Postradiation trismus in head and neck cancer survivors: a qualitative study of effects on life, rehabilitation, used coping strategies and support from the healthcare system.

PURPOSE: This study aimed to explore the experiences of head and neck cancer (HNC) survivors with postradiation trismus, specifically how oncological treatment affected their lives, rehabilitation, use of coping strategies, and healthcare experiences. METHODS: A qualitative descriptive approach was used and semi-structured interviews of 10 HNC survivors with postradiation trismus were conducted 6-30 months after completing oncological treatment. The interviews were transcribed verbatim and analyzed by qualitative content analysis. RESULTS: The analysis of interviews yielded four main categories: Bodily symptoms, Effects on life, Support from the healthcare system, and Strategies to handle life and symptoms. Participants reported ongoing problems with xerostomia, dysgeusia, eating, and limited physical fitness. Pain related to trismus was not a major issue in this cohort. Participants expressed limitations in their social lives due to their eating difficulties, yet a sense of thankfulness for life and overall satisfaction with the healthcare they received. Psychological and practical coping strategies developed by the participants were also revealed. CONCLUSION: The results highlight areas of unmet need among HNC survivors that healthcare providers can target by establishing multi-professional teams dedicated to individualizing post-cancer rehabilitation care.

Facial pain, health-related quality of life and trismus-related symptoms up to 5 years post-radiotherapy for head and neck cancer.

PURPOSE: Pain is a frequent symptom of head and neck cancer (HNC) but longitudinal studies investigating facial pain are scarce. We aimed to investigate prevalence of facial pain, its effect on health-related quality of life (HRQL) and trismus-related symptoms in a HNC cohort. METHODS: Patients (n = 194) were prospectively followed post completion of radiotherapy (RT). Outcome measures included facial pain, HRQL, trismus-specific symptoms, and maximal interincisal opening (MIO). RESULTS: Facial pain was reported by 50% at baseline. Corresponding figures for 3-, 12-, and 60 months post-RT were 70%, 54% and 41%. Moderate to severe pain was reported in 29-44% of patients reporting pain during the study period. Patients reporting pain scored significantly worse on more HRQL variables and trismus symptoms, as well as had significantly smaller MIO at all follow-up time points. CONCLUSIONS: Facial pain was common in HNC patients pre- and post-RT and remained prevalent up to 5 years after completion of RT. Reductions in MIO were associated with more facial pain. Pain was also associated with worse HRQL.

Trismus, health-related quality of life, and trismus-related symptoms up to 5 years post-radiotherapy for head and neck cancer treated between 2007 and 2012.

PURPOSE: Radiotherapy-induced trismus is present in up to 40% of patients treated radiotherapeutically for head and neck cancer (HNC) and impacts health-related quality of life (HRQL) negatively. This prospective study aimed to investigate the development of trismus and its influence on HRQL and trismus-related symptoms in HNC patients for up to 5 years post-radiotherapy completion as no such follow-up studies exist. METHODS: Patients (n = 211) were followed prospectively from pre-radiotherapy to 12 and 60 months post-radiotherapy. At each follow-up, maximum interincisal opening (MIO) was measured, and patients filled in the European Organization for Treatment of Cancer Quality-of-Life Questionnaire Core-30 (EORTC QLQ-C30), Head and Neck-35 (EORTC QLQ-HN35), and Gothenburg Trismus Questionnaire (GTQ). Trismus was defined as an MIO ≤ 35 mm. RESULTS: At 1 year post-radiotherapy, a total of 27% met the trismus criterion, and at 5 years post-radiotherapy, the corresponding figure was 28%. Patients in the trismus group scored significantly worse compared to the patients without trismus on 8/15 domains at 1 year post-radiotherapy on EORTC QLQ-C30, further worsening in 11/15 domains at 5 years post-radiotherapy. Similar results were found for EORTC QLQ-HN35. Patients with trismus reported more trismus-related symptoms according to the GTQ at both timepoints compared to those without trismus. CONCLUSION: This study highlights that HNC patients suffering from radiotherapy-induced trismus report poorer HRQL and more trismus-specific symptoms compared to patients without trismus. These differences persist and increase up to at least 5 years following treatment completion. Hence, our results highlight that radiotherapy-induced trismus affects long-term HRQL, jaw symptoms, and pain, further stressing the need for early and structured intervention.

