Modeling Adherence to Swallowing and Dental Regimens in Head and Neck Cancer

描述（由申请人提供）：一旦头颈癌患者开始放射治疗，他们必须执行困难和复杂的口腔健康方案，以防止永久性吞咽障碍和口腔感染的余生。为了预防吞咽困难，患者必须进行运动锻炼，以加强舌头和增加口咽结构的运动范围。然而，依从性很低，只有9.5%的R03参与者（n=97）在放疗期间尝试了一次或多次运动，之后依从性恶化。为了预防口腔感染，患者必须在每顿饭后刷牙、用牙线清洁和冲洗，并在睡前佩戴氟化物托盘。同样，我们的数据显示，坚持率很低，从30%到50%不等。不依从的主要原因是低估了口腔健康方案的重要性，疼痛，疲劳和不适。癌症幸存者对健康行为的坚持性研究不足，很少有研究调查疾病症状与分子和心理因素的作用。使用自我调节理论作为我们的参考点，我们将跟踪促炎细胞因子，个人和二元应对因素，以确定它们与200名口咽癌和喉癌患者在放射治疗及其他治疗过程中坚持多种口腔健康行为的相关性。主要目标：1）确定疾病感知是否显著预测3个月和6个月时吞咽练习和牙科治疗方案的依从性。2)确定疾病行为（抑郁、疲劳、疼痛）对疾病感知的影响是否由促炎细胞因子介导。3)探讨应对方式对应对方式评价的影响是否具有调节作用。研究设计：从M. D.将在基线进入研究、放疗结束后6周（或基线后3个月）和放疗后6个月对安德森和林登贝恩斯约翰逊社区医院进行评估。为了证实患者自我报告的吞咽练习依从性，将要求患者配偶或护理人员在两次随访时完成确证问卷，并使用牙科检查将自我报告的依从性与口腔健康相关联。总结：我们的研究采用了多学科的方法来整合分子细胞因子，社会理论和应对和疾病感知的心理结构的研究，以有意义的方式推动该领域的坚持。我们的应用程序已经仔细地绘制了一个概念框架，描绘了假设的介质和主持人的坚持在口咽和喉癌患者的样本，因为他们的进展，通过放射治疗的生存。由此产生的数据将产生重要和有用的信息，坚持困难的方案。 公共卫生相关性：确定坚持预防性吞咽练习和牙科治疗方案的关键因素，将是有价值的照射头颈部癌症幸存者，谁是永久性吞咽障碍和猖獗的龋齿的风险。使用自我调节理论来衡量个人因素作为出发点，本项目将评估潜在的生物介质和社会调节剂的坚持吞咽练习和牙科方案的纵向设计。

DESCRIPTION (provided by applicant): Once head and neck cancer patients begin radiation treatment, they must perform difficult and complicated oral health regimens to prevent permanent swallowing disorders and oral infection for the rest of their lives. To prevent dysphagia, patients must perform motor exercises that strengthen the tongue and increase range of motion in oropharyngeal structures. However, adherence was low, just 9.5% of our R03 participants (n=97) tried the exercises once or more during radiation, with adherence worsening afterward. To prevent oral infection, patients must brush, floss, and rinse after every meal and wear fluoride trays before bed. Again, our data show that adherence rates were low, ranging from 30 to 50%. The main reasons for nonadherence were underestimation of the importance of the oral health regimens, pain, fatigue and feeling ill. Adherence to health behaviors in cancer survivors is understudied, and very few studies have investigated the role of illness symptoms in conjunction with molecular and psychological factors. Using the Theory of Self-Regulation as our reference point, we will track proinflammatory cytokines, individual and dyadic coping factors to determine their association with adherence to multiple oral health behaviors in 200 oropharyngeal and laryngeal cancer patients as they progress through radiation and beyond. Primary Aims: 1) To determine whether illness perceptions significantly predict adherence to swallowing exercises and dental regimen at 3 months and 6 months. 2) To determine whether sickness behaviors (depression, fatigue, pain)'s effect on illness perceptions are mediated by proinflammatory cytokines. 3) To determine whether dyadic coping moderates the impact of coping on appraisal of coping. Study design: 200 patients recruited from M. D. Anderson and Lyndon Baines Johnson Community hospital will be assessed at baseline entry into the study, 6 weeks after the end of radiation therapy (or 3 months after baseline), and 6 months post-radiation. To provide corroboration of the patient's self-report of adherence to the swallowing exercises, patients spouses or caregivers will be asked to complete a corroborating questionnaire at the two follow-ups, and a dental examination will be used to correlate self-reported adherence with oral health. Summary: Our study uses a multidisciplinary approach to integrate the study of molecular cytokines, social theory and psychological constructs of coping and illness perceptions to move the field of adherence forward in a meaningful way. Our application has carefully mapped out a conceptual framework delineating the hypothesized mediators and moderators of adherence in a sample of oropharyngeal and laryngeal cancer patients as they progress through radiation treatment into survivorship. The resulting data will yield important and useful information regarding adherence to difficult regimens. PUBLIC HEALTH RELEVANCE: Identifying key factors in adherence to preventive swallowing exercises and dental regimens would be valuable to irradiated head and neck cancer survivors, who are at risk for permanent swallowing disorders and rampant caries. Using the Theory of Self-Regulation to measure individual factors as a starting point, this project will assess potential biologic mediators and social moderators of adherence to swallowing exercises and dental regimen in a longitudinal design.