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Chen R, Xie J, Chen J, Li X, Lin Q, Xu Q, Chen Y, Wang L, Zheng R, Xu B. Analysis of the Parotid Glands on an Energy Spectrum CT Iodine Map to Evaluate Irradiation-Induced Acute Xerostomia in Patients With Nasopharyngeal Carcinoma. Technol Cancer Res Treat 2024; 23:15330338241256814. [PMID: 38773777 PMCID: PMC11113032 DOI: 10.1177/15330338241256814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/15/2024] [Accepted: 05/02/2024] [Indexed: 05/24/2024] Open
Abstract
Objective: This prospective study aims to evaluate acute irradiation-induced xerostomia during radiotherapy by utilizing the normalized iodine concentration (NIC) derived from energy spectrum computed tomography (CT) iodine maps. Methods: In this prospective study, we evaluated 28 patients diagnosed with nasopharyngeal carcinoma. At 4 distinct stages of radiotherapy (0, 10, 20, and 30 fractions), each patient underwent CT scans to generate iodine maps. The NIC of both the left and right parotid glands was obtained, with the NIC at the 0-fraction stage serving as the baseline measurement. After statistically comparing the NIC obtained in the arterial phase, early venous phase, late venous phase, and delayed phase, we chose the late venous iodine concentration as the NIC and proceeded to analyze the variations in NIC at each radiotherapy interval. Using the series of NIC values, we conducted hypothesis tests to evaluate the extent of change in NIC within the parotid gland across different stages. Furthermore, we identified the specific time point at which the NIC decay exhibited the most statistically significant results. In addition, we evaluated the xerostomia grades of the patients at these 4 stages, following the radiation therapy oncology group (RTOG) xerostomia evaluation standard, to draw comparisons with the changes observed in NIC. Results: The NIC in the late venous phase exhibited the highest level of statistical significance (P < .001). There was a noticeable attenuation in NIC as the RTOG dry mouth grade increased. Particularly, at the 20 fraction, the NIC experienced the most substantial attenuation (P < .001), a significant negative correlation was observed between the NIC of the left, right, and both parotid glands, and the RTOG evaluation grade of acute irradiation-induced xerostomia (P < .001, r = -0.46; P < .001, r = -0.45; P < .001, r = -0.47). The critical NIC values for the left, right, and both parotid glands when acute xerostomia occurred were 0.175, 0.185, and 0.345 mg/ml, respectively, with AUC = 0.73, AUC = 0.75, and AUC = 0.75. Conclusion: The NIC may be used to evaluate changes in parotid gland function during radiotherapy and acute irradiation-induced xerostomia.
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Affiliation(s)
- Runfan Chen
- Department of Radiotherapy, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
- School of Medical Imaging, Fujian Medical University, Fuzhou, China
| | - Jiangao Xie
- Department of Radiology, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Jianmin Chen
- Department of Statistics, University of Connecticut, Storrs, USA
| | - Xiaobo Li
- Department of Radiotherapy, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
- School of Medical Imaging, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumours (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Haematological and Breast Malignancies), Fuzhou, China
| | - Qingliang Lin
- Department of Radiotherapy, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Qizhen Xu
- Department of Radiotherapy, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Yanyan Chen
- Department of Radiotherapy, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Lili Wang
- Department of Radiology, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Rong Zheng
- Department of Radiotherapy, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumours (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Haematological and Breast Malignancies), Fuzhou, China
| | - Benhua Xu
- Department of Radiotherapy, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumours (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Haematological and Breast Malignancies), Fuzhou, China
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Wiriyakijja P, Niklander S, Santos-Silva AR, Shorrer MK, Simms ML, Villa A, Sankar V, Kerr AR, Riordain RN, Jensen SB, Delli K. World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00068-8. [PMID: 37198047 DOI: 10.1016/j.oooo.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth. STUDY DESIGN A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized. RESULTS From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains. CONCLUSION There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.
