The worst side effect of radiation for head and neck cancer is mucositis. We know that “-itis” means inflammation so mucositis must be inflammation of the mucous lining of the mouth and throat, the oral mucosa.
Radiotherapy kills rapidly dividing cancer cells but the oral mucosa breaks down and builds up rapidly too so its cells are also damaged. This damage is seen as ulcers and infections and a lot of pain which has to be handled with opiates like morphine.
During treatment, oncologists grade the degree of mucositis and treat it accordingly. I don’t think I got beyond Grade 2 (or was it 3?) but it was certainly painful. Even a banana would sting my mouth. Because surgery was my main mode of treatment, my radiation was limited to one side of my face and my side effects were bearable. Some people treated by chemo and radiation alone have a bigger dose and worse side effects.
Many people can’t eat at all because of the pain and have to be tube fed.
Signs and symptoms of mucositis include:
- Red, shiny, or swollen mouth and gums
- Blood in the mouth
- Sores in the mouth or on the gums or tongue
- Soreness or pain in the mouth or throat
- Difficulty swallowing or talking
- Feeling of dryness, mild burning, or pain when eating food
- Soft, whitish patches or pus in the mouth or on the tongue
- Increased mucus or thicker saliva in the mouth
This is where a special humidifier comes in. Andrew McCann, a radiation oncologist at Auckland Hospital, led a trans-Tasman study on the use of humidifiers (RadioHUM) during and after radiation for head and neck cancer patients.
The device used in the study was a humidifier/flow generator with latex free, plastic nasal cannula that deliver 44 mg of water per liter of air at a rate of 30 L/min. The humidified air is delivered through the nose and can be worn by patients during the day or while they sleep at night.
The study took place in 2007 and 2011 and proved that those who use the machines can avoid hospitalisation and heavy pain relief – they can also get on with their lives.
Dr McCann says, “The rationale for using a humidifier is quite simple: moisturising wounds generally assists them to heal faster.”
Since the study ADHB has purchased a large number of these devices. The ENT ward and Outpatients use them regularly. Radiation oncology also purchased some machines from Dry July money some years ago. Patients can borrow them from the ADHB for a period of time but if they want to have their own device at home indefinitely, they need to return the hospital humidifier and purchase their own.
Some patients find the machine difficult to use so compliance (getting patients to use them) can be low.
Other patients call them “lifesavers”. According to nurses, teaching patients how to use them is the key to their success.
Here is what a caregiver said, “The other great thing about these humidifiers for the H&N patient is that they add moisture to the awful thick gloopy secretions that come with the radiation. They help to thin them , which helps to avoid the vomiting and coughing which is often associated with the thick secretions/saliva.”
New Zealand is the home of humidifiers
“New Zealand is the home of humidification”, said an Atos Medical rep at a Speech Language Therapist study day last week.
What he means is that New Zealand company Fisher and Paykel makes medical humidifiers for most of the world. The Atos rep was referring to HME filters which help laryngectomees filter, heat and humidify the air that comes through the hole in their throat ( the Stoma). He thought it was ironic that New Zealand is the leading country in the world for making humidification devices but most DHBs in NZ won’t provide HMEs. This is another matter altogether but it makes it clear that other countries see NZ and Fisher and Paykel as leading the world in the field of humidification.