Assessing the reliability and validity of the revised WCCNR Stomatitis Staging System for cancer therapy-induced stomatitis

Karin Olson, John Hanson, Joan Hamilton, Dawn Stacey, Margaret Eades, Deborah Gue, Harry Plummer, Karen Janes, Margaret Fitch, Debra Bakker, Pamela Baker, Catherine Oliver

Abstract


Before developing interventions for stomatitis, nurses require a simple, valid and reliable approach to staging severity. The eight-item WCCNR was previously validated for chemotherapy-induced stomatitis. In this study, the validity and reliability of the WCCNRR, a shorter three-item tool for staging stomatitis caused by chemotherapy, radiotherapy, or both, was assessed. Pairs of data collectors evaluated 207 patients from 10 Canadian cancer centres. The WCCNRR correlated well with the MacDibbs Mouth Assessment (r=0.44, p=0.0002 to r=0.54, p<0.0001), a standardized tool for staging radiotherapy-induced stomatitis. Agreement between data collectors at five sites was acceptable (kappa=0.75); three additional sites were close to this target. Findings indicate that the WCCNRR is a valid and reasonably reliable tool for staging stomatitis due to cancer therapy.


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References


Beck, S. (1979). Impact of a systematic oral care protocol on stomatitis

after chemotherapy. Cancer Nursing, 2(3), 185-199.

Bennett, J., Muss, H., Droshow, J., Wolff, S., Krementz, E., Cartwright,

K., et al. (1988). A randomized multi-center trial comparing

mitoxantrone, cyclophosphamide, and fluorouracil with doxorubicin,

cyclophosphamide, and fluorouracil in the therapy of metastatic breast

carcinoma. Journal of Clinical Oncology, 6, 1611-20.

Berger, A., & Eilers, J. (1998). Factors influencing oral cavity status

during high-dose antineoplastic therapy: A secondary data analysis.

Oncology Nursing Forum, 25(9), 1623-1626.

Browman, G., Levine, M., Goodyear, M., Russell, R., Archibald, S.,

Jackson, B., et al. (1988). Methotrexate/fluorouracil scheduling

influences normal tissue toxicity but not antitumour effects in patients

with squamous cell head and neck cancer: Results from a randomized

trial. Journal of Clinical Oncology, 6, 963-8.

Bruya, M., & Madeira, N. (1975). Stomatitis after chemotherapy.

American Journal of Nursing, 75(8), 1349-1352.

Chapko, M., Syrjala, K., Schilter, L., Cummings, L., & Sullivan, K.

(1989). Chemoradiaotherapy toxicity during bone marrow

transplantation: Time course and variation in pain and nausea. Bone

Marrow Transplant, 4, 181-6.

Cohen, J. (1977). Statistical power analysis for the behavioural science

(rev.). New York: Academic Press.

Cox, J. (Ed.). (1994). Moss’ radiation oncology (7th ed.). St. Louis:

Mosby.

Dibble, S., Shiha, G., MacPhail, L., & Dodd, M. (1996). MacDibbs

Mouth Assessment: A new tool to evaluate mucositis in the radiation

therapy patient. Cancer Nursing, 4(3), 135-139.

Dodd, M., Dibble, S., Miaskowski, C., MacPhail, L., Greenspan, D.,

Paul, S., & Larson, P. (2000). Randomized clinical trial of the

effectiveness of three commonly used mouthwashes to treat

chemotherapy-induced mucositis. Oral Surgery, Oral Medicine,

Oral Pathology, 90(1), 39-47.

Dodd, M., Dibble, S., Miaskowski, C., Paul, S., Cho., M., MacPhail, L.,

et al. (2001). A comparison of the affective state and quality of life of

chemotherapy patients who do and do not develop chemotherapyinduced

oral mucositis. Journal of Pain and Symptom

Management, 21(6), 498-505.

Dodd, M., Miaskowski, C., Dibble, S., Paul, S., MacPhail, L., &

Greenspan, L. (2000). Factors influencing oral mucositis in patients

receiving chemotherapy. Cancer Practice, 8(6), 291-297.

Dose, M. (1995). The symptom experience of mucositis, stomatitis, and

xerostomia. Seminars in Oncology Nursing, 11(4), 248-255.

Eilers, J., Berger, A., & Petersen, M. (1988). Development, testing, and

application of the oral assessment guide. Oncology Nursing Forum,

(3), 325-330.

Epstein, J., & Spektor, W. (1993). Radiation therapy and pain in patients

with head and neck cancer. Oral Oncology, European Journal of

Cancer, 2(9B), 191-199.

Fountzilas, G., Daniilidis, J., Kalogera-Fountzilas, A., Apostolidis, T.,

Vritsios, A., & Tourkantonis, A. (1988). Combined therapy of locally

advanced squamous epithelial cancers in the area of the head and neck

[German]. Laryngologie, Rhinologie, Otologie, 67(4), 165-70.