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Pugh SL, Rodgers JP, Moughan J, Bonanni R, Boparai J, Chen RC, Dignam JJ, Bruner DW. Do reminder emails and past due notifications improve patient completion and institutional data submission for patient-reported outcome measures? Qual Life Res 2020; 30:81-89. [PMID: 32894431 DOI: 10.1007/s11136-020-02613-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE NRG Oncology, part of the National Cancer Institute's National Clinical Trials Network, took efforts to increase patient-reported outcome measures (PROMs) completion and institutional data submission rates within clinical trials. Lack of completion diminishes power to draw conclusions and can be a waste of resources. It is hypothesized that trials with automatic email reminders and past due notifications will have PROM forms submitted more timely with higher patient completion. METHODS Automatic emails sent to the research associate were added to selected NRG Oncology trials. Comparisons between trials with and without automatic emails were analyzed using Chi-square tests with respect to patient completion and timeliness of form submission rates. Multivariable analyses were conducted using repeated measures generalized estimating equations. If PROMs were not completed, a form providing the reason why was submitted and counted towards form submission. RESULTS For both disease sites, form submission was significantly higher within 1 month of the form's due date for the studies with automatic emails vs. those without (prostate: 79.7% vs. 75.7%, p < 0.001; breast: 59.2% vs. 31.3%, p < 0.001). No significant differences in patient completion were observed between the breast trials. The prostate trial with automatic emails had significantly higher patient completion but this result was not confirmed in the multivariable analysis. CONCLUSIONS Although patient completion rates were higher on trials with automatic emails, there may be confounding factors requiring future study. The automatic emails appeared to have increased the timeliness of form submission, thus supporting their continued use on NRG Oncology trials.
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Affiliation(s)
- Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA.
| | - Joseph P Rodgers
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Roseann Bonanni
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Jaskaran Boparai
- NRG Oncology Operations Center, American College of Radiology, Philadelphia, PA, USA
| | | | - James J Dignam
- NRG Oncology Statistics and Data Management Center, University of Chicago, Chicago, IL, USA
| | - Deborah W Bruner
- Emory University Hospital/Winship Cancer Institute, Atlanta, GA, USA
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Pereira RMDS, Bastos MDR, Ferreira MP, de Freitas O, de Macedo LD, de Oliveira HF, Ricz HMA, Motta ACF, Macedo AP, Tirapelli C, Pedrazzi V. Topical pilocarpine for xerostomia in patients with head and neck cancer treated with radiotherapy. Oral Dis 2020; 26:1209-1218. [PMID: 32248594 DOI: 10.1111/odi.13343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate a pilocarpine spray as a treatment for xerostomia in patients treated with radiotherapy (RT) for head and neck cancer (HNC). METHODS This was a placebo-controlled, double-blind, crossover clinical trial of patients complaining of dry mouth after RT for HNC. Forty patients were randomly assigned to either placebo or pilocarpine (1.54%) spray and instructed to use three times a day for 3 months. After 1-month washout period, patients were crossed over to receive placebo or pilocarpine. The assessments were salivary flow (Stimulated Whole Saliva Flow - SWSF), xerostomia (Xerostomia Inventory - XI), and quality of life (QoL/Oral Health Impact Profile - OHIP-14), assessed at baseline, 1 hr (only SWSF), and at 1, 2, and 3 months of treatment. RESULTS Posttreatment SWFS was not statistically different between pilocarpine and placebo regardless of the treatment sequence (paired T test; p > .05), except for the SWFS rates at 2 months after therapy. When comparing pilocarpine with placebo in the time points, there was no significant difference (p > .05) for QoL or XI. Significant differences in improvement in QoL and xerostomia experience appeared along time for pilocarpine group. CONCLUSION The topical application of pilocarpine spray tested was similar to placebo on SWSF assessments in patients treated with RT for HNC.
