A Quasi Experimental Study to Evaluate the Efficacy of Sesame Oil on Radiation Induced Xerostomia among patients with Head and Neck Cancer

 

R. Suvitha1, K. Kanchana2, T. Nirmala3

1M.Sc. Nursing Student, College of Nursing, SRIPMS, Coimbatore.

2Associate Professor, College of Nursing, SRIPMS, Coimbatore.

3Principal, College of Nursing, SRIPMS, Coimbatore.

*Corresponding Author Email: kanchanakumar9@gmail.com

 

ABSTRACT:

A quasi experimental study to evaluate the efficacy of sesame oil on radiation induced xerostomia among patients with head and neck cancer. Non randomized quasi experimental pretest posttest control group design was adopted in this study. By using purposive sampling technique, 26 samples were selected based on inclusion criteria, 13 in experimental and 13 in control group. The demographic variables, clinical profile of the samples were collected, the level of Xerostomia was assessed by modified GRIX questionnaire in both experimental and control group. Intervention was given to experimental group and routine treatment was given to control group. It was identified that the mean level of Xerostomia among head and neck cancer patient in the experimental and control group was 51.08 and 30.4 respectively with mean difference of 20.54. Likewise the standard deviation of the experimental and control group was 4.63 and 4.92 respectively. The calculated ‘t’ value 10.96 was greater than the table value of 2.06 at 0.05 level of significance. Hence, it was concluded that sesame oil mouth rinsing is an effective method to reduce the radiation induced Xerostomia among patient with head and neck cancer.

 

KEYWORDS: Sesame oil, Radiation induced Xerostomia, Head and neck cancer.

 

INTRODUCTION:

Cancer has become a big threat to human beings globally. As per India population census the rate of mortality due to cancer was high and alarming with 806000 exist cases by the end of last century. Cancer is the second most common disease in India responsible for maximum mortality with about 0.3% million deaths per year. Cancers of the head and neck which include cancers of the Oral cavity, larynx (voice box), pharynx, salivary glands and nose/ nasal passages. India accounts 30% of the world’s new cases of cancers of the oral cavity.

World head and neck cancer day was declared as 27thJuly of every year (IFHNOS 2014). Radiation therapy is one of the main treatment options for head and neck cancer. Cancer patients undergoing radiation therapy of the head and neck encounter acute and chronic changes to their soft tissue as well as transient and permanent sensory disturbances. Radiation therapy results in deterioration in dental and periodontal health as well as a risk of osteoradionecrosis.  Xerostomia is the most prominent complication in patients with head and neck cancer, because Radiation therapy usually involves administering a high radiation

dose to the salivary glands bilaterally (Dirix.P.,2006). Due to radiation therapy, Patient describes the subjective symptoms of “dry mouth” termed as Xerostomia.

 

 

Xerostomia have a hypo function of the salivary output leading to functional oral disorders such as sore throat, altered taste, dental decay, changes in voice quality, and impaired chewing and swallowing function. These factors may ultimately cause reduced nutritional intake and weight loss and significantly affect general health and quality of life of the head and neck cancer patients. (De Graeff and De Leeuw., 1999).

 

NEED FOR THE STUDY:

According to WHO (2019) annual incidence of head and neck cancer worldwide is more than 5,50,000 cases with around 300000 death each year. Male to female ratio ranges from 2:1 to 4:1. About 90% of head and neck cancer are squamous cell carcinoma. Head and neck is the six leading cancer by incidence worldwide. Magnitude of problem in India, overall 57.5% of globally head and neck cancer occur in  Asia especially in India. Xerostomia is an unfortunately prevalent and distressing side effect of cancer treatment. In order to improve the quality of life of patients with head and neck irradiation, nurses has an inevitable role to prevent and manage radiation induced Xerostomia. Various studies revealed that oil pulling can be effective in reducing the dry mouth for head and neck cancer patient undergoing radiation therapy to improve the quality of life. Hence the researcher felt that oil pulling is one of the important herbal remedy to meet the needs of head and neck cancer patients suffering from Xerostomia and thus improve their quality of life.

 

STATEMENT OF THE PROBLEM:

A Quasi Experimental Study To Evaluate The Efficacy of Sesame Oil on Radiation Induced Xerostomia Among Patients with Head And Neck Cancer at Selected Hospital, Coimbatore.

