Association of nutritional counselling with the severity of radiation-induced oral mucositis in patients with nasopharyngeal carcinoma: a retrospective study

Background

Radiation oral mucositis (RIOM) is one of the most common side effects of radiotherapy (RT) in patients with nasopharyngeal carcinoma (NPC). The nutritional status of the body is an important factor affecting the efficacy of radiotherapy and chemotherapy, as well as the prognosis of patients. The aim of the study was to explore the relationship between nutrition counseling (NC) and radiation-induced oral mucositis (RIOM), and to provide a reference for the prevention and treatment of RIOM in clinical practice.

Methods

We conducted a retrospective cohort study using the data among 147 NPC patients who received radical radiotherapy. Patients were divided into NC group and control group and radiation-induced Oral Mucositis (RIOM) classification i.e. mild RIOM (grade 0–1 group) and severe RIOM (grade ≥ 2 group). Univariate and multivariate analyses were used to analyze the association between baseline data of the patients and severity of RIOM.

Results

Of the 147 patients with NPC, there were 46.9% (69/147) patients who received NC, while control group accounted for 53.1% (78/147). There was no statistically significant difference in age, gender, stage, smoking, drinking, body mass index (BMI) before RT, Patient Generated Subjective Global Assessment (PG-SGA) score and Hospital Anxiety and Depression Scale (HADS) score between NC group and control group. However, there was a significant difference in the incidence of severe RIOM patients between NC group and control group (40.6% vs. 69.2%). Univariate analysis showed that NPC patients had PG-SGA score ≥ 4 (P < 0.001; HR : 0.14; 95% CI: 0.04–0.45), the amplitude of weight loss (WL)  ≥ 3% (P < 0.001; HR: 0.62; 95% CI: 0.50–0.77), lower hemoglobin (P = 0.01; HR: 0.97; 95% CI: 0.95–0.99) and patients with NC (P < 0.001; HR: 3.24; 95% CI: 1.64–6.40) were significantly associated with severe RIOM. Multivariate analysis showed that PG-SGA ≥ 4 (P = 0.23; HR: 0.23; 95% CI: 0.06–0.86) and WL ≥ 3% (P < 0.001; HR: 0.63; 95% CI: 0.50–0.80) were risk factors for severe RIOM, whereas receiving nutrition consultation was a protective factor (P = 0.03; HR: 2.49; 95% CI: 1.09–5.66).

Conclusion

NC was beneficial in reducing severe RIOM and PG-SGA ≥ 4. WL ≥ 3% exacerbate severe RIOM.