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

描述（由申请人提供）：头颈癌患者一旦开始放射治疗，他们必须执行困难和复杂的口腔健康方案，以防止终身永久性吞咽障碍和口腔感染。为了防止吞咽困难，患者必须进行运动锻炼，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锻炼，之后依从性恶化。为防止口腔感染，患者必须在饭后刷牙、用牙线剔牙、漱口，并在睡前佩戴氟化物托盘。我们的数据再次显示，依从率很低，从30%到50%不等。不遵医嘱的主要原因是低估了口腔健康方案的重要性、疼痛、疲劳和感觉不适。对癌症幸存者坚持健康行为的研究不足，很少有研究调查疾病症状与分子和心理因素的作用。利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、个体和双源应对因素，以确定它们与200名口咽喉癌患者在放射治疗及放疗后的多种口腔健康行为的依从性之间的关系。主要目的：1)确定疾病感知是否能显著预测3个月和6个月时吞咽练习和牙科治疗方案的依从性。2)探讨疾病行为（抑郁、疲劳、疼痛）对疾病感知的影响是否由促炎因子介导。3)确定二元应对是否调节应对对应对评价的影响。研究设计：从m.d. Anderson和Lyndon Baines Johnson社区医院招募的200名患者将在基线入组时、放射治疗结束后6周（或基线后3个月）和放射后6个月进行评估。为了证实患者坚持吞咽练习的自我报告，患者的配偶或照顾者将被要求在两次随访中完成一份确证问卷，并使用牙科检查将自我报告的坚持与口腔健康联系起来。摘要：我们的研究采用多学科方法，将分子细胞因子、社会理论和应对和疾病感知的心理结构结合起来，以有意义的方式推动依从性领域的发展。我们的应用程序仔细地绘制了一个概念框架，描述了口咽喉癌患者样本中从放射治疗进展到生存的粘附性的假设介质和调节因子。由此产生的数据将提供关于坚持困难的方案的重要和有用的信息。

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.