 

OBJECTIVES OF THE STUDY:

1.       To assess the level of Xerostomia among patient with head and neck cancer patients.

2.       To find out the efficacy of sesame oil on radiation induced Xerostomia among patient with head and neck cancer.

3.       To find out the association between the level of Xerostomia with selected demographic variables.

 

HYPOTHESIS:

There is a significant difference in the level of Xerostomia before and after the sesame oil administration among experimental group.

 

REVIEW OF LITERATURE:

Worldwide, head and neck cancer accounts for more than 650,000 cases and 330,000 deaths annually. Males are affected significantly more than females, with a ratio ranging from 2:1 to 4:1. The incidence rate in males exceeds 20 per 100,000 in regions of France, Hong Kong, the Indian subcontinent, Central and Eastern Europe, Spain, Italy, and Brazil, and among African Americans in the United States. Mouth and tongue cancers are more common in the Indian subcontinent, nasopharyngeal cancer is more common in Hong Kong, and pharyngeal and/or laryngeal cancers are more common in other populations (Stenson, 2020).

 

Jaguar, et al., (2017) conducted a study on Clinical features and preventive therapies of radiation-induced Xerostomia in head and neck cancer patient: a literature review. Xerostomia or dry mouth is one of the most common and disturbing adverse effects following radiotherapy for head and neck cancer. This complication strongly increases the risk for dental caries, difficulties with chewing, swallowing and sleep disorders with significant impact on patients’ quality of life. This study discusses the clinical features and current knowledge of Xerostomia prevention in order to evaluate the real possibilities of reducing the incidence and severity of this complication in Head and neck cancer patients.

 

Peirce (2016) analyzed and suggested five natural remedies for dry mouth (Xerostomia) More than one in ten people have intense mouth dryness. Cancer patients often get dry mouth (Xerostomia) after radiation to the head and neck. It can also interrupt good eating habits that keep you strong and well-nourished. These are the five natural remedies such as mouthwash out of saline and baking soda, Sugarless Chews & Lozenges, Ginseng and Other Herbal Remedies, sesame or vegetable Oil and Acupuncture.

 

Thankam (2012) conducted a study on effectiveness of vegetable oil mouth rinsing in reducing radiation  induced Xerostomia among patients receiving radiation therapy. Quasi experimental pre-test post-test control group design was utilized in this study. Samples were selected using simple random sampling technique. Groningen Radiation Induced Xerostomia Questionnaire was used to assess Xerostomia level. Experimental group received vegetable oil (10ml sesame oil) mouth rinsing three times a day before meals for 10 days. Mean post- test Xerostomia level of experimental group (14.2) was lower than the mean post-test Xerostomia level of control group (43.76). It was found that there was a significant association between the post-test level of Xerostomia in experimental group and selected variables such as tumor site, previous history of tobacco use and betel nut chewing. It was found that there was a significant association between the post-test level of Xerostomia in experimental group and selected variables such as tumor site χ˛ value 4.344 at 1 df(3.84)p (>0.05), previous history of tobacco use and betel nut chewing χ˛ value 8.863 at 3 df (7.82) p (>0.05). These findings suggest that vegetable oil mouth rinsing is effective in reducing radiation induced Xerostomia among patients receiving radiation therapy over head and neck cancer.

 

METHODOLOGY:

Research approach:

Quantitative experimental research approach design was adopted for this study

 

Research setting:

The study was conducted in day care, oncology general ward, and special ward of Sri Ramakrishna hospital Coimbatore.

 

Population:

All patients are receiving radiation therapy for head and neck cancer.

 

Sampling technique:

Purposive sampling technique was adopted.

 

Sample size:

Total 26 patients were selected for this study.

 

Criteria for sample selection:

 

Inclusion criteria:

1.       Patients who are receiving external radiation therapy for cancer in head and neck areas.

2.       Patient who have exposed to external radiation therapy for minimum seven sitting over head and neck areas.

3.       Patient with mild to severe Xerostomia level in Groningen Radiation Induced Xerostomia Questionnaire.

4.       Both male and female patients who can communicate by orally.

5.       Patients who had oral ulceration and fungal infection.

Exclusion Criteria:

1.       Patients are on artificial stimulant for salivation.

2.       Patient who underwent surgery in mouth.

 

Data collection instruments:

The tool consists of:

 

Section A: Demographic Data:

A questionnaire was designed to collect the demographic data related to age, gender, educational status, occupation, religion, marital status, co morbid illness, family history of cancer, personal habit and dietary habit.

 

Section B: Clinical profile of the sample:

Clinical profile of the sample includes diagnosis, site, stages cancer diagnosis, type of treatment at present, number of fractional dose during radiation therapy, duration of Xerostomia and nature of dietary pattern.

