whether the expression of hyaluronan in the epithelium and connective tissue stroma and EGFR in the tumour correlates with the risk for developing cervical metastasis in N0 patients, and to find out whether the 3-year tumour-specific survival rates correlates with the expression of HA in the epithelium and EGFR in the tumour. To establish an animal model for radiation-induced mucositis and to use that model to examine the pattern of invading inflammatory cells. To investigate whether the expression of podoplanin in tongue cancer correlates with the risk for cervical metastasis and to determine whether the total amount of lymph vessels in the diagnostic biopsy has any impact on the clinical outcome. To investigate the differences in the metabolome of tongue cancer cell lines with different radiosensitivity. The most important findings of this thesis were: The expression of EGFR and hyaluronan hade the same pattern of expression in both tumour and adjacent tissues before radiotherapy. The expression of EGFR was increased in the epithelium of the adjacent tissue close to the tumour after radiotherapy. The intensity of the staining of hyaluronan was correlated to the 3-year survival rates in patients with tongue cancer. An experimental model for radiation-induced oral mucositis in rat was established and in this model a temporal pattern of macrophage invasion with two different subtypes of macrophages was found. There were no correlation between the expression of podoplanin in the tumour tissue and the cervical metastasis rate in patients with tongue cancer, but the younger patients were more likely to have a higher expression of podoplanin in their tumour than elder patients. Tongue cancer cell lines with different radiosensitivity respond to irradiation with different patterns of metabolic expressions.

Trabalho apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária
O cancro é um problema de saúde pública a nível mundial, devido à sua crescente prevalência, com grande impacto individual e social. Têm-se verificado progressos importantes no tratamento oncológico, aumentando a expectativa de vida dos doentes, pelo que é de extrema importância para a sua recuperação e reintegração na sociedade, melhorar a Qualidade de Vida Relacionada com a Saúde (QdVRS) dos mesmos. A radioterapia é uma das modalidades terapêuticas mais utilizadas no tratamento do patologia oncológica de cabeça e pescoço, podendo estar associada ou não à cirurgia ou quimioterapia. No entanto, apesar do tratamento radioterápico visar atingir apenas as células neoplásicas, pode provocar efeitos secundários nocivos nas células normais da zona irradiada, interferindo na QdVRS do doente ou mesmo alterando a evolução do próprio tratamento. Algumas das complicações mais frequentes da radioterapia na cavidade oral são a xerostomia, mucosite, disfagia, candidose, entre outras. Assim, o Médico Dentista tem um papel fundamental na equipa multidisciplinar de tratamento oncológico, permitindo minimizar a frequência e morbilidade das complicações decorrentes da doença ou do seu tratamento e, consequentemente, melhorar a QdVRS destes doentes. Neste estudo pretende-se avaliar o impacto do tratamento radioterápico na QdVRS dos doentes oncológicos de cabeça e pescoço. Para isso, 91 doentes oncológicos de cabeça e pescoço do Instituto Português de Oncologia Francisco Gentil do Porto (IPOPFG) responderam a dois questionários diferentes sobre QdVRS: EORTC QLQ-C30 (avaliação geral da QdVRS) e QLQ-H&N35 (módulo específico para pacientes com patologia oncológica de cabeça e pescoço). Os resultados obtidos indicam que aquando do diagnóstico, a maioria dos tumores encontra-se em estádios avançados da doença (58.5%), sendo a QdVRS dos homens mais afectada comparativamente à das mulheres. Conclui-se que é de extrema importância a sensibilização da população para o cancro oral e a necessidade de exames de rotina da cavidade oral de modo a permitir o diagnóstico precoce da doença. Due to its increasing prevalence cancer is a public health problem worldwide with huge individual and social impact. There have been significant advances in cancer treatment, increasing patients’ life expectancy. Thus it is of utmost importance to their recovery and reintegration into society to improve patients’ Health-Related Quality of Life (HRQoL). Radiation therapy is one of the most used therapies in the treatment of the head and neck cancer, and may be used together with surgery or chemotherapy. However, despite aiming at targeting only the neoplastic cells, it can cause harmful side effects in normal cells of the radiated area, interfering in the patient's HRQoL or even changing the evolution of the treatment itself. Some of the most frequent complications of radiotherapy in the oral cavity are xerostomy, mucositis, dysphagia, candidiasis, among others. So, the Dentist has a fundamental role in the multidisciplinary team of oncological treatment, minimizing the frequency and morbidity of the complications arising from the disease or its treatment and, consequently, improving the HRQoL of these patients. This study aims to evaluate the impact of radiation treatment on the HRQoL of patients with head and neck cancer. To do this, 91 patients with head and neck cancer being treated at Instituto Português de Oncologia Francisco Gentil (Portuguese Institute of Oncology Francisco Gentil - IPOPFG), in Porto, answered to two different questionnaires on HRQoL: EORTC QLQ-C30 (general assessment of HRQoL) and QLQ-H&N35 (specific module given to patients with head and neck cancer). The results obtained indicate that at the time of diagnosis, most tumors are in advanced stages of the disease (58.5%), the HRQoL of men being more affected when compared to that of women. It is concluded that it is of utmost importance the awareness of the population to oral cancer and the need for routine examinations of the oral cavity to allow for early diagnosis of the disease.

