Radiation-induced oral mucositis: Correlation between clinician-assessed WHO grades and patient-reported outcomes, an exploratory prospective observational pilot study

Abstract

Purpose

Oral mucositis is a frequent, dose-limiting toxicity of chemoradiotherapy of head and neck cancer. Clinician-based grading such as the world health organization mucositis scale provides objective assessment of visible lesions, but patient-reported oral mucositis symptom scale capture the subjective functional impact, which may not always correspond with clinical findings. This pilot study examined the association between clinician grading and patient-reported measures and explored differences between benzydamine and bicarbonate rinses.

Oral mucositis is a frequent, dose-limiting toxicity of chemoradiotherapy of head and neck cancer. Clinician-based grading such as the world health organization mucositis scale provides objective assessment of visible lesions, but patient-reported oral mucositis symptom scale capture the subjective functional impact, which may not always correspond with clinical findings. This pilot study examined the association between clinician grading and patient-reported measures and explored differences between benzydamine and bicarbonate rinses.

Patients and methods

Twenty patients with head and neck cancer receiving definitive chemoradiotherapy were enrolled; ten received benzydamine and ten bicarbonate rinses. Weekly world health organization mucositis grading and patient-reported oral mucositis symptoms (10-item Visual Analogue Scale assessing pain, speech, eating, swallowing, and taste) were recorded across seven weeks. Spearman's correlation was performed, and descriptive comparisons were made between rinse groups.

Twenty patients with head and neck cancer receiving definitive chemoradiotherapy were enrolled; ten received benzydamine and ten bicarbonate rinses. Weekly world health organization mucositis grading and patient-reported oral mucositis symptoms (10-item Visual Analogue Scale assessing pain, speech, eating, swallowing, and taste) were recorded across seven weeks. Spearman's correlation was performed, and descriptive comparisons were made between rinse groups.

Results

All patients developed mucositis by week 7. Peak severity ranged from grade 1 to grade 4, with most patients reaching grade 3. Median onset of ulcerative mucositis (grade 2 or worse) was week 3. Patient-reported oral mucositis symptoms correlated with World Health Organization grades (Spearman's ρ = 0.72, p < 0.01) and increased with ulcerative progression. Taste alteration and difficulty eating solids were most affected domains. Some patients reported symptoms despite absent visible lesions. No significant differences were found between the two rinse groups.

All patients developed mucositis by week 7. Peak severity ranged from grade 1 to grade 4, with most patients reaching grade 3. Median onset of ulcerative mucositis (grade 2 or worse) was week 3. Patient-reported oral mucositis symptoms correlated with World Health Organization grades (Spearman's ρ = 0.72, p < 0.01) and increased with ulcerative progression. Taste alteration and difficulty eating solids were most affected domains. Some patients reported symptoms despite absent visible lesions. No significant differences were found between the two rinse groups.

Conclusions

Patient-reported outcome measure symptoms scale strongly complement World Health Organization grading, capturing symptom escalation and functional impairments under-recognized by clinician assessment. Findings support the need for larger multicentre studies integrating clinician and patient assessments.

Patient-reported outcome measure symptoms scale strongly complement World Health Organization grading, capturing symptom escalation and functional impairments under-recognized by clinician assessment. Findings support the need for larger multicentre studies integrating clinician and patient assessments.