2730 - Unmet Needs and Treatment Priorities in Oral Mucositis Management during Head and Neck Radiotherapy

Purpose/Objective(s):

Oral mucositis affects up to 90% of patients receiving radiotherapy (RT) for head and neck cancer. It frequently requires multimodal pain management, including the use of systemic opioids. While pain severity is well-recognized, less is known about patient-reported gaps in current management and priorities for future therapies. We conducted a patient engagement study to characterize treatment utilization, perceived effectiveness, functional burden, and unmet needs to inform patient-centered care and future study design.

Materials/Methods:

We surveyed patients at our institution with head and neck cancer who were currently receiving RT, had completed RT within the prior year, or had previously required referral to pain management. Participants completed an in-clinic survey evaluating the timing and severity of oral mucositis pain, medications used and perceived efficacy, desired features of new treatments, and preferences related to clinical trial participation.

Results:

45 patients completed the survey. Mean worst oral mucositis pain during RT was 7.4/10 (SD 2.64). Pain onset occurred most commonly during RT weeks 2-4 (78%). Worst pain was most frequently reported during RT weeks 6-7 and/or post-RT (70%). The most commonly used medications were lidocaine (67%) and MuGard (64%), with 83% of users reporting symptomatic relief for each. 58% used systemic opioids (including morphine solution), with 88% of users reporting relief from at least one opioid agent.

The most difficult problems during RT were pain when eating (67%), pain when drinking (44%), and weight loss due to pain (33%). The most important problems patients wanted relief from were being able to eat (84%), being able to drink (60%), and weight loss (33%). The most desired features of a new treatment were long-lasting effect (67%), fast pain relief (53%), and few or no side effects (42%). When considering trial participation, contributing to research that may help future patients was most frequently ranked first, followed by minimal disruption to daily life, and clear information about the study and expectations. A proposed 12-14 week study including 8 in-person visits and one phone call was acceptable to less than half of participants. The median acceptable number of visits was 5 (range 1-14; n=32). The most preferred methods for reporting symptoms were an app-based system (44%) and phone call with a study nurse (42%).

Conclusion:

Patients undergoing RT for head and neck cancer experience a high pain burden that significantly impairs essential functions, particularly eating and drinking. While current therapies provide relief for most, there remains a critical unmet need for long-lasting, fast-acting treatments with fewer side effects. These findings underscore the importance of patient-centered approaches that prioritize functional outcomes and inform the design of future studies on oral mucositis management.