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Affiliation(s)
- Raony Môlim de Sousa Pereira
- Departament of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Mônica Danielle Ribeiro Bastos
- Departament of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Maíra Peres Ferreira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Osvaldo de Freitas
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Leandro Dorigan de Macedo
- Dentistry and Stomatology Division, Ribeirão Preto Clinical Hospital, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Hilton Marcos Alvez Ricz
- Ophthalmology, Otolaryngology and Head and Neck Surgery Department, Otolaryngology and Head and Neck Surgery Department, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Carolina Fragoso Motta
- Department of Stomatology, Public Health and Forensic Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Paula Macedo
- Departament of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Camila Tirapelli
- Departament of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Vinicius Pedrazzi
- Departament of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Krčálová E, Horáček J, Gabalec F, Žák P, Doležal J. Scintigraphic evaluation of salivary gland function in thyroid cancer patients after radioiodine remnant ablation. Eur J Oral Sci 2020; 128:204-210. [PMID: 32239618 PMCID: PMC7318700 DOI: 10.1111/eos.12689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 12/11/2022]
Abstract
Radioiodine (131I, RAI) has traditionally been used in thyroid cancer treatment but its benefit should be balanced against possible risks. Among them, salivary gland dysfunction has often been discussed, although the reported data have been inconsistent. The aim of our prospective study was to evaluate salivary gland function in 31 thyroidectomised patients (6 men, 25 women; median age 52 yr) before and 4–6 months after RAI remnant ablation (RRA), using activity of 3.7 GBq 131I‐NaI. Salivary gland uptake and excretion fractions were quantitatively assessed with 99mTc – pertechnetate salivary gland scintigraphy. Pre‐ and post‐treatment values were compared using Wilcoxon signed rank test. No statistically significant difference in the pre‐ and post‐treatment values was observed in parotid or submandibular glands uptake, or in the parotid or submandibular excretion fractions. The calculated power for minimum relevant difference of 25% with the sample size of 31 ranged between 86% and 96% for the individual variables, making our negative results reasonably reliable. The results suggest that RRA with the most commonly used activity of 3.7 GBq has no important impact on salivary gland function. Therefore, the concerns about putative salivary gland functional deterioration following RRA are probably unjustified.
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Affiliation(s)
- Eva Krčálová
- Nuclear Medicine Department, University Hospital Hradec Králové, Hradec Králové, Czech Republic.,Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Jiří Horáček
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic.,4th Department of Internal Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Filip Gabalec
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic.,4th Department of Internal Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Pavel Žák
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic.,4th Department of Internal Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jiří Doležal
- Nuclear Medicine Department, University Hospital Hradec Králové, Hradec Králové, Czech Republic
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Iovoli AJ, Ostrowski A, Rivers CI, Hermann GM, Groman A, Miller A, Singh AK. Two- Versus Four-Times Weekly Acupuncture-Like Transcutaneous Electrical Nerve Stimulation for Treatment of Radiation-Induced Xerostomia: A Pilot Study. J Altern Complement Med 2020; 26:323-328. [PMID: 31985266 DOI: 10.1089/acm.2019.0131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: Xerostomia occurs in the majority of patients undergoing chemoradiation therapy for head and neck cancer (HNC). Acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) treatment has been studied as an encouraging modality to improve salivary function and related symptoms. The purpose of this study was to compare ALTENS treatment by using a four-times weekly schedule for 6 weeks versus a twice-weekly schedule for 12 weeks with a validated xerostomia scale at 15 months from the start of ALTENS treatment. Materials and Methods: This single-center randomized study was conducted in 30 patients treated with radiotherapy with or without chemotherapy for HNC between 2014 and 2017, who had at least grade 1 or 2 symptomatic dry mouth (xerostomia) according to CTEP NCI Common Terminology Criteria for Adverse Events (CTCAE version 4.0). These patients were randomly assigned to receive ALTENS four-times weekly for 6 weeks or two-times weekly for 12 weeks. The University of Michigan 15-item Xerostomia-related Quality of Life Scale (XeQoLS) was administered at 6, 9, 15, and 21 months from the start of ALTENS treatment. A random-effects generalized linear model was used to model the overall XeQoLS score at the 15-month endpoint; adjusted for a random time effect, a fixed treatment arm, and interaction of time and treatment. Comparison between arms was based on a 0.05 nominal significance level. Results: XeQoLS decreased for all patients (although not statistically for each arm) from a mean of 22 and 21 at baseline (in the four times per week and twice weekly arms) to 12 in both arms at 15 months, with no difference between arms (p = 0.68). There were no attributable grade 1-3 adverse events. Arms were balanced for age, gender, race, and baseline xerostomia. Conclusions: This study demonstrates that both ALTENS regimens are safe, well tolerated, and appear to be equally effective. We now routinely make ALTENS units available for home use.