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Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES
Introduction: Malignant neoplasms represent one of the main causes of morbi-mortality in Brazil and worldwide. Radiotherapy, whether associated or not with chemotherapy, is the therapeutic modality most often used for cancer of the head and neck. However, it can trigger reactions at the oral level, such as oral mucositis, the most limiting side effect, with intense pain and difficulty eating, which may require the suspension of oncologic treatment for the patient. Polyhexanide has been used effectively and safely in the treatment of acute and chronic wounds. Objectives: To describe the clinical-epidemiologic profile and investigate the efficacy of polyhexanide in the treatment of oral mucositis and pain relief, in the period of 8-15 days, among patients with cancer of the head and neck undergoing treatment with radiotherapy (whether associated or not with chemotherapy). Methods: A randomized clinical trial was conducted, parallel and double-blind, among patients with cancer of the head and neck undergoing radiotherapy treatment with or without chemotherapy, in the High Complexity Oncology Unit of Feira de Santana, Bahia, who developed oral mucositis, were 18 years of age or older and consented to participation and signed informed consent forms in the period of July 2015 to May 2016. Two equal groups were formed by random allocation?an intervention group (polyhexanide gel) and a control group (gel without polyhexanide). These groups were reevaluated after 8 and 15 days of use of the gels. Clinical exams, evaluations of the medical records, and interviews with the application of a survey instrument used in the study were approved by the Committee for Ethics in Human Subjects Research of the State University of Feira de Santana, under the number 1.074.479/2015. Statistical analysis consisted of relative and absolute frequencies, averages, medians, and standard deviation, and the p-value?considered statistically signification when <0.05?were obtained by non-parametric Friedman tests, Wilcoxon the posts with signs and Wilcoxon-Mann-Whitney. Results: The findings were presented as an article. The mean age was 59.68 years; 58.8% men; 67.6% Brown/Black, and 79.4% with an elementary school education or less. The majority of tumors (64.7%) already presented in advanced stage, and the most frequent were those of the pharynx (23.5%) and the oral cavity (20.4%). Radiotherapy associated with chemotherapy was the most used therapy. Grades III and IV of oral mucositis were the most frequent in the third and fourth weeks of radiotherapy treatment. A total of 34 individuals were accompanied, 17 in the intervention group and 17 in the control group. After a period of 8 to 15 days, statistically significant differences were observed (p<0.05) in relation to the reduction in severity of the oral mucositis and pain, between the time points of gel use in the intervention group. Conclusions: Knowledge of the clinical-epidemiologic profile of patients undergoing oncology treatment with oral mucositis is important to establish potentially effective treatments. In this study polyhexanide represented an effective therapy in the treatment of oral mucositis and relief of pain, with positive results in the first 8 days of use.
As neoplasias malignas representam uma das principais causas de morbimortalidade no Brasil e no mundo. A Radioterapia, associada ou n?o a quimioterapia, ? a modalidade terap?utica mais empregada para o c?ncer de cabe?a e pesco?o. Todavia, pode desencadear rea??es em n?vel bucal, como a mucosite oral, o efeito mais limitante, com dor intensa e dificuldades na alimenta??o, podendo requerer at? a suspens?o do tratamento oncol?gico do paciente. A polihexanida tem sido empregada no tratamento de feridas agudas e cr?nicas, com efic?cia e seguran?a. Objetivos: Descrever o perfil cl?nico-epidemiol?gico e investigar a efic?cia da polihexanida no tratamento da mucosite oral e do al?vio da dor, no per?odo de 8 e 15 dias, em pacientes com c?ncer de cabe?a e pesco?o, sob tratamento com radioterapia associada ou n?o a quimioterapia. M?todos: Realizou-se um ensaio cl?nico randomizado, paralelo e duplo cego, com todos os pacientes com c?ncer de cabe?a e pesco?o sob tratamento com radioterapia associada ou n?o a quimioterapia, na Unidade de Alta Complexidade em Oncologia de Feira de Santana, Bahia, que desenvolveram mucosite oral, tinham 18 anos ou mais de idade e aceitaram participar assinando o termo de consentimento livre e esclarecido, no per?odo de julho de 2015 a maio de 2016. Dois grupos foram igualmente formados por aloca??o aleat?ria, o de interven??o (gel de polihexanida) e o grupo controle (gel sem polihexanida), e reavaliados nos intervalos de 8 e 15 dias de uso dos g?is. Avalia??es cl?nicas, de prontu?rios e entrevistas com aplica??o de formul?rio foram aplicadas neste estudo aprovado pelo Comit? de ?tica em Pesquisa com Seres Humanos da Universidade Estadual de Feira de Santana sob o n?mero 1.074.479/2015. Para a an?lise estat?stica empregaram-se as frequ?ncias relativas e absolutas, m?dias, medianas e desvio-padr?o, e o valor de p, considerado estatisticamente significativo quando ? 0,05 foi obtido por meio dos testes n?o param?tricos de Friedman, Wilcoxon dos postos com sinais e Wilcoxon-Mann-Whitney. Resultados: Os achados foram apresentados em forma de artigo. A m?dia de idade foi de 59,68 anos; 58,8% homens; 67,6% de cor parda e 79,4% analfabetos ou com baixo grau de escolaridade. A maioria (64,7%) dos tumores j? se apresentava em est?dio avan?ado, sendo os mais frequentes os da faringe (23,5%) e cavidade oral (20,4%). A Radioterapia associada ? quimioterapia foi a terap?utica mais empregada. Graus III e IV de mucosite oral foram mais frequentes nas 3? e 4? semanas de tratamento radioter?pico. Um total de 34 indiv?duos foi acompanhado, sendo 17 do grupo de interven??o e 17 do grupo controle. Ap?s um per?odo de 8 e 15 dias, observaram-se diferen?as estatisticamente significativas (p<0,05) em rela??o a redu??o da gravidade da mucosite oral e da dor, entre os tempos de uso do gel no grupo de interven??o. Conclus?es: O conhecimento do perfil cl?nico-epidemiol?gico de pacientes em tratamento oncol?gico com mucosite oral faz-se importante para se estabelecer terap?uticas potencialmente eficazes. Neste estudo a polihexanida apresentou-se como uma terap?utica eficaz no tratamento da mucosite oral e controle da dor, com resultados positivos ainda nos primeiros 8 dias de uso.

