Development of an oral assessment tool to evaluate appetite in patients with head and neck cancer receiving radiotherapy.

PURPOSE: The objective of this study was to develop an oral assessment tool for evaluating the appetite of patients with head and neck cancer receiving radiotherapy, who had dysgeusia, xerostomia, and oral mucositis, as well as to verify its validity and reliability. METHODS AND SAMPLE: A draft oral assessment tool, which included a 5-point scale and 19 items, was prepared based on an interview survey of 30 patients. The resultant questionnaire survey was provided to 209 subjects. RESULTS: On the basis of factor analysis of construct validity, 3 factors (dysgeusia and loss of favors), (salivation abnormality and loss of moisture in the oral cavity), and (pain in the oral cavity and lack of motivation) comprising 14 items were adopted for the final survey. During a review of criteria validity, a correlation was found between the scores of the three factors and overall oral assessment tool, and the scores of taste sensitivity, xerostomia, oral mucositis, and appetite with a correlation coefficient of r = 0.41-0.89 (p < 0.01). With regard to reliability, stability was determined as 0.87 (p < 0.01) according to test-retest study results. Internal consistency was confirmed by a Cronbach's alpha coefficient of 0.83 (p < 0.01) and an interclass correlation coefficient of 0.80 (p < 0.01). CONCLUSIONS: On the basis of the validity and reliability of the oral assessment tool developed, it has been found to be practical for use in the assessment of appetite of patients with head and neck cancer.

Adverse effects and appetite suppression associated with particle beam therapy in patients with head and neck cancer.

AIM: This purpose of this study was to investigate the relationship between the appetite and various factors that are associated with particle beam therapy, including the adverse effects of radiation, dry-mouth period, analgesic medication use, frequency of oral care, and participants' characteristics, in 121 patients with head and neck cancer. METHODS: A path analysis was used to evaluate the causal relationship of the factors that affected the participants' appetite. RESULTS: At a cumulative dose of 40 GyE, the factors that impacted the participants' appetite included xerostomia, oral mucositis, age, frequency of oral care, and analgesic medication use. At a cumulative dose of 50 GyE, the factors that affected the participants' appetite were xerostomia, sensitivity to taste, oral mucositis, dry-mouth period (in the morning), frequency of oral care, number of artificial teeth, and analgesic medication use. The results indicate that interventions to avoid appetite suppression during particle beam therapy will differ according to a radiation schedule of 40 GyE, compared to 50 GyE. CONCLUSIONS: These results are important to consider when deciding how best to maintain the dietary intake of patients who are receiving particle beam therapy.

Analysis of causal models of diet for patients with head and neck cancer receiving radiation therapy.

PURPOSE: This study seeks to establish causal models of diet which maintain the appetite of head and neck cancer patients receiving radiation therapy. SAMPLE AND METHODS: We collected data from 208 patients at two radiation doses, 30/50 Gy, using a questionnaire on appetite and analyzed the items using structural equation modeling. RESULTS: In the causal model for 30 Gy, we established a path using the four intervening variables "ease of consuming foods in smooth forms," "ease of consuming foods with a chewable texture and suitable temperature," "ease of consuming lightly seasoned foods with a flavorful smell," and "overall ease of consuming a given meal" from the temporal relationship between "dietary preferences" and "maintaining appetite while caring for the oral cavity." In the causal model for 50 Gy, we established a path between "ease of consuming foods with a mild temperature and smell," and "maintaining appetite while caring for the oral cavity" using the four intervening variables "ease of consuming foods that are easy to swallow," "ease of consuming foods that dissolve well in the mouth," "ease of consuming foods with a mild taste," and "overall ease of consuming a given meal." The goodness of fit indices for both models were above 0.85 for both the goodness of fit index (GFI) and adjusted GFI (AGFI), and less than 0.08 for root mean square error of approximation (RMSEA), indicating a satisfactory goodness of fit. CONCLUSIONS: Food characteristics help to maintain patient appetite at cumulative radiation doses of 30/50 Gy.

Appetite and adverse effects associated with radiation therapy in patients with head and neck cancer.

PURPOSE: The relationship between radiation treatment and adverse effects resulting in changes in appetite was studied in patients with head and neck (H&N) cancer. METHODS AND SAMPLE: Path analysis was used to evaluate the following factors in 117 patients receiving radiation therapy for H&N cancer: daily fluctuations in saliva production, analgesic use, frequency of oral care, subject characteristics, and appetite. RESULTS: At 20 Gy of radiation, appetite was affected by Brinkman index value, age, and sensitivity to taste (R2=0.48, p<0.001); at 30 Gy of radiation, appetite was affected by frequency of oral care, xerostomia symptoms, age, sensitivity to taste, and oral mucositis (R2=0.52, p<0.001); and at 50 Gy of radiation, appetite was affected by low saliva production in the morning, frequency of oral care, xerostomia symptoms, sensitivity to taste, analgesic use, and oral mucositis (R2=0.62, p<0.001). CONCLUSIONS: The results of this study suggest that care taken to avoid a decrease in appetite due to adverse effects of radiation therapy should differ according to the dosage and schedule of radiation therapy. These findings represent important data for health care professionals to understand and support appropriate dietary intake and improved quality of life for H&N cancer patients receiving radiation therapy.