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Affiliation(s)
- Austin J Iovoli
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Alexander Ostrowski
- Department of Information Technology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Charlotte I Rivers
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Gregory M Hermann
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Adrienne Groman
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Austin Miller
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Iovoli AJ, Singh AK. Accupuncture-like transcutaneous electrical nerve stimulation therapy success using a commercially available unit 8 years post-radiation for xerostomia: a case report. JOURNAL OF RADIOTHERAPY IN PRACTICE 2017; 16:217-220. [PMID: 30713469 PMCID: PMC6358275 DOI: 10.1017/s1460396917000024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Accupuncture-like transcutaneous electrical nerve stimulation (ALTENS) therapy has been shown in prospective studies to be effective in the treatment of radiation-induced xerostomia. Those studies treated patients within 27 months from end of radiation with ALTENS delivered in the clinic using a Codetron unit. However, that unit is no longer produced and there is limited data on success of ALTENS when delivered at home. METHODS A 50-year old man with xerostomia, 8 years post-radiation for T4N1 squamous cell carcinoma of the tonsillar fossa, was given ALTENS with a currently commercially available unit from Girish Surgical. He used the unit at home, 20 minutes daily for 8 weeks. RESULTS After 8 weeks of ALTENS therapy the patient saw a reduction in the Self-Reported University of Michigan Xerostomia-Related Quality of Life Scale from 20 to 1. CONCLUSION This case report demonstrates (1) the Girish Surgical unit is effective, (2) self-administration of ALTENS in patients who cannot come to clinic regularly may be practical and (3) ALTENS can still offer durable benefit to patients even 8 years after chemoradiation therapy.
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Affiliation(s)
- Austin J Iovoli
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
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Pugh SL, Wyatt G, Wong RKW, Sagar SM, Yueh B, Singh AK, Yao M, Nguyen-Tan PF, Yom SS, Cardinale FS, Sultanem K, Hodson DI, Krempl GA, Chavez A, Yeh AM, Bruner DW. Exploratory Factor Analysis of NRG Oncology's University of Washington Quality of Life Questionnaire-RTOG Modification. J Pain Symptom Manage 2017; 53:139-145.e2. [PMID: 27899312 PMCID: PMC5191964 DOI: 10.1016/j.jpainsymman.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/24/2016] [Accepted: 08/02/2016] [Indexed: 10/20/2022]
Abstract
CONTEXT The 15-item University of Washington Quality of Life questionnaire-Radiation Therapy Oncology Group (RTOG) modification (UW-QOL-RTOG modification) has been used in several trials of head and neck cancer conducted by NRG Oncology such as RTOG 9709, RTOG 9901, RTOG 0244, and RTOG 0537. OBJECTIVES This study is an exploratory factor analysis (EFA) to establish validity and reliability of the instrument subscales. METHODS EFA on the UW-QOL-RTOG modification was conducted using baseline data from NRG Oncology's RTOG 0537, a trial of acupuncture-like transcutaneous electrical nerve stimulation in treating radiation-induced xerostomia. Cronbach α coefficient was calculated to measure reliability; correlation with the University of Michigan Xerostomia Related Quality of Life Scale was used to evaluate concurrent validity; and correlations between consecutive time points were used to assess test-retest reliability. RESULTS The 15-item EFA of the modified tool resulted in 11 items split into four factors: mucus, eating, pain, and activities. Cronbach α ranged from 0.71 to 0.93 for the factors and total score, consisting of all 11 items. There were strong correlations (ρ ≥ 0.60) between consecutive time points and between total score and the Xerostomia Related Quality of Life Scale total score (ρ > 0.65). CONCLUSION The UW-QOL-RTOG modification is a valid tool that can be used to assess symptom burden of head and neck cancer patients receiving radiation therapy or those who have recently completed radiation. The modified tool has acceptable reliability, concurrent validity, and test-retest reliability in this patient population, as well as the advantage of having being shortened from 15 to 11 items.
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Affiliation(s)
- Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania, USA.
| | - Gwen Wyatt
- Michigan State University, East Lansing, Michigan, USA
| | - Raimond K W Wong
- Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Stephen M Sagar
- Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Bevan Yueh
- University of Minnesota/Masonic Cancer Center, Minneapolis, Minnesota, USA
| | | | - Min Yao
- Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Sue S Yom
- UCSF Medical Center, San Francisco, California, USA
| | | | | | - D Ian Hodson
- Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Greg A Krempl
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ariel Chavez
- John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Alexander M Yeh
- Indiana University Hospital/Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
| | - Deborah W Bruner
- Emory University/Winship Cancer Institute, Atlanta, Georgia, USA
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