Estudo de fase III, prospectivo, aleatorizado e duplo-cego de prevenção de mucosite oral com laser de baixa potência. Foram incluídos pacientes portadores de câncer de cabeça e pescoço, tratados com radioquimioterapia. Grupo A laser 2,5 J/cm2 diariamente durante o tratamento e grupo B laser placebo. Inclusão de 75 pacientes (A/B 37/38). Grau III /IV mucosite: A/B 2a semana (4/5) P=1.0, 4a semana (4/12) P=0.04 e 6a semana (8/9) P=1.0. Interrupções da RT devido à mucosite A/B 0/6 P=0.02. Dor severa A/B 2a semana (5/5), 4a semana (8/8) e 6a semana (8/8) P=1.0. O tratamento com laser foi efetivo, tendo adiado o aparecimento da mucosite severa e reduzido as interrupções da radioterapia.
Phase III, prospective, randomized, double-blind study of oral mucositis prophylaxis by low energy laser. Patients included had a diagnosis of head and neck cancer and were managed with radiochemotherapy. Arm A laser 2.5 J/cm2 daily throughout treatment and B sham laser. Inclusion of 75 patients (A/B 37/38). Grade III /IV mucositis A/B: week 2 (4/5) P=1.0, week 4 (4/12) P=0.04 and week 6 (8/9) P=1.0. Treatment breaks due to mucositis A/B 0/6 P=0.02. Severe pain A/B week 2 (5/5), week 4 (8/8) and week 6 (8/8) P=1.0. Low laser therapy was effective, delaying severe mucositis and reducing radiotherapy breaks.

Oral mucositis is a common and costly consequence of cancer treatment that currently lacks adequate intervention options. Patients treated for head and neck malignancies are at particularly high risk of severe mucositis, which significantly impedes delivery of therapy and consequently results in poorer outcomes in this population. As such, the quantitative objective of this review was to identify the effectiveness of agents and devices for oral mucositis prevention in newly diagnosed adult head & neck cancer patients being treated with radiotherapy with or without chemotherapy. The methodological framework developed by the Joanna Briggs Institute was followed to conduct the review. The quantitative component of the review considered any randomised controlled trials. In the absence of RCTs other research designs, such as non-randomised controlled trials and before and after studies, were considered for inclusion in a narrative summary to enable the identification of current best evidence. Databases were searched for published and non-published studies. A total of 202 studies were retrieved for review, with 81 studies excluded after reading the full article for clearly not meeting the inclusion criteria of the review. Two reviewers independently assessed 123 studies for methodological quality, excluding 51 for a range of reasons including failure to present baseline data, and use of intervention for mucositis treatment rather than prophylaxis. In the final 72 studies, 13 interventions provided sufficient evidence to be combined in meta-analyses. Only 8 interventions provided weak evidence of benefit to prevent oral mucositis in head and neck cancer patients treated with radiotherapy, with or without chemotherapy, including amifsotine (intravenous administration), aloe vera, G-CSF, honey, sucralfate, morning radiotherapy, providone-iodine and Wobe-Mugos E. Honey was the only intervention to significantly reduce severe mucositis during radiotherapy in all studies, indicating that this is a promising agent deserving further investigation. The remaining interventions had either too few studies conducted or conflicting results to make conclusions regarding effectiveness. A lack of studies which examined the same intervention and inconsistency in reporting of outcomes prevented aggregation of study results into statistical meta-analysis for most interventions. Furthermore, a general need for additional well designed, adequately powered studies of interventions contributed to the lack of evidence. Future mucositis intervention studies require appropriate placebo controls and double blinding to increase the level of evidence available for the few promising interventions identified.
Thesis (M.Phil.) -- University of Adelaide, The Joanna Briggs Institute, 2012

