A Cross-sectional Analysis Of Risk Factors For Radiotherapy And Chemotherapy-induced Oral Mucositis

Radiotherapy or chemotherapy may cause Oral Mucosa Inflammatory Lesions. Oral Mucosa Inflammatory Lesions is a kind of inflammatory response in oral cavity, especially the severe injury caused by anti-cancer radiotherapy or chemotherapy, when cancer patients receive radiotherapy or chemotherapy. It can be caused by standard-dose radiotherapy, chemotherapy, and HSCT pretreatment and it will cause the patient's oral mucosa become thinner, even damaged. According to the international standard on anti-cancer drugs' side effect (WHO), Oral Mucosa Inflammatory Lesions caused by radiotherapy or chemotherapy can be divided into five levels by patients'response: Level 0 (No response); LevelⅠ(with mucosal erythema, little hurt, but no effect on taking food and drinking water); LevelⅡ(with erythema and disseminated ulcers, clear hurt, and the patient can take semifluid food only); LevelⅢ(mucosal ulcer and hurt become severer, and the patient can take fluid food only); LevelⅣ(mucosal ulcers become bigger and joined with putrescence, hurt become severe, and the patient cannot take food). Problems on taking food cause malnutrition and lower resistance of the patient, so that the patient has a higher risk to get injected on the whole body, needs to stay in hospital for a longer time, and has to suffer a higher pay. All these will cause bad effects to the patient's HRQOL. According to a new study, 38% of the radiotherapy patients and 42% of the high-dose chemotherapy patients think that oral mucosa inflammatory lesions are the first side effect they suffered most in the radiotherapy or chemotherapy treatment. Among the patients who suffered cancers in the head and neck, oral mucosa inflammatory lesions occur to 85%～100% of the radiotherapy patients, to 90%～100% of the high-dose chemotherapy patients, and to 37% of the patients who suffer cancer in other parts of the body.Objective: By researching on the factors causing radiotherapy-induced or chemotherapy-induced oral mucosa inflammatory lesions, the author tries to provide a scientific basis for preventing and reducing the occurrence of oral mucosa inflammatory lesions. There are a lot of factors which may induce oral mucosa inflammatory lesions. However, the author only select the following twelve factors to do the research: sex, age, dentures, severity of nausea and vomiting, educational evaluations, hospitalization days, whether the chemotherapy plan contains fluorouracil (5-FU), cancer location, PH value in oral cavity, radiation times, leukocyte decreasing degree, and oral evaluation.Methods: At our hospital, select patients who are willing to receive oral evaluation as the research objects, take a close evaluation on each patient by measuring and recording the patient's oral PH value, make a close study on the patient's case, and collect required materials as much as possible. Divide the patients into two groups: One group contains patients who have oral mucosa inflammatory lesions and the other group contains patients who have not oral mucosa inflammatory lesions. Compare the two groups to find the difference on the twelve research factors. Perform X2 check on each factor, and select some factors on which two groups have statistical differences to make a multi-factor logistic regression analysis. All these statistical analysis should be performed with the software SPSS13.0.Results: The occurrence rate of radiotherapy or chemotherapy-induced oral mucosa inflammatory lesions is 34.4%, among which LevelⅠis 16.2% (composition ratio: 47.1%) and LevelⅣis 3.0% (composition ratio: 8.8%). Based on location, the composition ratio is 27.4% for buccal division and 3.2% for hard palate, while the occurrence rate is respectively 17.2% and 2.0%.In the X2 check, the difference has no statistical sense in sex, age, and oral PH value.In the X2 check, the difference has statistical sense in denture, severity of nausea and vomiting, educational evaluations, hospitalization days, whether the chemotherapy plan contains fluorouracil (5-FU), cancer location, radiation times, leukocyte decreasing degree, and oral evaluation.Take factors on which difference has statistical sense in the X2 check as the independent variable, the occurrence of oral mucosa inflammatory lesions as the dependent variable, and perform a multi-factor logistic regression analysis. The factors which finally come into the regression equation are: nausea and vomiting, long hospitalization time, the chemotherapy plan contains fluorouracil (5-FU), cancer locates in the head or neck, leukocyte decreasing degree is high, and the oral evaluation score is high. Conclusion:The occurrence rate of radiotherapy or chemotherapy-induced oral mucosa inflammatory lesions is high up to 34.4%, among which LevelⅠis higher than LevelⅣ. Non-keratinized epithelial tissues such as buccal division and lips are the places where oral mucosa inflammatory lesions occur most often. X2 check shows that sex, age, and oral PH value are not the critical factors which cause oral mucosa inflammatory lesions.Multi-factor logistic regression analysis shows that the following factors are critical in causing oral mucosa inflammatory lesions: nausea and vomiting, long hospitalization time, the chemotherapy plan contains fluorouracil (5-FU), cancer locates in the head or neck, the leukocyte decreasing degree is high, and the oral evaluation score is high.Many nursing workers have not recognized the importance of oral cavity protection, the pain of the patients because of oral mucosa inflammatory lesions, and the negative effects on the treatment results. Some nursing workers do not know how to evaluate the patient's oral cavity and use the traditional experience to do the oral protection for the patients, in short of clinical evidence based on scientific research. Enhancing the training to the nursing workers and paying more attention to the oral evaluation can reduce the occurrence of the oral mucosa inflammatory lesions. The nursing workers can take the corresponding actions according to the factors causing oral mucosa inflammatory lesions, pay more attention to the oral cavity protection, and release the pain for the patients. Enhancing the health education to the patients is also an efficient way to reduce the occurrence of oral mucosa inflammatory lesions.