Publications
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Westgaard, Kristine Løken; Amdal, Cecilie Delphin; Taylor, Katherine J.; Falk, Ragnhild Sørum; Bjordal, Kristin & Singer, Susanne
[Show all 15 contributors for this article]
(2025).
Oral health-related quality of life among long-term head and neck cancer survivors: a multinational study.
Supportive Care in Cancer.
ISSN 0941-4355.
33(10).
doi:
10.1007/s00520-025-09930-8.
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Purpose Our aim was to investigate oral health-related quality of life (OHRQoL) and toxicities in long-term head and neck cancer (HNC) survivors diagnosed ≥five years earlier. Methods HNC survivors treated between 2007 and 2013 participated in an international cross-sectional study. They completed the European Organization for Research and Treatment of Cancer (EORTC) core quality of life questionnaire (EORTC QLQ-C30) and the oral health module (EORTC QLQ-OH15) and attended a hospital examination. Clinicians scored toxicities using the Common Terminology Criteria for Adverse Events version 5.0. OHRQoL was analyzed based on four types of treatment: surgery, radiotherapy, chemoradiotherapy without surgery and surgery with postoperative (chemo) radiotherapy. Survivors were divided into three groups according to the EORTC QLQ-OH15 oral health-QoL scale score; the lowest (defined as poor OHRQoL), middle and highest tertile. Results Eleven sites in six countries enrolled 404 HNC survivors. The median time since diagnosis was 8.4 years, the mean age was 66 years and 67% were male. A total of 116 (29%) of the survivors reported poor OHRQoL. They were more often females and survivors with advanced disease. The survivors with poor OHRQoL also had more toxicity: dysphagia, trismus, osteonecrosis of the jaw, oral pain and dry mouth. There were no clinically significant differences in OHRQoL between the four treatment groups. Conclusion Our study showed that the survivors who reported poor OHRQoL also had a high level of late toxicity. This highlight the need for improved follow-up of the oral health of HNC survivors many years after initial treatment, especially for women and those who were treated for advanced disease.
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Singer, Susanne; Amdal, Cecilie Delphin; Bjordal, Kristin; Herlofson, Bente Brokstad; Astrup, Guro Lindviksmoen & Boehm, Andreas
[Show all 27 contributors for this article]
(2025).
Late Toxicity and Long‐Term Quality of Life in Survivors of Cancer of the Major Salivary Glands More Than 5 Years After Diagnosis: A Multi‐National Study.
Head and Neck.
ISSN 1043-3074.
doi:
10.1002/hed.28263.
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Background Because salivary gland cancers (SGC) are rare and include different tumor subtypes, data on their long‐term quality of life and late toxicities are sparse. Methods Multi‐national study including SGC survivors more than 5 years after diagnosis. They completed the European Organisation for Research and Treatment of Cancer (EORTC) quality of life core questionnaire together with its head and neck cancer module and reported problems that were most bothering for them. Toxicity was clinically assessed. Results Altogether, 60 survivors from nine countries participated and reported dry mouth (mean score 37.2), use of painkillers (35.0), problems with sexuality (30.1), insomnia (28.9), fatigue (27.8), trismus (24.9), and sticky saliva (23.3). The most frequently mentioned long‐term problem was dry mouth , mentioned by a third of all participants. The most frequent toxicities were hearing impairment , soft tissue fibrosis , dry mouth , and cranial neuropathies . Conclusions Dry mouth is a frequent and disturbing problem in SGC survivors.
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Hynne, Håvard; Aqrawi, Lara A.; Jensen, Janicke Liaaen; Thiede, Bernd; Palm, Øyvind & Amdal, Cecilie Delphin
[Show all 10 contributors for this article]
(2022).
Proteomic Profiling of Saliva and Tears in Radiated Head and Neck Cancer Patients as Compared to Primary Sjögren’s Syndrome Patients.
International Journal of Molecular Sciences.
ISSN 1661-6596.
23(7).
doi:
10.3390/ijms23073714.