Background and aim: Virtually all patients who receive head and neck radiotherapy develop some degree of oral mucositis. Severe oral mucositis may necessitate an interruption of the course of radiotherapy and thus can serve as a dose-limiting factor. Periodontitis is a host-driven inflammatory response to a pathogenic bacterial biofilm in the subgingival environment, resulting in the progressive destruction of the tissues that support the teeth, specifically the gingiva, periodontal ligament, and alveolar bone. This disease affects more than 50% of the population. Considering that radiation-induced oral mucositis and periodontitis are both characterised by the continuing presence of systemic inflammation, they may be associated through a primed inflammatory response as proposed by the “two-hit” model. Alternatively, both conditions may be correlated as they represent a dysregulation of the inflammatory response. To date, no studies have looked into the association between these conditions. The aim of this study is to determine whether the severity of oral mucositis is associated with the severity of periodontitis in cancer patients undergoing head and neck radiotherapy. Materials and methods: Eighty-five consecutive patients seeking dental clearance prior to head and neck radiotherapy were assessed for their eligibility for participation in the study. Forty-one patients met the inclusion criteria. The severity of oral mucositis was measured according to the WHO system. The severity of periodontitis was assessed clinically and radiographically. Gingival crevicular fluid was sampled and levels of eight cytokines were determined using a multiplexed bead immunoassay. The association between radiation-induced oral mucositis and periodontitis was analysed using logistic and linear regression, and two-way contingency tables. Results: The mean age of the whole study population was 63.3 ± 11.0 years (range 44.8 to 82.9 years). The majority of patients were male (73%). The primary tumour site was most commonly the oral cavity and salivary gland (45%), followed by the pharynx (33%) and larynx and others (21%). The duration of radiotherapy was significantly associated with the severity of oral mucositis (p-value=0.038). A trend towards increased pocket depth and clinical attachment levels was noted in patients with oral mucositis grades 1-4, but this was not statistically significant. Conclusion: Patients seeking dental clearance prior to head and neck radiotherapy at the Special Needs Unit, Adelaide Dental Hospital, were a good representation of the general head and neck cancer population. The resultant lack of association between radiation-induced oral mucositis and periodontitis was attributed to the extraction of teeth prior to periodontal examination, lack of uniformity of cancer treatment regimens and lack of statistical power. Hence, larger studies with a tighter inclusion criteria (e.g. similar radiotherapy protocol, without chemotherapy or surgery) are now required to follow-up on these preliminary findings.
Thesis (D.Clin.Dent.) -- University of Adelaide, School of Dentistry, 2014

Radiotherapy is a mainstay treatment modality used for the treatment of more than 80% of patients with head and neck cancer (HNC). Despite the technological advances in radiotherapy delivery, two key limitations remain a challenge for HNC radiotherapy. First, HNC radiotherapy is associated with unacceptable levels of normal tissue toxicities. One of the most frequent and troublesome toxicities is oral mucositis (OM). Radiotherapy-induced OM refers to the inflammation and/or ulceration of the oral mucosa following radiotherapy. It can affect more than 90% of patients with HNC, with varying degrees of severity. The major challenges related to OM are the lack of effective interventions to prevent or treat OM and the lack of a robust predictive marker to predict OM risk. The second limitation of HNC radiotherapy is heterogeneity in patients' response in terms of tumour control and recurrence. Currently, there are no biomarkers to identify patients with a favourable response and those at risk for primary tumour failure or tumour recurrence. Therefore, finding new targets for OM interventions and predictive biomarkers to predict radiotherapy outcomes will help address these limitations of HNC radiotherapy and improve treatment success. Recent years have witnessed a growing interest in the role of the gut microbiome in cancer treatment efficacy and toxicity, including radiotherapy. The gut microbiome, a collection of microorganisms residing in the gastrointestinal tract, plays a central role in the modulation of systemic immune and inflammatory responses. Given that OM is an inflammatory condition and radiotherapy-induced immunogenic cell death is a key pathway by which radiotherapy kills tumour cells, we hypothesised that the gut microbiome may influence both the pathogenesis of OM and radiotherapy response through modulation of immune and inflammatory signalling. As such, this thesis aimed to investigate the impact of the gut microbiome on the development of radiotherapy-induced OM and radiotherapy outcomes in preclinical and clinical settings. Firstly, I investigated this in preclinical studies described in chapters 3-5. In chapter 3, I successfully developed an antibiotic-induced gut microbiota depletion (AIMD) method that allows for studying the development of OM in the absence of major bacterial taxa. In chapter 4, I established a radiation-induced OM model in rats using a single radiation dose of 20 Gy. These two models were used to conduct the main animal study (chapter 5), which demonstrated that the gut microbiome is involved in the pathogenesis of OM, particularly the healing stage, through the modulation of inflammatory cytokines. Lastly, to translate my preclinical findings to the clinical settings, I investigated whether patient pre-treatment gut microbiome is associated with the severity of OM and radiotherapy response in patients with HNC (chapter 6). The results from this clinical study showed that certain microbes in the baseline gut microbiome are associated with OM severity and tumour recurrence. Together, the results from this thesis suggest that the gut microbiome is involved in the pathogenesis of OM and is associated with radiotherapy response offering a potential target to treat or prevent OM and predict treatment outcomes.
Thesis (Ph.D.) -- University of Adelaide, School of Biomedicine, 2021

