The incidence of trismus and long-term impact on health-related quality of life in patients with head and neck cancer

Abstract Background. Trismus is a common symptom related to the treatment of head and neck (H&N) cancer. To date there are few prospective studies regarding the incidence of trismus and the patients’ experience of trismus in daily life activities. The aim of the study was to assess the incidence of trismus in H&N cancer patients and the impact on health-related quality of life (HRQL), by evaluating the patients before and after oncological treatment. Material and methods. We used the criteria for trismus of maximum interincisal opening (MIO) ≤ 35 mm and measured the patients at several occasions before and after treatment during one year. The patients answered the HRQL questionnaires EORTC QLQ C30, EORTC QLQ H&N 35, Gothenburg Trismus Questionnaire (GTQ) and the Hospital Anxiety and Depression Scale (HADS). Results. The incidence of trismus was 9% pre-treatment and 28% at the one-year follow-up post-treatment. The highest incidence, 38%, was found six months post-treatment. Patients with tumours of the tonsils were most prone to develop trismus. Patients with trismus reported greater HRQL impairments with regard to the GTQ domains; mouth opening (p < 0.001), jaw-related problems (p < 0.05), eating limitations (p < 0.05) and muscular tension (p < 0.001) six months post-treatment. EORTC QLQ H&N 35 scores indicated clinically significantly more problems with dry mouth, swallowing and pain for patients with trismus, 6–12 months post-treatment. Furthermore, all patients reported pain, anxiety and depression pre- and post-treatment. Conclusion. The incidence of trismus in patients with H&N cancer is non-negligible. Trismus severely impairs HRQL and negatively affects daily life activities in patients with H&N cancer. Further studies regarding symptomatic treatment of patients with trismus are highly warranted. The symptom-specific questionnaire GTQ is useful to identify the problems in this group of patients given it is responsive to showing change over time.

[1]  J. Yates,et al.  Evaluation of patients with advanced cancer using the karnofsky performance status , 1980, Cancer.

[2]  H J Tagnon,et al.  The European Organization for Research on Treatment of Cancer. , 1986, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[3]  S. Taylor.  Head and neck cancer. , 1991, Cancer chemotherapy and biological response modifiers.

[4]  K. Ichimura,et al.  Trismus in patients with malignant tumours in the head and neck , 1993, The Journal of Laryngology & Otology.

[5]  S. Kaasa,et al.  Development of a European Organization for Research and Treatment of Cancer (EORTC) questionnaire module to be used in quality of life assessments in head and neck cancer patients. EORTC Quality of Life Study Group. , 1994, Acta oncologica.

[6]  A. Jemal,et al.  Global cancer statistics , 2011, CA: a cancer journal for clinicians.

[7]  M. Goldstein,et al.  The effects of antitumor irradiation on mandibular opening and mobility: a prospective study of 58 patients. , 1999, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[8]  S. Kaasa,et al.  A prospective multicentre study in Sweden and Norway of mental distress and psychiatric morbidity in head and neck cancer patients , 1999, British Journal of Cancer.

[9]  S. Kaasa,et al.  A Prospective Study of Quality of Life in Head and Neck Cancer Patients. Part II: Longitudinal Data , 2001, The Laryngoscope.

[10]  J. Epstein,et al.  Quality of life and oral function in patients treated with radiation therapy for head and neck cancer , 2001, Head & neck.

[11]  F. Fang,et al.  The Degree and Time‐Course Assessment of Radiation‐Induced Trismus Occurring After Radiotherapy for Nasopharyngeal Cancer , 2005, The Laryngoscope.

[12]  S. Burri,et al.  Radiation-Induced trismus in head and neck cancer patients , 2006, Supportive Care in Cancer.

[13]  J. Roodenburg,et al.  Criteria for trismus in head and neck oncology. , 2006, International journal of oral and maxillofacial surgery.

[14]  F. Hilgers,et al.  Speech and swallowing after surgical treatment of advanced oral and oropharyngeal carcinoma: a systematic review of the literature , 2009, European Archives of Oto-Rhino-Laryngology.

[15]  Leslie H. Sobin,et al.  Comprar TNM Classification of Malignant Tumours, 7th Edition | C. Wittekind | 9781444332414 | Wiley , 2009 .

[16]  S. North.  CHAPTER 13 – Tumours of head and neck , 2009 .

[17]  F. Spijkervet,et al.  A systematic review of trismus induced by cancer therapies in head and neck cancer patients , 2010, Supportive Care in Cancer.

[18]  H. Pau,et al.  Limited mouth opening after primary therapy of head and neck cancer , 2010, Oral and Maxillofacial Surgery.

[19]  J. Johnson,et al.  Trismus in head and neck cancer patients in Sweden: incidence and risk factors. , 2010, Medical science monitor : international medical journal of experimental and clinical research.

[20]  Robert P Takes,et al.  Comorbidity in head and neck cancer: a critical appraisal and recommendations for practice. , 2010, Oral oncology.

[21]  Paul Symonds,et al.  Diagnostic validity of the Hospital Anxiety and Depression Scale (HADS) in cancer and palliative settings: a meta-analysis. , 2010, Journal of affective disorders.

[22]  L. Peters,et al.  Optimising the therapeutic ratio in head and neck cancer. , 2010, The Lancet. Oncology.

[23]  S. Rogers,et al.  Longitudinal evaluation of restricted mouth opening (trismus) in patients following primary surgery for oral and oropharyngeal squamous cell carcinoma. , 2011, The British journal of oral & maxillofacial surgery.

[24]  A. Jemal,et al.  Global Cancer Statistics , 2011 .

[25]  J. Lewin,et al.  Functional Outcomes after Chemoradiotherapy of Laryngeal and Pharyngeal Cancers , 2012, Current Oncology Reports.

[26]  A. Molassiotis,et al.  Prediction of post-treatment trismus in head and neck cancer patients. , 2012, The British journal of oral & maxillofacial surgery.

[27]  N. Pauli,et al.  Development and validation of the Gothenburg Trismus Questionnaire (GTQ). , 2012, Oral oncology.