Blanchard, D., Bollet, M., Dreyer, C., Binczak, M., Calmels, P., Couturaud, C., ... & Albert, S. (2014). Management of somatic pain induced by head and neck cancer treatment: Pain following radiation therapy and chemotherapy. Guidelines of the French Otorhinolaryngology Head and Neck Surgery Society (SFORL). European Annals of Otorhinolaryngology, Head and Neck Diseases, 131, 253–256. 

DOI Link

Purpose & Patient Population

PURPOSE: To provide a SFORL guideline for the management of somatic pain induced by head and neck cancer treatment concerning the management of pain following radiation therapy and chemotherapy
 
TYPES OF PATIENTS ADDRESSED: Patients with head and neck cancer receiving radiation and chemotherapy 

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Evidence-based guideline  
 
PROCESS OF DEVELOPMENT: Literature review and level of evidence grading guides by the L'Agence Nationale d'Accréditation et d'Evaluation en Santé (ANAES) guide to literature analysis and grading
 
SEARCH STRATEGY:
  • DATABASES USED: Not stated
  • KEYWORDS: Not stated
  • INCLUSION CRITERIA: Not stated (based on each reviewer’s experience)
  • EXCLUSION CRITERIA: Not stated

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results Provided in the Reference

Many systematic reviews were used as references such as the Cochrane Library, but no number articles reviewed or how these were chosen were mentioned. Selection was based on each reviewer’s experience. 

Guidelines & Recommendations

Guideline 1: To limit early and late toxicity, radiation therapy should at least be conformal and, if indicated, intensity-modulated, to deliver a homogeneous dose to target volumes and spare healthy tissue as far as possible (grade B).
 
Guideline 2: To reduce radiation therapy-induced pain, patients should be prescribed a nutritional assessment with hygiene, diet, postural instructions as well as smoking cessation and alcohol abuse counseling (grade B).
 
Guideline 3: To prevent and treat radiation-induced microsites, it was recommended to:
  • Assess and eradicate dental infection sites ahead of radiation therapy and transmit irradiated volumes to the dentist
  • Use a soft toothbrush and replace it regularly
  • Apply fluoride to dental splints
  • Perform regular mouth rinses with nonalcoholic saline solution
  • Ensure the early diagnosis and treatment of bacterial, fungal, and viral super infections (grade B).
Guideline 4: Stress preventive measures against painful late complications of radiation therapy (expert opinion).

Limitations

  • No clear statement of review process
  • No stated inclusion or exclusion criteria
  • Number of articles retrieved and reviewed for these guidelines was not provided

Nursing Implications

The categorization using the ANAES guides to determine level of evidence and grades was appropriate. However, the search methods used in these guidelines were not clearly stated and need reconfirmation because there was no way to know whether the search was comprehensive. The recommendations were grade B and expert opinions.