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Patients with head and neck cancer (HNC) and patients with primary Sjögren’s syndrome (pSS) may exhibit similar symptoms of dry mouth and dry eyes, as a result of radiotherapy (RT) or a consequence of disease progression. To identify the proteins that may serve as promising disease biomarkers, we analysed saliva and tears from 29 radiated HNC patients and 21 healthy controls, and saliva from 14 pSS patients by mass spectrometry-based proteomics. The study revealed several upregulated, and in some instances overlapping, proteins in the two patient groups. Histone H1.4 and neutrophil collagenase were upregulated in whole saliva of both patient groups, while caspase-14, histone H4, and protein S100-A9 were upregulated in HNC saliva only. In HCN tear fluid, the most highly upregulated protein was mucin-like protein 1. These overexpressed proteins in saliva and tears play central roles in inflammation, host cell injury, activation of reactive oxygen species, and tissue repair. In conclusion, the similarities and differences in overexpressed proteins detected in saliva from HNC and pSS patients may contribute to the overall understanding of the different pathophysiological mechanisms inducing dry mouth. Thus, the recurring proteins identified could possibly serve as future promising biomarkers
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Westgaard, Kristine Løken; Hynne, Håvard; Amdal, Cecilie Delphin; Young, Alix; Singh, Preet Bano & Chen, Xiangjun
[Show all 12 contributors for this article]
(2021).
Oral and ocular late effects in head and neck cancer patients treated with radiotherapy.
Scientific Reports.
11:4026,
p. 1–11.
doi:
10.1038/s41598-021-83635-w.
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A broader understanding of oral and ocular late effects in head and neck cancer (HNC) patients who underwent intensity-modulated radiotherapy (IMRT) may provide valuable information in follow-up and improve quality of life. Twenty-nine HNC patients treated at least 6 months earlier and 30 age-matched controls were recruited. After completing several questionnaires: Oral Health Impact Profile-14 (OHIP-14), Shortened Xerostomia Inventory (SXI), Ocular Surface Disease Index (OSDI) and McMonnies Dry Eye questionnaire (MDEQ), participants underwent oral and ocular examinations. Oral examination included clinical oral dryness score (CODS) and secretion rates of unstimulated and stimulated saliva (UWS, SWS). Ocular examination included tear film break-up time, Schirmer test and ocular surface staining. The patients had more problems related to dry mouth than controls based on CODS and SXI, and more complaints of dry eye disease based on OSDI and MDEQ. UWS and SWS rates and oral health related quality of life were significantly lower in the patient group. Subjective oral dryness (SXI) correlated significantly with subjective ocular dryness (OSDI and MDEQ). Our study demonstrates that HNC patients treated with IMRT experience late effects in terms of xerostomia and ocular dryness underlining the importance of interdisciplinary approach in the evaluation and follow-up of HNC patients.
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Chen, Xiangjun; Badian, Reza; Hynne, Håvard; Amdal, Cecilie Delphin; Herlofson, Bente Brokstad & Utheim, Øygunn Aass
[Show all 10 contributors for this article]
(2021).
Alterations in meibomian glands in patients treated with intensity-modulated radiotherapy for head and neck cancer.
Scientific Reports.
11:22419,
p. 1–7.
doi:
10.1038/s41598-021-01844-9.
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Patients undergoing intensity-modulated radiotherapy (IMRT) for head and neck cancer may have increased incidence of dry eye disease and the exact mechanism is unclear. The present study aims to assess tear film and meibomian gland (MG) features in patients who received IMRT for head and neck cancer not involving the orbital area. Twenty-seven patients (64.7 ± 9.8 years) and 30 age-matched controls (61.4 ± 11.0 years) underwent a comprehensive dry eye work-up. Compared to the control group, the patients had more lid margin abnormalities, and worse meibum quality. The MG loss, calculated as (tarsal area-MG area)/tarsal area, was higher in the patient group in both the upper (53.0 ± 12.0% vs. 35.1 ± 10.3%, p < 0.001) and lower lids (69.5 ± 12.6% vs. 48.5 ± 12.5%, p < 0.001). In the patient group, more MG loss in the lower lids correlated with worse meibum quality (r = 0.445, p = 0.029). In contrast, there was no significant difference in aqueous tear production level, measured with Schirmer test. Patients treated with IMRT for head and neck cancer seemed to have comparable lacrimal gland function to the controls despite more dry eye symptoms. However, the patients had MG functional and morphological changes, which may present a higher risk for developing dry eye disease.