 

Section C: Modified GRIX questionnaire:

This is a standardized tool which is developed by Beetz and et al., (2010). This tool consists of 14 item questionnaire with four subscales: Xerostomia during day and night and sticky saliva during day and night. The researcher modified GRIX questionnaire which includes the symptoms of Xerostomia it become 17 item questionnaires and it’s interpret with scoring according to the level of Xerostomia.

 

Data collection procedure:

Samples were selected based on inclusion and exclusion criteria. In experimental group Sesame oil mouth rinsing 10ml for five minutes was given three times a day before meals for 10 days. In control group routine treatment was given. The level of Xerostomia among patient receiving radiation therapy was assessed on 5th day and reassessed on 10th day by using modified GRIX questionnaire for both experimental and control group. Analysis was done after data collection.

 

Table1: Demographic variables of the sample

S. No

Demographic variables

Number of patients

Experimental group n=13

Control group n=13

 

 

Frequency

Percentage %

Frequency

Percentage %

1

Age in years

 

 

 

 

 

21-30

1

7.7

-

-

 

31-40

4

30.8

3

23.1

 

41-50

5

38.5

3

23.1

 

51-60

1

7.7

1

7.7

 

61-70

2

15.4

6

46.2

2

Gender

 

 

 

 

 

Male

10

76.9

11

84.6

 

Female

3

23.1

2

15.4

 

Trans Gender

-

-

-

-

3

Educational status

 

 

 

 

 

Illiterate

4

30.8

7

53.8

 

Middle School

4

30.8

1

7.7

 

High School

2

15.4

4

30.8

 

Higher Secondary

2

15.4

1

7.7

 

Graduate

1

7.7

-

-

5.

Occupation

 

 

 

 

 

Government job

-

-

3

23.1

 

Private job

5

38.5

2

15.4

 

business

3

23.1

-

-

 

 

House wife

-

-

2

15.4

 

others

5

38.5

6

46.2

6.

Religion

 

 

 

 

 

Hindu

12

92.3

12

92.3

 

Christian

1

7.7

1

7.7

 

Muslim

-

-

-

-

 

others

-

-

-

-

7.

Marital status

 

 

 

 

 

Married

12

92.3

13

100

 

Single

1

7.7

-

-

 

Divorce

-

-

-

-

8.

Co morbid

 

 

 

 

 

Yes

4

30.8

2

15.4

 

No

9

69.2

11

84.6

9.

Family history of cancer

 

 

 

 

 

Yes

 

 

 

 

 

no

13

100

13

100

10

Personal habits

 

 

 

 

 

Tobacco chewing

3

23.1

3

23.1

 

Alcohol

3

23.1

4

30.8

 

Smoking

2

15.4

-

-

 

Alcohol and smoking

4

30.8

4

30.8

 

No ill habits

1

7.7

2

15.4

 

Clinical Profile of the Sample:

The Clinical profile of patients with cancer diagnosis, site of tumour, stages of tumour, duration of cancer diagnosed, type of treatment patients currently undergoing, fractional dose of radiation therapy, patients suffering with xerostomia, type of diet undergoing radiation therapy. Results of the study shows that majority of them have oropharyngeal cancer in both experimental and control group 5(38.5%). Site of tumor depicts that majority of them have tumor in head region among both experimental group 11(84.6%) and control group 10 (76.9%). Likewise in Duration of cancer diagnosed in the experimental group 9(30.8) majority of them were within 6 month of duration and in the control group 10(76.9) most of them were recently diagnosed.

In view of type of treatment majority of them  undergoing both radiation and chemotherapy treatment in experimental group 9(69.2) and only radiation therapy in control group 7(53.8). Tumor classification most of them fall under grade IV in experimental group 9(69.2) and grade III in control group 10(76.9). Fractional dose majority of them receive more than 200 centigrade of fractional dose in both experimental 10(76.9) and control group 7(53.8).

 

Patients Suffering with xerostomia is comparatively less than 5 days in both experimental group 7(53.8) and control group 7(53.8). Dietary pattern whole group had liquid type of dietary pattern in experimental and control group 13(100).

