Humidifying mouth and throat during radiotherapy reduces mucositis and hospital stay

Patients who received daily humidification of the mouth and throat region beginning from day one of radiation therapy treatment spent nearly 50% fewer days in the hospital to manage their side effects, according to new research. These findings were presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium in Scottsdale, Arizona.

The study was conducted by the Trans Tasman Radiation Oncology Group and evaluated 210 head and neck cancer patients in New Zealand and Australia from June 2007 through June 2011. Patients in this phase 3 trial were randomized to institutional standard of care (control arm) or humidification using the Fisher & Paykel Healthcare MR880 humidifier. The humidified air is delivered through the nose via a plastic interface (mask-type apparatus) that can be worn by patients while sleeping or while sitting during the day.

Patients began humidification on day one of radiation therapy and continued until the ulceration in their mouth and throat had resolved. On average, humidification patients spent 57% as many days in the hospital to manage side effects (control = 4.1 days vs humidification = 2.3 days). The return of eating patterns to close to normal was also significantly higher at 3 months after radiotherapy in the group using humidifiers.

Only 43 patients (42% of the patients in the humidification arm) met the defined benchmark of humidification compliance and were able to contribute to the per protocol analysis; the mean average use of humidification for these patients was 3.6 hours per day (range of 0 to 14 hours/day). In patients who met the humidification compliance benchmark, functional mucositis score—which was based on a clinician assessment of mucositis symptom burden for patients—was reduced. The proportion of compliant humidification patients who never required a feeding tube was also increased.

"Mucositis (inflammation and ulceration of the mouth and throat) is a painful side effect of radiation therapy that can negatively affect patients' quality of life. This study has provided efficacy signals consistent with a role for humidification in reducing symptom burden for patients during radiotherapy for head and neck cancer. Preventing or reducing hospitalizations may also mean it is cost-effective. The rationale for using humidification is based on the fact that moisturizing wounds generally helps them heal faster," said Andrew Macann, FRANZCR, lead author of the study and a radiation oncologist at Auckland City Hospital in Auckland, New Zealand.

Macann explained that these results are encouraging, particularly because humidification was favored across clinician-reported outcomes, patient-reported outcomes, and independent data such as hospitalizations. He stated that, although patients in the study did not use the humidifiers as much as was hoped, the study obtained feedback about why some patients did not like using the humidifier. He explained that the next step is to work at increasing the proportion of patients who use the humidifier effectively.

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