A 5-year prospective study of health-related quality of life in irradiated head and neck cancer patients: three trends of HRQL over time.

PURPOSE: Head and neck cancer (HNC) is one of the fastest increasing cancer-types, where both disease and oncologic treatment have severe impact on health-related quality of life (HRQL). This study aimed to report HRQL prospectively up to 5-years following radiotherapy-treatment in HNC and to, if possible, identify trends in HRQL over time. METHODS: This prospective study followed 211 patients receiving curatively intended radiotherapy pre-diagnosis, 3-, 6-, 12- and 60-months post-radiotherapy completion. HRQL was measured using EORTC QLQ-C30 and EORTC QLQ-HN35. RESULTS: A deterioration three months post-radiotherapy was reported in 14/15 domains of EORTC QLQ-C30. Eight out of 12 domains had recovered to baseline-values at 12 months post-radiotherapy and remained unchanged up to study endpoint. Corresponding figures for EORTC QLQ-HN35 were deteriorations in 15/16 domains at three months post-radiotherapy, with recovery of 5 domain at 12-months, whereas the other 11 domains remained significantly worse at 5-years post-RT compared to baseline. CONCLUSION: Following the deterioration in HRQL seen immediately following radiotherapy, the continued course of HRQL can be divided into three trends: short-term deterioration, long-term deterioration and long-term improvements. The combination of disease- and diagnosis-specific questionnaires is crucial when assessing HRQL in the HNC population.

A prospective 5-year study of trismus prevalence and fluctuation in irradiated head and neck cancer patients.

BACKGROUND: Trismus is a complication post-radiotherapy for head and neck cancer (HNC), which causes pain, eating limitations and reduced quality-of-life. However, little is known about the condition long-term or how trismus fluctuates within an irradiated population. AIM/OBJECTIVE: To prospectively map trismus prevalence in irradiated HNC patients up to 5-years following treatment completion including describing intra-group fluctuation of maximum interincisal opening (MIO). MATERIALS AND METHODS: 211 patients receiving curatively intended radiotherapy for HNC were included in this prospective study. Patients were followed pre-radiotherapy (baseline), 3-, 6-, 12-, 24-, 36- and 60-months post-radiotherapy completion using MIO. RESULTS: Mean MIO at baseline, 12-months and 5-years following radiotherapy were 51.5 mm, 41.7 mm and 41.3 mm respectively. A total of 28% (n = 36) fulfilled the trismus criterion at 5-years post-radiotherapy. Eighty percent of patients (n = 24) with trismus at 5 years post-radiotherapy also suffered from trismus at 12 months post-radiotherapy, whilst 88-92% of all patients reported reduced MIO at any given timepoint compared to baseline. 15% of patients never exceeded an MIO of >35 mm at any time-point. CONCLUSION: Trismus is a prevalent long-term complication of HNC and its treatment, which does not appear to heal spontaneously. The majority of fluctuations in MIO occur during the first 12 months post-radiotherapy completion.

The effect of jaw exercises on anxiety and depression in patients with head and neck cancer receiving radiotherapy: Prospective 2-year follow-up study.

BACKGROUND: This nonrandomized matched study investigates jaw exercise effect on anxiety/depressive symptoms in head and neck cancer patients with trismus during 2 years postradiotherapy. METHODS: Fifty patients with trismus postradiotherapy were included in a 10-week jaw-training intervention. A matched control group was included (N = 50). Maximum interincisal opening (MIO) ≤ 35 mm was used as the trismus criterion. Patients were assessed using MIO and Hospital Anxiety Depression Scale preintervention, postintervention, and at 2-year follow-up. RESULTS: A significant difference was found in depressive symptoms between the intervention group and control group (4% vs 33%) at 2-year follow-up, with more control group patients reporting possible depression. In the intervention group, significantly fewer patients had possible/probable depressive symptoms at follow-up (4%) compared to preintervention (34%). No change was seen within the control group. CONCLUSION: Structured jaw exercise in patients with postradiation trismus had positive effects on MIO and depressive symptoms but does not seem to have any significant effects on anxiety symptoms.