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Aqrawi, Lara A.; Chen, Xiangjun; Hynne, Håvard; Amdal, Cecilie Delphin; Reppe, Sjur & Aass, Hans Christian Dalsbotten
[Show all 14 contributors for this article]
(2020).
Cytokines Explored in Saliva and Tears from Radiated Cancer Patients Correlate with Clinical Manifestations, Influencing Important Immunoregulatory Cellular Pathways.
Cells.
9(9).
doi:
10.3390/cells9092050.
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Although radiotherapy is a common form of treatment for head and neck cancer, it may lead to tissue damage in the salivary and lacrimal glands, possibly affecting cytokine expression in the gland fluid of treated individuals. Cytokine profiles in saliva and tear fluid of 29 radiated head and neck cancer patients and 20 controls were screened using a multiplex assay. Correlations between cytokine expression and clinical oral and ocular manifestations were examined, and cellular pathways influenced by these cytokines were assessed using the Functional Enrichment Analysis Tool. Significantly elevated cytokines identified in patient saliva were CCL21, IL-4, CX3CL1, CCL2, CXCL1 and CCL15. Many of these cytokines correlated positively with objective signs of oral dryness, and reduced saliva production in the patients. Although CCL21 and IL-4 levels were significantly lower in patient tear fluid, they correlated with subjective ocular symptoms. These increased salivary cytokines affected pro-inflammatory and apoptotic cellular pathways, including T cell signalling, several interleukin signalling pathways, TNF and TGF-β receptor signalling, and the apoptotic p53 pathway. In conclusion, the upregulated salivary cytokines identified suggest an interplay between innate and adaptive immunity, affecting immunoregulatory cellular pathways. Whether this is due to late effects of radiotherapy or tissue repair remains to be investigated.
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Herlofson, Bente Brokstad; Løken, Kristine & Støre, Geir
(2012).
Orale komplikasjoner ved moderne kreftbehandling.
Den norske tannlegeforenings Tidende.
ISSN 0029-2303.
122,
p. 130–133.
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Kreftpasienter lever lenger med sin sykdom ettersom nye og intensive medikamentelle behandlingsregimer implementeres. Tannhelsepersonell må derfor være innstilt på å øke sin kunnskap om orale problemstillinger ved kreft og kreftbehandling, for å kunne bidra til en optimal og helhetlig kreftomsorg. Mer forskning er nødvendig, spesielt for å bedre dokumentasjon av orale bivirkninger på lang sikt ved medikamentell kreftbehandling.
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Herlofson, Bente Brokstad & Løken, Kristine
(2006).
Hvordan påvirkes munnhulen av kreftbehandling?
Den norske tannlegeforenings Tidende.
ISSN 0029-2303.
116(7),
p. 414–418.
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Herlofson, Bente Brokstad & Westgaard, Kristine Løken
(2022).
The Oral Health Subproject - part of the Late toxicity and long-term quality of life study in head and neck cancer survivors.
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Herlofson, Bente Brokstad; Kjølle, Gry Karina; Westgaard, Kristine Løken; Løndalen, Ayca & Bruland, Øyvind
(2018).
Osteonecrosis of the jaw in a patient with bone metastatic prostate cancer after long-term bisphosphonate treatment with severe deterioration following radium-223.
Clinical Genitourinary Cancer.
ISSN 1558-7673.
p. 1–4.
doi:
10.1016/j.clgc.2018.05.003.
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Published
May 14, 2018 11:37 AM
- Last modified
Oct. 26, 2023 8:49 AM
