Oral and Ocular Findings in Radiated Head and Neck Cancer Patients

Objectives: To investigate oral and ocular dryness in head and neck cancer patients after radiotherapy, and compare to age and gender matched controls.
Methods: Thirty cancer patients who had completed radiotherapy in the head and neck region (RT-group) (age 64±10y), and thirty sex- and age-matched controls (age 58±17y) were recruited. All participants underwent a comprehensive oral and ocular examination. Oral testing included the Shortened Xerostomia Inventory Questionnaire (SXI), evaluation of clinical oral dryness score (CODS) and unstimulated- and stimulated whole saliva (UWS, SWS ml/min). Ocular examination included McMonnies Dry Eye questionnaire (MDEIS), tear film break-up time (TFBUT), Schirmer test (ST) and ocular surface staining (OSS with Oxford grading score). Intergroup comparisons were tested with Mann-Whitney U test and correlations were tested using Spearman's rho using SPSS Version 25. P-values <0.05 were considered significant.
Results: The RT-group demonstrated worse oral objective findings compared to controls; increased CODS (5.8±1.9 vs 1.6±1.6, p<0.001), decreased UWS (0.1±0.09 vs 0.3±0.2, p<0.001) and SWS (1.0±0.4 vs 1.8±0.8, p<0.001). Subjective oral dryness scores were less favorable in the RT-group compared to controls (SXI: 11.9±2.4 vs 6.0±1.0, p<0.001). Subjective dry eye scores were worse in the RT-group (MDEIS: 8.3±4.5 vs 2.8±2.5, p<0.001). Objective dry eye results did not differ between the groups (TFBUT: 5.9±5.0 vs 4.9±3.6, p=0.98), (OSS: 0.8±1.5 vs 0.9±1.0 p=0.225), (ST: 13.2±10.4 vs 16.5±10.0, p=0.161). The subjective oral and ocular findings (SXI and MDEIS) were highly correlated within the groups (r=0.6, p<0.001).
Conclusions: The post-radiation sequelae of head and neck cancer have negative consequences for oral health and may influence ocular health. A broader understanding of oral and ocular correlations is important in the interdisciplinary evaluation and follow-up of cancer patients treated with radiotherapy in the head and neck region.