Gussgard Anne Margrete, Hope Andrew J, Jokstad Asbjorn, Tenenbaum Howard, Wood Robert
Princess Margaret Hospital, Toronto, Ontario, Canada; Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
Princess Margaret Hospital, Toronto, Ontario, Canada.
PLoS One. 2014 Mar 10;9(3):e91733. doi: 10.1371/journal.pone.0091733. eCollection 2014.
Treatment of oral mucositis (OM) is challenging. In order to develop and test useful treatment approaches, the development of reliable, reproducible and simpler methods than are currently available for assessment of OM is important. A Patient-Reported Oral Mucositis Symptom (PROMS) scale was assessed in patients with head and neck cancer to determine if the patient-reported OM experience, as determined by using the PROMS scale, correlate with OM assessed by clinician-based scoring tools.
Fifty patients with head and neck cancer and undergoing radiotherapy consented to participate. They were examined before cancer treatment and twice weekly during 6-7 weeks of therapy and once 4-6 weeks after therapy. Signs of OM were evaluated using the 3 clinician-based scoring tools; NCI-CTCAE v.3, the OMAS criteria and the Total VAS-OMAS. The participants' OM experiences were recorded using PROMS-questionnaires consisting of 10 questions on a visual analogue scale. Spearman rank correlation test were applied between the PROMS scale values and the clinician-determined scores. Repeated measures mixed linear models were applied to appraise the strengths of correlation at the different time points throughout the observation period.
Thirty-three participants completed all stages of the study. The participant experience of OM using the PROMS scale demonstrates good correlations (Spearman's Rho 0.65-0.78, p<0.001) with the clinician-determined scores on the group level over all time points and poor to good correlations (Spearman's Rho -0.12-0.70, p<0.001) on the group level at different time points during and after therapy. When mouth opening was problematic, i.e. during the 6th and 7th week after commencing cancer treatment, the Spearman's Rho varied between 0.19 and 0.70 (p<0.001).
Patient experience of OM, as reported by the PROMS scale may be a feasible substitute for clinical assessment in situations where patients cannot endure oral examinations.
口腔黏膜炎（OM）的治疗具有挑战性。为了开发和测试有效的治疗方法，开发比目前可用的更可靠、可重复且更简单的OM评估方法很重要。对头颈部癌患者评估了患者报告的口腔黏膜炎症状（PROMS）量表，以确定使用PROMS量表确定的患者报告的OM经历是否与基于临床医生评分工具评估的OM相关。
50名头颈部癌且正在接受放疗的患者同意参与。在癌症治疗前、治疗6至7周期间每周检查两次以及治疗后4至6周检查一次。使用3种基于临床医生的评分工具评估OM体征；美国国立癌症研究所不良事件通用术语标准第3版（NCI-CTCAE v.3）、口腔黏膜炎评估量表（OMAS）标准和总视觉模拟量表-OMAS。使用由10个视觉模拟量表问题组成的PROMS问卷记录参与者的OM经历。在PROMS量表值与临床医生确定的分数之间应用Spearman等级相关检验。应用重复测量混合线性模型来评估整个观察期内不同时间点的相关强度。
33名参与者完成了研究的所有阶段。使用PROMS量表的参与者OM经历在所有时间点的组水平上与临床医生确定的分数显示出良好的相关性（Spearman相关系数为0.65 - 0.78，p<0.001），在治疗期间和治疗后的不同时间点组水平上相关性为差到良好（Spearman相关系数为 -0.12 - 0.70，p<0.001）。当张口有问题时，即在开始癌症治疗后的第6周和第7周，Spearman相关系数在0.19至0.70之间变化（p<0.001）。
PROMS量表报告的患者OM经历在患者无法耐受口腔检查的情况下可能是临床评估的可行替代方法。
