ABSTRACT
Objective: Radiation therapy (RT) for head and neck cancer (HNC) can result in severe xerostomia, or the subjective feeling of dry mouth. Characterizing xerostomia is critical to designing future clinical trials investigating how to improve HNC patients' quality of life (QoL). Few studies have investigated the very late (>5 years post-RT) effects of RT for HNC. We undertook preliminary studies quantifying very late xerostomia. Methods: Six adults who underwent RT for HNC at least 5 years prior and reported xerostomia were enrolled. Five healthy adults without a self-reported history of HNC or xerostomia were enrolled as controls. All participants completed three validated surveys to measure xerostomia-related QoL. Salivary production rates were measured and compositional analysis of the saliva and oral microbiome was completed. Results: The QoL survey scores for the HNC participants were significantly worse as compared to the control participants. The HNC participants produced less unstimulated saliva (p = .02) but not less stimulated saliva. The median salivary mucin significantly higher in HNC participants than in control participants (p = .02). There was no significant difference between the pH, amylase, or total protein. Microbiome analysis revealed alpha diversity to be significantly lower in the HNC participants. Conclusion: In the survivors of HNC who suffer from late toxicities, multiple means of measuring toxicity may be useful. We found that in patients with radiation-induced xerostomia over 5 years after therapy, not only were the QoL surveys significantly worse, as expected, but other measurements such as mucin and oral microbiome diversity were also significantly different. Level of evidence: 3.
ABSTRACT
Background The COVID-19 pandemic has posed substantial impact on people?s life and wellbeing, especially for the aging population who are at greater risk. This study compared the difference in the impact between older adults from underrepresented racial/ethnic groups (URGs) versus non-URGs. Method The National Alzheimer?s Coordinating Center COVID-19 Impact Survey was self-reported by 221 participants aged 49-99 years from the Wisconsin Alzheimer?s Disease Research Center clinical core between August and December, 2020. 43 participants who reported ?Black or African American? or ?American Indian or Alaska Native? in primary or secondary race or reported ?Yes? to Hispanic? ethnicity were classified as URGs. The remaining 178 participants who reported only ?White? or ?Asian? in the primary and secondary races and ?No? to ?Hispanic? ethnicity were classified as non-URGs. The survey inquired on (1) COVID-19 symptoms, testing, diagnosis, and hospitalization;(2) worrying, social isolation, and disruption on everyday life associated with the pandemic;(3) related cognitive, psychiatric, and behavioral changes;and (4) change of willingness in research participation. Group differences on survey responses were tested using Fisher?s exact test, non-parametric Kruskal-Wallis test, and binary or ordinal logistic regressions. Result No significant group difference was found in sex, age, and clinical diagnosis. However, URG participants had lower education and higher Clinical Dementia Rating (CDR) scores (Table 1). URGs were approximately doubled non-URGs in the percentages of experiencing COVID-19 symptoms, having a positive diagnosis, and reporting ?very much? or ?extremely? worrying about getting COVID-19 and changing willingness to participate in clinical research. Controlling for sex, age, education, and CDR score, URGs were more likely to be tested for COVID-19 (Odds Ratio = 2.37), have significantly reduced income (OR=4.74), experience change in memory or thinking (OR=2.97), and report a greater total number of psychiatric or behavioral changes (OR=2.04). However, URGs felt less isolated from family or friends (OR=0.55). Conclusion URGs had greater medical, psychological, and economical consequences than non-URGs, which implied racial/ethnic disparities associated with the pandemic. Future research is needed to identify inequities in the social determinants and understand their association with disparities, which would help inform policies and strategies to achieve health equity.