Alice Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Support Care Cancer. 2012 Oct;20(10):2335-42. doi: 10.1007/s00520-011-1343-1. Epub 2011 Dec 14.
This study sought to characterize the range of oral symptoms and affect upon quality of life reported by pediatric and adolescent patients in relation to the severity of oral mucositis and symptom burden during chemotherapy.
A multicenter study included 140 patients between 6 and 18 years of age who had been treated with chemotherapy. Participants completed the self-report Mouth and Throat Soreness-related Questions of the Oral Mucositis Daily Questionnaire (OMDQ) for 14 days and the Oral Mucositis-specific Quality of Life Measure (OMQoL) at baseline, day 7, and day 14.
The incidences of non-severe and severe mucositis were 23% (n = 32) and 18% (n = 25), respectively. The symptoms reported by the patients with oral mucositis were related to eating (82.4%), swallowing (78.9%), drinking (75.4%), sleeping (71.9%), and talking (43.9%). Approximately 39% (22 out of 57) of patients with mucositis reported at least two simultaneous symptoms resulting from oral mucositis. About a quarter of them (25%, 14 out of 57) reported having all five symptoms concurrently. The mean area under curve (AUC) scores for symptom severity were significantly higher in the severe mucositis group (mean 0.95 to 1.21; 95% CI 0.76 to 1.34) compared with the non-severe (mean 0.50 to 1.06; 95% CI 0.35 to 1.30) and the without mucositis (mean 0 to 0.09; 95% CI 0 to 0.12) groups (p < 0.001). Wald's method generated two clusters: a low-symptom group (n = 102; 72.9%) and a high-symptom group (n = 38; 27.1%). The high-symptom group reported significantly lower mean AUC OMQoL subscale scores (mean 62.2 to 79.2; 95% CI 55.9 to 88.2 versus mean 93.1 to 97.1; 95% CI 91.7 to 98.3, respectively; p < 0.001) and higher mean AUC distress score (mean 1.9 ± 0.5; 95% CI 1.7 to 2 versus mean 1.1 ± 0.2; 95% CI 1.1 to 1.1, respectively; p < 0.001) than the low-symptom group. Swallowing and sleeping had the strongest standardized coefficients in OMQoL subscale scores (swallowing: -0.321 to -0.767; sleeping: -0.406 to -0.773), as well as distress scores (0.468 and 0.557, respectively).
Severe oral mucositis is a common cause of morbidity in pediatric and adolescent patients undergoing chemotherapy. High-symptom burden due to mucositis may have profound impacts on patient quality of life and levels of psychological distress.
本研究旨在描述儿科和青少年患者在化疗期间口腔黏膜炎严重程度和症状负担与口腔症状和生活质量之间的关系。
一项多中心研究纳入了 140 名年龄在 6 至 18 岁之间接受化疗的患者。参与者在 14 天内完成了口腔黏膜炎每日问卷（OMDQ）的口腔和喉咙疼痛相关问题和口腔黏膜炎特异性生活质量量表（OMQoL）的基线、第 7 天和第 14 天的自我报告。
非严重和严重黏膜炎的发生率分别为 23%（n=32）和 18%（n=25）。口腔黏膜炎患者报告的症状与进食（82.4%）、吞咽（78.9%）、饮水（75.4%）、睡眠（71.9%）和说话（43.9%）有关。约 39%（22/57）的黏膜炎患者报告至少有两种同时发生的口腔黏膜炎相关症状。大约四分之一（25%，14/57）的患者同时报告了所有五种症状。严重黏膜炎组的症状严重程度平均曲线下面积（AUC）评分显著高于非严重组（平均 0.95-1.21；95%置信区间 0.76-1.34）和无黏膜炎组（平均 0-0.09；95%置信区间 0-0.12）（p<0.001）。Wald 法生成了两个聚类：低症状组（n=102；72.9%）和高症状组（n=38；27.1%）。高症状组报告的 OMQoL 亚量表平均 AUC 得分显著较低（平均 62.2-79.2；95%置信区间 55.9-88.2 与平均 93.1-97.1；95%置信区间 91.7-98.3，分别；p<0.001），而平均 AUC 苦恼得分较高（平均 1.9±0.5；95%置信区间 1.7-2 与平均 1.1±0.2；95%置信区间 1.1-1.1，分别；p<0.001）比低症状组。吞咽和睡眠在 OMQoL 亚量表评分（吞咽：-0.321 至-0.767；睡眠：-0.406 至-0.773）和苦恼评分（0.468 和 0.557）方面具有最强的标准化系数。
严重的口腔黏膜炎是儿科和青少年患者化疗期间常见的发病率原因。由于黏膜炎导致的高症状负担可能对患者的生活质量和心理困扰水平产生深远影响。
