Once head and neck cancer patients begin radiation treatment, they must perform difficult and complicated oral health regimens to prevent permanent swallowing disorders and oral infection for the rest of their lives. To prevent dysphagia, patients must perform motor exercises that strengthen the tongue and increase range of motion in oropharyngeal structures. However, adherence was low, just 9.5% of our R03 participants (n=97) tried the exercises once or more during radiation, with adherence worsening afterward. To prevent oral infection, patients must brush, floss, and rinse after every meal and wear fluoride trays before bed. Again, our data show that adherence rates were low, ranging from 30 to 50%. The main reasons for nonadherence were underestimation of the importance of the oral health regimens, pain, fatigue and feeling ill. Adherence to health behaviors in cancer survivors is understudied, and very few studies have investigated the role of illness symptoms in conjunction with molecular and psychological factors. Using the Theory of Self-Regulation as our reference point, we will track proinflammatory cytokines, individual and dyadic coping factors to determine their association with adherence to multiple oral health behaviors in 200 oropharyngeal and laryngeal cancer patients as they progress through radiation and beyond. Primary Aims: 1) To determine whether illness perceptions significantly predict adherence to swallowing exercises and dental regimen at 3 months and 6 months. 2) To determine whether sickness behaviors (depression, fatigue, pain)'s effect on illness perceptions are mediated by proinflammatory cytokines. 3) To determine whether dyadic coping moderates the impact of coping on appraisal of coping. Study design: 200 patients recruited from M. D. Anderson and Lyndon Baines Johnson Community hospital will be assessed at baseline entry into the study, 6 weeks after the end of radiation therapy (or 3 months after baseline), and 6 months post-radiation. To provide corroboration of the patient's self-report of adherence to the swallowing exercises, patients spouses or caregivers will be asked to complete a corroborating questionnaire at the two follow-ups, and a dental examination will be used to correlate self-reported adherence with oral health. Summary: Our study uses a multidisciplinary approach to integrate the study of molecular cytokines, social theory and psychological constructs of coping and illness perceptions to move the field of adherence forward in a meaningful way. Our application has carefully mapped out a conceptual framework delineating the hypothesized mediators and moderators of adherence in a sample of oropharyngeal and laryngeal cancer patients as they progress through radiation treatment into survivorship. The resulting data will yield important and useful information regarding adherence to difficult regimens.
Identifying key factors in adherence to preventive swallowing exercises and dental regimens would be valuable to irradiated head and neck cancer survivors, who are at risk for permanent swallowing disorders and rampant caries. Using the Theory of Self-Regulation to measure individual factors as a starting point, this project will assess potential biologic mediators and social moderators of adherence to swallowing exercises and dental regimen in a longitudinal design.
| Shinn, Eileen Huh; Basen-Engquist, Karen; Baum, George et al. (2013) Adherence to preventive exercises and self-reported swallowing outcomes in post-radiation head and neck cancer patients. Head Neck 35:1707-12 |