 

Level of Xerostomia:

 

The assessment level of Xerostomia among head and neck cancer patient in the experimental group, on initial assessment shows 12(92.5%) patients had mild level of Xerostomia and 1(7.7%) had moderate level of Xerostomia. On the 5th day assessment shows 11 (84.6%) patients had mild level of Xerostomia and 2(15.4%) patients had moderate level of Xerostomia. On the 10th day assessment shows 10(76.9%) patients had mild level of Xerstomia and 3(23.1%) patients had moderate level of Xerostomia. In control group, on initial assessment shows, 9 (69.2%) patient had mild level of Xerostomia,4(30.8%) had moderate level of Xerostomia. On the 5th day assessment 2(15.4%) patients had mild level of Xerostomia, 9(69.2%) patients had moderate level of Xerostomia and 2(15.4%) patients had severe level of Xerostomia. On the 10th day post-test 10(76.9%) had moderate level of Xerostomia and 3 (23.1%) patients had moderate level of Xerostomia.

 

Analysis on the efficacy of sesame oil on radiation induced Xerostomia on 10th day of post-test among experimental and control group.

S. No

Study group

Mean

SD

Mean differences

Calculated t value

1.

2.

Experimental group

Control group

51.08

30.54

4.63

4.92

20.54

10.96*

*Significant at 0.05 level

 

H1: "There is significant difference in the 10th of day post-test radiation induced xerostomia among head and neck cancer between experimental group and control group” was accepted. This study finding reveals that sesame oil mouth rinsing will reduce the radiation induced xerostomia.

 

Association between the Pre-test Level of Xerostomia and selected Variables among Patients receiving Radiation therapy.

There is no significant association between the pretest scores and selected demographic variables such as age, gender, region of tumor, duration of cancer, type of treatment, tumor classification, fractional dose, suffering with Xerostomia among patients with head and neck cancer receiving radiation therapy.

 

RESULTS AND DISCUSSION:

The data on gender reveals that, in the experimental group, majority 10(76.9%) patients were males 3(23.1%) patients were female and in the control group,  11(84.6%) patients were males and 2(15.4%) were females.

 

According to WHO (2019) annual an incidence of head and neck cancer worldwide is more than 5,50,000 cases with around 300000 death each year. Male to female ratio ranges from 2:1 to 4:1. Independent ’t’ test was used to compare the efficacy of sesame oil on 10th day of post-test radiation induced xerostomia among head and neck cancer patient in the experimental and control group. It was identified that the mean level of xerostomia among head and neck cancer patients in the experimental and control group was 51.08 and 30.54 respectively with a mean difference of 20.54. Likewise the standard deviation of the experimental and control group was 4.63 and 4.92 respectively. The calculated ‘t’ value 10.96 was greater than the table value of 2.06 at 0.05 level of significance. Hence the research hypothesis H1: "There is significant difference in the 10th of day post-test radiation induced xerostomia among head and neck cancer between experimental group and control group” was accepted.

 

A similar study was conducted by Thankam (2012) the results states that vegetable oil mouth rinsing is effective in reducing radiation induced xerostomia among patients receiving radiation therapy over head and neck cancer.

 

CONCLUSION:

Patients with Xerostomia are often a challenge regarding diagnosis and treatment, although Xerostomia is not considered as a disease, it has a potential effect on the oral cavity. Sesame oil mouth rinsing (oil pulling) is a herbal remedy and cost effective method to reduce the radiation induced Xerostomia and thus promote the wellbeing among head and neck cancer patients. Hence, the researcher concluded that sesame oil mouth rinsing is an effective method to reduce the radiation induced Xerostomia.

 

REFERENCES:

1.          Dirix., Sandra., Bogaert. (2006). Radiation induced xerostomia in patients with head and neck cancer. American Cancer Society Journals. 107(11):2525-2534. Retrieved from website: https://doi.org/10.1002/cncr.22302.

2.          De Graeff, and et al., (1999) Quality of Life in Head and Neck Cancer Patients:Validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire- H&N35. American Society of Clinical Oncology. 0732- 183X/99/1703/1008.

3.          Cassolato, Turnbells. (2004). Xerostomia: Clinical Aspects and Treatment. A. Gerodontology. 20(2): 64-67.

4.          Lew, J., and Smith, J. A. (2007). Mucosal graft-vs-host disease. Journal of Oral Diseases, 13(6), 519-529.

5.          World Health Organization. (2019). WHO report on prevalence and incidence of head and neck cancer.

 

 

Received on 06.04.2021                Modified on 03.05.2021

Accepted on 25.05.2021            ©A&V Publications All right reserved

Asian J. Nursing Education and Research. 2021; 11(4):523-527.

DOI: 10.52711/2349-2996.2021.00124