A Study of the Trismus Condition of Patients with Head and Neck Cancer Who Have Undergone Concomitant Chemoradiotherapy and the Preventive Effect of Oral Rehabilitation on Trismus

The leading cause of death in Taiwan has been malignant tumor since 1982. In 2008, head and neck cancer was the fifth in cancer causes of death. Concomitant chemoradiotherapy (CCRT) is considered the most appropriate treatment for cancer now. However, after undergoing CCRT, approximately 5 to 47% patients have trismus side effect, which heavily influences patients’ food-taking, oral hygiene, even social and life qualities. Only few studies adopted preventive intervention, but with diverse results, while most studies focused on giving passive range-of-motion exercise after trismus happened to patients with head and neck cancer. Two steps were then invented for this study. The first phase aimed to explore the trismus changes within 3 months after patients with head and neck cancer undergone CCRT and figure out the predictor of trismus. Then we probed into the effect of oral rehabilitation upon trismus and life quality in the second phase. Longitudinal study and purposive sampling were adopted in the first phase. Subjects are patients with I to IV period head and neck cancer, who underwent CCRT for the first time, and completed structured questionnaires and related scale when in ward or outpatient services. The variables included: personal data, pain, fatigue, anxiety, depression, and life quality. Ultrasonic was used to measure the function of temporomandibular joint. Weight, height, and Body Mass Index (BMI) were measured to understand the nourishment changes of patients during research process. Data will be collected at one day before therapy (T0), one month after therapy (T1), two months after therapy (T2), and three months after therapy (T3). Experimental research design was used in the second phase, which pointed the comparison between the influences caused by trismus on physiology (pain, weight, BMI), psychology (fatigue, anxiety, depression), and life quality of patients with head and neck cancer, who had or had not undergone CCRT. According to the trismus predictors of the first phase, high risk subjects were selected and randomly divided into experimental and control groups. The intervention include three times of oral rehabilitation a day lasted for twelve weeks. The outcome indicators include the function of temporomandibular joint, BMI, pain, fatigue, anxiety, depression, and quality of life. Data will be collected at one day before therapy (T0), one month after therapy (T1), two months after therapy (T2), and three months after therapy (T3). SPSS18.0 was used for descriptive and inferential data analysis, including percentage, mean, and standard deviation. The predictors of trismus will be examined by multiple regression and the effect of oral rehabilitation upon the physiology, psychology, and life quality resulted from trismus will be verified by GEE model. We hope that appropriate nursing interventions could be developed to help easing off the trismus of patients with head and neck cancer who have undergone CCRT and the influence on physiology and psychology resulted from it, and further promote the life quality of patients with head and neck cancer.