Objective: Evaluate a patient-reported-oral mucositis scale (PROMS) on its own and in relation to existing measures of mucositis. Methods: 50 patients with head and neck cancer receiving radiotherapy were examined before cancer treatment, twice weekly during 6-7 weeks of therapy and post-therapy. Oral mucositis (OM) signs were evaluated clinically using NCI-CTCAE v.3, OMAS criteria and Total VAS-OMAS score. OM symptoms were recorded on PROMS-VAS questionnaires. Albumin and polymorphonuclear neutrophils were measured in saline rinses. The PROMS data were subjected to Spearman rank correlations versus the other clinical and biomarker data. Results: 33 participants completed the study. Significant correlations (p<.001) were seen between PROMS scores and other clinical and biomarker indicators of OM at a group level. Significant variations were seen between individuals. Conclusion: The PROMS tool demonstrates good correlation with other clinical indicators of OM and adds novel dimensions to currently available methods of assessments used for quantification of OM.

碩士
國立臺北護理健康大學
護理研究所
103
The oral mucosa are the first line of defense for the gastrointestinal system and also a necessary channel for food and fluid intake. 35 to 40% of patients undergoing chemotherapy have oral mucositis. Damaged mucosa can be severely painful for patients, greatly impacting their swallowing, eating, speaking, oral care, and quality of life. This increases risks of local or systemic infection and may also endanger the lives of patients. In severe cases, damaged mucosa may force therapy to be interrupted (Harris, Eilers, Harriman, Cashavelly, & Maxwell, 2008; Molassiotis, 2007). There have been several related studies on oral mucositis prevention in Taiwan and overseas; however, most of them discuss the effect of different mouthwashes on oral mucosa. According to the literature, only 3 studies, all of which are relatively outdated, have focused on the effectiveness of preventing changes associated with oral mucositis by using oral care; there has never been a study, meanwhile, that investigated the effectiveness of preventing and treating oral mucositis using evidence-based oral mucositis nursing guidelines. The Health Promotion Administration, Ministry of Health and Welfare, authorized the Taiwan Oncology Nursing Society to develop the “Oral Mucositis Nursing Guidelines,” which became the research motive for exploring the effectiveness of oral mucositis nursing guidelines for improving oral mucositis in head and neck cancer patients. A quasi-experimental design was adopted for this study using convenience sampling on patients from a medical center who were diagnosed with hematologic cancer and who received intravenous chemotherapy. The first 30 patients that received therapy were recruited as the control group for routine nursing and health education that was originally being adopted in the ward. After all data on the control group was collected, another 30 patients were recruited as the experimental group, who received a systematic, organized, and integral intervention program called “Oral Mucositis Nursing Guidelines.” The purpose of this study was to understand: 1) the effect of participants’ implementation of different oral care programs on oral mucosa; 2) the effect of participants’ implementation of different oral care programs on oral function ; 3) the effect of participants’ implementation of different oral care programs on pain; and 4) the effect of participants’ implementation of different oral care programs on quality of life. The research results can serve as nursing guidelines for treating head and neck cancer patients with oral mucositis who are receiving chemotherapy. The research results showed that patients in the test group experienced less severe oral mucositis using “oral care guidelines” than those in the control group using “conventional oral care” at five, ten, and fourteen days after intervention. The test group had fewer instances of oral mucositis level 2 or greater at ten days after chemotherapy compared to the control group. From day five to ten, patients in the test group also experienced fewer cases of oral mucositis level 2 or greater than patients in the control group. These differences were statistically significant. The increases in the incidence rates of oral mucositis level 2 or greater between ten to fourteen days after chemotherapy were also significantly different. Ten and fourteen days after intervention, oral functionality (including voice, swallowing, lips, tongue, saliva, mucosa, gingiva, and teeth or dentures) for patients in the test group was less affected than that for patients in the control group. These differences were statistically significant. Ten and fourteen days after chemotherapy, the severity of oral pain for patients in the test group was less than that for patients in the control group. Ten and fourteen days after chemotherapy, use of “oral care guidelines” lessened the impact on quality of life (including pain, swallowing, sensation, speech, social dining, social contact, and sexual activities) for patients in the test group compared to patients in the control group. Conclusion: Overall, use of “oral care guidelines” can effectively reduce the severity of oral mucositis and effectively lower the incidence rate for oral mucositis level 2 or greater ten days after intervention. The “oral care guidelines” can also lessen the impact on oral function, reduce the severity of patients’ oral pain, and improve patient quality of life at ten and fourteen days after chemotherapy compared to “conventional oral care.”

