Jellema AP et al. (2007) Impact of radiation-induced xerostomia on quality of life after primary radiotherapy among patients with head and neck cancer. Int J Radiat Oncol Biol Phys [doi:10.1016/j.ijrobp.2007.04.021]

Xerostomia is the most frequently reported late side effect of radiation for the treatment of head and neck cancer. Uncertainty regarding the clinical relevance of radiation-induced xerostomia in relation to patient quality of life (QOL) led Jellema et al. to test the following two hypotheses: firstly, that higher grades of radiation-induced toxicity correlate with worse QOL; and secondly, that the impact of radiation-induced xerostomia on overall QOL lessens with time.

Late xerostomia (assessed with the RTOG Late Radiation Morbidity Scoring System) and QOL (EORTC QLC-C30 scale) were evaluated at baseline and every 6 months from 6 to 24 months after radiotherapy in 288 patients with stage I–IVB head and neck cancer without distant metastases. At 6 weeks, approximately two-thirds of patients had xerostomia. The presence of xerostomia was significantly associated with several QOL measures, including overall QOL outcome, physical functioning, social functioning, fatigue and insomnia. The magnitude of the effect seemed to be dependent on age and sex—women were more affected than men for several QOL measures (possibly because women are more prone to insomnia, which could exacerbate some of the effects), while younger patients were more affected in physical and social functioning than were older patients with the same grade of xerostomia. Although the incidence of xerostomia decreased with time, its effect on overall QOL increased (effect size 0.09 at 6 months, rising to 0.22 at 24 months).

The prevention of radiation-induced xerostomia could, therefore, result in marked improvements in QOL for these patients.