碩士
臺北醫學大學
護理學研究所
103
The main purposes of this study are:(1)Analysis of the relevant xerostomia factors in the head-neck cancer patients; (2)Analysis of the relevant mucositis effecting factors in the head-neck cancer patients;(3) Analysis of the correlation between xerotomia and mucositis;(4)Analysis of the disease characteristics in the head-neck patients, as well as the resulted effects to the xerostomia, mucositis, and living qualities;(5) Analysis of the therapy conditions, as well as the resulted effects to the xerostomia, mucositis, and living qualities. This study adopted the longitudinal and correlative research designs. It selected the cases that were complied with the conditions in the treatment room of Radiation Oncology Department in the northern medical center; with totally 38 persons. The “Xerostomia Questionnaire” and “NCI-CTCAE V3.0 Version of Mucositis Evaluation Scale” were filled-in respectively before the performances of radiation therapies in patients (the current weeks), as well as filled-in every week during the therapies(6~7weeks) and after the therapies(1~3weeks); in order to conduct the grading evaluation of clinically inspections on mucositis. Also, the “EORTC QLQ-H&N35 Living Quality Questionnaire” was filled-in before the radiation therapies(the current weeks), during the therapies(Week 5), and after the therapies(Week 3); in order to evaluate the changes of correlations and living qualities of patients during the subjected radiation therapeutic process, xerostomia, and mucositis. After the data were collected, they were statistically analyzed through the descriptive statistics, generalized estimating equation(G.E.E.), and Pearson correlation. The results found that: (1)The demographic variables did not affect the xerostomia levels (p>0.05).(2)The living qualities of smokers are less than the non-smokers (p<0.1). For those who drank before the therapies, their xerostomia conditions are more severe (p<0.05). The highest xerostomia score was reached during the 4~6 weeks of therapies (p<0.05). In the third week after therapies, the mucositis conditions of smokers are more sever (p=0.011). For the diagnosed regions, the scores of oral cancer and oropharyngeal cancer were the highest scores (p<0.05). (3) For the part of therapeutic conditions, the xerostomia scores of those who subjected to the total dose of radiation therapy higher than 6600cGY and those who medicated with mucositis treatment drugs were the highest scores (p<0.05). The more higher xerosomia scores of those who only subjected to CCRT therapy, the more tendency to occur the level 2-5 mucositis. (4) The higher xerostomia scores of those who drank, the more sever of their mucositis (p<0.1). (5) The xerostomia scores did not affect the living qualities. The living qualities of those who have mucositis of grade 2-5 had poorer living qualities (p<0.05). For those elder head-neck patients, their living qualities are better than those younger patients (p<0.05). Those who chewed betel nuts had the poorer living qualities (p<0.001). The living qualities of those who used the Narcotic analgesics had the better living qualities (p<0.028). The living qualities of CCRT therapeutic group had the better living qualities (p<0.001).

碩士
長庚大學
護理學研究所
84
The alterationin oral membrane of cancer patients is a common health promblem which caused by head neck radiotherapy. Approximately 50~78%patients demonstrated the symptoms of : mucositis , oral ulcer , xerostoma , painful of swallowing and chewing , The purposes of this study were to explore the effects of roal care protocol on oral menbrane structure , oral function , WBC and body weight of cancer patients undergone head and neck radiotherapy. A quasi-experiment study (1)Experimental group presented lower alteration in oral mucous structure then control group.(2)Experimental group demonstrated lower alted oral eunction then control groupexcept oral taste.(3)There was no significant difference in WBC change between two group. (4)experimental group had lower body weight change than control group. The results of this study suggested that the oral care protocol can be an affective nursing intervention in clinical setting.

碩士
中臺科技大學
護理系碩士班
105
Half of head and neck cancer patients have oral mucositis when they undergo chemotherapy or radiotherapy with oral mucositis, the patient may feel tenderness oral pain, and some of patients may develop sepsis even death. To give oral hygiene nursing instruction before treatment because an important issue. Multimedia with video instruction maybe and useful tool to help patients realize. The portuuce of oral hygiene whether of using multimedia nursing instruction can reduce oral mucositis in head and neck patients. Head and neck cancer patients who receive CCRT or RT. The patient take the multimedia nursing instruction and control group will take the paper nursing instruction. Total of 66 patients are included, each group will have 33 patients. We will compare the oral mucositis grading and pain severity visual analog scale between these two groups before, 3 weeks, 6 weeks after the nursing instruction. The severity of mucositis and pain are reduced in the multimedia group.Multimedia nursing instruction is a newly developed method and suitable for patient care. The content of the video can be recorded according the different nursing topics, such as oral care guidelines. They are also more easily to understand than the reading instructions. The multimedia nursing instruction may also decrease the loading of nursing staffs and provide adjustable learning time of the patients.

碩士
義守大學
醫務管理學系
105
Objective: This study was examined the mucositis and the quality of life and related factors among patients with head and neck cancer after treatment. Methods: Using a cross-sectional design, 160 patients who were diagnosed head and neck cancer, and recruited from a general hospital in southern Taiwan. Data was collected from January 2016 to May 2017 by face to face interview using a self - reported structured questionnaires. Outcome measurements included the World Health Organization (WHO) oral mucositis grade and the European Cancer Research and Treatment Organization developed the EORTC QLQ-H & N 35 Quality of Life Scale. Results: The top five impact of patients’ quality of life after head and neck cancer treatment were: dry mouth, saliva sticky, pain problems, swallowing problems, and disease awareness. There were a significantly different between oral mucositis grade and cancer staging. There were significant correlation between oral mucositis grade, life-quality pain, swallowing, eating with people, social contact, dry mouth, saliva sticky problems and overall quality of life. There were significant correlation between the frequency of radiotherapy, head and neck pain, swallowing, feeling, dry mouth, and saliva stickiness. In the stepwise regression model, four factors were the predictors of overall global quality of life, included oral mucositis (12%), sex (5%), oral cancer (4%), and hypopharyngeal carcinoma (4%), and account for 25.0% total variance. Conclusions and clinical applications: This study might provide appropriate clinical educational oral care before treatment of patients with head and neck cancer. Health care professionals are responsible to aware the cancer staging, patients sex different, cancer type, and provide appropriate nursing intervention to decrease the oral mucositis after treatment and improve the quality of life.

碩士
高雄醫學大學
口腔衛生科學研究所碩士在職專班
99
BACKGROUND: The modern medical policy has shifted from cure disease to health promotion. The treatment related morbidity usually profoundly affects the QOL of these patients. Thus, the issue of health-related quality of life (QOL) has become more important. OBJECTIVE: The study was designed to evaluate the QOL, oral health status and its prognosticators of head and neck cancer (HNC) patients after radiotherapy (RT). MATERIALS AND METHODS: A cross-sectional study was conducted at a medical center in southern Taiwan. A total 181 patients with completion of RT more than 3 months were enrolled. The questionnaire of EORTC QLQ-C30 and HNC module (EORTC QLQ-H&N35) were used. The prognosticators of QOL were assessed by using t-test or ANOVA and multiple regression. RESULTS: The mean score of “global health status” is 68.9 (SD: 22.1). “Dry mouth” was the most common head and neck related symptoms (53.4±30.9). 81.8% of patients had received initial pre-RT dental care. The regular dental care after RT declined to 34.5%. The factors of significantly affecting general QOL were tumor sites and techniques of RT. For the oral-health related QOL, the factors of significantly affecting teeth problem were female, oral/ oropharynx and hypopharynx/ larynx, posttreatment 3-12 months, conventional RT and 3-D conformal RT; trismus were age >50 years, oral/ oropharynx, posttreatment 3-12 months and 3-D conformal RT. CONCLUSION: QOL of HNC patients was mainly affected by some oral-related symptoms, especially dry mouth and teeth problems. Low compliance of persistent dental care was commonly found. The clinicians should pay more attention to the problems of oral health for the patients to improve their QOL.

碩士
長庚大學
護理學研究所
97
The purposes of this study were to explore the change of severity in oral complications and quality of life in different treatment time point of radiotherapy for patients with head and neck cancer and to evaluate the impact of severity of oral complications on quality of life. This study used a descriptive longitudinal research design. Consecutive sampling was conducted at a medical center in northern Taiwan, and 45 head and neck cancer patients were sampled at six time points: before radiotherapy, and the second, fourth, sixth, eighth, and 12th week after radiotherapy. Severity of oral complications and quality of life was assessed by the Radiation Therapy Oral Complication Severity Scale and European Organization Research and Treatment of Cancer Core Questionnaire of Quality of Life (EORTC QLQ-C30 Chinese version), respectively. Generalized Estimation Equations (GEE) were used for data analysis. The results showed that: (1) the linearity of trend test showed that the overall severity of oral complications and the subscales of symptom significantly increased over the treatment course; whereas the overall quality of life, physical and cognitive functions became significantly worse; (2) the overall severity of oral complications, oral mucositis and xerostomia significantly increased from fourth week of radiotherapy, and the severity of taste change significantly increased from second week of radiotherapy; (3) the overall quality of life, physical and cognitive functions became significantly worse, while there was no significant differences among emotional, social and role functions over the treatment course; (4) the overall severity of oral complications significantly influenced on overall quality of life, physical, emotional, social and cognitive functions but did not impact on the role function in multivariate analyses. In regard to individual oral complication, oral mucositis and xerostomia significantly influenced on overall quality of life and social functions, respectively, and the severity of taste change significantly influenced on emotional and role functions. Therefore, nurses should more carefully assess oral complications and quality of life of head and neck cancer patients during and immediately after their radiotherapy, continuously provide patients with information regarding oral complications of radiotherapy, and effectively manage suffering induced by oral complications of radiotherapy to improve the quality of life of patients with severe oral complications caused by radiotherapy.

博士
高雄醫學大學
牙醫學研究所
97
Radiotherapy (RT) is an effective treatment for radiosensitive head and neck (H&N) cancers, especially for carcinomas of nasopharynx(NPC) and tonsil. It is wildly used either alone or concurrent with chemotherapy. The side effects of RT, particularly the irreversible salivary gland damage and rampant caries severely affects the quality of life of surviving patients, these complications present long-term challenges to both dentists and oncologists. On the other hand, the establishment of an animal caner model for RT will facilitate the development on radiooncological sciences. Therefore, the aim of the fist part of this study was to construct an oral care model of H&N radiotherapy patients. A total of 232 NPC and 62 oral cancer patients underwent regular recall dental examinations and treatments according to a standard protocol of our Dental Department. The mean number of carious tooth of the NPC patient population during/after RT was significantly higher than the population before RT (7.18±7.10 vs. 2.45±2.85; c2= 46.32, p<0.0001). As compared patients using fluoride trays to those without using, the former had a significantly higher rate of dental follow-up compliance (c2=48.56, p<0.0001). Therefore, fluoride tray fabrication is recommended for dentate NPC patients receiving RT. By contrast, the oral cancer RT patients, their caries rate was not related to radiation experience, and their dental compliances were related to their survival condition rather than fluoride trays. Therefore, the oral care model should be modified for NPC and oral cancer patients according to their different treatment modalities. The objective of the second part study was to establish an animal cancer model for RT. Fifty-three hamsters was divided randomly into the experimental groups A, B and control groups C to G. After treating the pouches of groups A and B animals with 7, 12-dimethyl benz[a]anthrance (DMBA) thrice a week for 12 weeks, the heads of the animals received fractionated radiation (7Gy/twice/week) of a total dose of 21Gy and 42Gy with a 6 MV linear accelerator, respectively. The untreated pouches of groups C and D animals were similarly irradiated. The pouches of groups E and F animals were treated with DMBA or mineral oil for 12 weeks, respectively. The pouches of group G animals remained untreated throughout the experiment. The volume of buccal pouches were significantly decreased to 2/3 and less than 1/2 after carcinoma induction and RT in both groups A and B when comparing with group G. There were no obvious mucositis after fractionated radiation in groups C and D. 55.55% in groups A (5 in 9 animals) and 11.11% in B (1 in 9 animals) have visible residual exophytic tumors after RT. Microscopically, the endophytic tumor numbers in group A was significant increased when compared with group E. Both the exophytic tumor and total tumor numbers were decreased for group B animal. There were significant differences on the exophytic tumor and total tumor numbers among groups A, B and E (p<0.0001, p<0.001). Moreover, the main radiogenic killing effect is necrosis, but the residual tumor cells indicating the possibilities of recurrence. Immunohistological examinations showed p53 and iNOS were associated with the radiation-induced apoptosis of the hamster buccal pouches. The radioresistancy of DMBA-induced buccal pouch carcinoma of hamster may be related to over-expression of survivin, an antiapoptosis protein. Although p53 was not expressed in animals receiving high radiation dose, iNOS may increase the radiosensitivity. Furthermore, via TUNEL staining, the early apoptosis was found in serous cells and ductal cells rather than mucous cells of the parotid and submandibular glands, but submandibular glands were more radiosensitive than parotid counterparts. In conclusion, our study indicate that, (1) a pre-RT dental care regimen should be conducted simultaneously with the H&N cancer patient’s treatment plan to treat the disease; (2) the hamster pouch cancer model could be employed to study the fractionated radiation effect on both cancer cells and normal tissues.

碩士
輔仁大學
護理學系碩士班
107
The incidence of head and neck cancer is the fourth highest among men with cancer in Taiwan. Surgery and concurrent radiochemotherapy are the main treatments and oral mucositis is one of the most common side effects. The purpose of this study was to develop a continuous, bidirectional interactive oral care intervention, and to investigate its effects on the physical symptoms of oral mucositis and oral pain, as well as on the quality of life in patients with head and neck cancer undergoing concurrent radiochemotherapy. A quasi-experimental longitudinal study design was conducted in the outpatient department of a radiation oncology clinic at a medical center in northern Taiwan from July 2017 to May 2018. Based on different treatment periods, thirty-two patients in the control group was first selected to receive general routine oral care; then thirty-one patients in the experimental group was selected to receive additional individual oral care programs. The study collected data on oral mucositis, oral pain and quality of life at eight time points during and after concurrent radiochemotherapy. The data were analyzed using one-way repeated measures ANOVA, two-way repeated measures ANOVA, and two-way repeated measures ANCOVA with SPSS 22.0 software. The results of the study showed that, overall, the patients with head and neck cancer experienced non-linear changes in oral mucositis, oral pain, and quality of life. Most of them gradually increased to the highest severity at the end of treatment followed by a decline. However, the levels of severity in most outcome variables at one month after treatment were still never returned to the initial treatment level. In addition, after an additional oral care intervention was implemented, the following results were observed: (1) A statistical difference was not found between 2 groups measured by the World Health Organization (WHO) mucositis grading system scale. However, the increasing score using the Oral Assessment Guide (OAG) was significantly lower in experimental group during the traumatic phase (i.e. treatment period) but declined at a slower rate during the repair phase (one-month period following the end of the treatment) when compared to the control group. (2) There was no significant different between two groups during the traumatic phase, but declined at a slower rate in experimental group during the repair phase. (3) During the traumatic phase, the experimental group experienced better quality of life (lower scores in pain, dry mouth, and discomfort felling) than the control group; and in terms of life quality related olfactory and taste sensation abnormalities, the severity increased in the control group but flatted in the experimental group. During the repair phase, the severity of life quality related dry mouth and saliva viscosities in the experimental group was significantly alleviated compared to the control group. Besides, from the start of the treatment till the fifth week after, the quality of life in sexual life was also better in the experimental group than in the control group. Compared to traditional approach that utilizes leaflet-based guidance, the investigated oral care intervention can better meet patients’ needs. It is recommended to adjust the content of the intervention, such as incorporating telephone interviews during the initial guidance period to ensure patients’ correct implementation, emphasizing the impact of poor oral care to increase patients’ motivation to engage in self-care. This oral care program, if further extended to the routine care of clinical patients, will benefit more patients with head and neck cancer who receive treatment and improve the overall quality of care.