Fountzilas, G., Nicolaou, A., Sridhar, K., Sideras, T., Haritanti, A., &

Anastasakis, C., et al., (1989). Induction chemotherapy with

cisplatinum, 5-fluorouracil, bleomycin, mitamycin-C, and hydroxyurea

for previously untreated locally advanced squamous cell carcinomas of

the head and neck. Archives Oto-Rhino-Laryngology, 246, 373-7.

Graham, K., Pecoraro, D., Bentura, M., & Meyer, C. (1993). Reducing

the incidence of stomatitis using a quality assessment approach.

Cancer Nursing, 16(2), 117-122.

Greenberg, M. (1990). Pre-chemotherapy dental treatment to prevent

bacteremia. National Cancer Institute Monographs, 9, 49-50.

Hortobagyi, G., Frye, D., Busdar, A., Ewer, M., Fraschini, G., Hug, B., et

al. (1989). Decreased cardiac toxicity of doxorubicin administered by

continuous intravenous infusion in combination chemotherapy for

metastatic breast carcinoma. Cancer, 63, 37-45.

Kin, R., Iwamori , S., Saeki, S., Nishimawari, K., Akiyama, H., Nagusa,

Y., et al. (1988). Clinical observations of hepatic artery infusion

therapy combined with hepatic artery ligation in metastatic liver

cancers. Gan To Kagaku Ryoho, 15, 661-5.

Kolbinson, D., Schubert, M., Flournoy, N., & Truelove, E. (1988). Early

oral changes following bone marrow transplantation. Oral Surgery,

(1), 130-138.

Larson, P., Miaskowski, C., MacPhail, L., Dodd, M., Greenspan, D.,

Dibble, S., et al. (1998). The PRO-SELF (C) Mouth Aware program:

An effective approach for reducing chemotherapy-induced mucositis.

Cancer Nursing, 21(4), 263-268.

Levi, J., Thomson, D., Harvey, V., Gill, G., Raghavean, D., Tattersall, M.,

et al. (1990). Effective salvage chemotherapy with etoposide,

dactinomycin, and methotrexate in refractory germ cell cancer.

Journal of Clinical Oncology, 8, 27-32.

Madeya, M. (1996). Oral complications from cancer therapy: Part 1—

pathophysiology and secondary complications. Oncology Nursing

Forum, 23(5), 801-807.

McGuire, D., Altomonte, V., Peterson, D., Wingard, J., Jones, R., &

Grochow, L. (1993). Patterns of mucositis and pain in patients

receiving preparative chemotherapy and bone marrow transplantation.

Oncology Nursing Forum, 20(10), 1493-1502.

McGuire, D., Yeager, K., Peterson, D., Owen, D., & Wingard. J. (1998).

Acute oral pain and mucositis in bone marrow transplant and leukemia

patients: Data from a pilot study. Cancer Nursing, 21(6), 385-393.

Miller, A., Hoogstraten, B., Staquet, M., & Winkler, A. (1981). Reporting

results of cancer treatment. Cancer, 47(1), 207-214.

National Institutes of Health. (1990). National Institutes of Health

Consensus Development Conference on oral complications of cancer

therapies: Diagnosis, prevention, and treatment. National Cancer

Institute Monographs, 7(7), 1-25, Bethesda, MD.

Passos, J., & Brand, L. (1966). Effects of agents used for oral hygiene.

Nursing Research, 15(3), 196-202.

Rothwell, B., & Spektor, W. (1990). Palliation of radiation related

mucositis. Special Care in Dentistry, 10(1), 21-25.

Sonis, S. (1993). Oral complications of cancer therapy. In V. DeVita, S.

Hellman, & S. Rosenberg (Eds.), Cancer: Principles and practice of

oncology (2nd ed.). Philadelphia: J.B. Lippincott.

Sonis, S., Eilers, J., Epstein, J., LeVeque , F., Liggett, W., Mulagha, M.,

et al. (1999). Validation of a new scoring system for the assessment of

clinical trial research of oral mucositis induced by radiation or

chemotherapy. Cancer, 85(10), 2103-2113.

Thatcher, D., Lind, M., Morgenstern, G., Carr, T., Chadwich, G., & Jones,

R., et al. (1989). Cancer, 63, 1296-302.

Thomas, C. (1997). Taber’s cyclopedic medical dictionary (18th ed.).

Philadelphia: F.A. Davis.

Van Drimmelen, J., & Rollins, H.F. (1969). Evaluation of a commonly

used oral hygiene agent. Nursing Research, 18(4), 327-332.

Verdi, C., Garewal, H., Koenig, M., Vaughn, B., & Burkhead, T. (1995).

A double-blind, randomized, placebo-controlled, crossover trial of

pentoxifylline for the prevention of chemotherapy-induced oral

mucositis. Oral Surgery, Oral Medicine, Oral Pathology, 80(1),

-42.

Western Consortium for Cancer Nursing Research (WCCNR). (1987).

Priorities for cancer nursing research. Cancer Nursing, 10(6),

-326.

Western Consortium for Cancer Nursing Research (WCCNR). (1991).

Development of a staging system for chemotherapy-induced

stomatitis. Cancer Nursing, 14(1), 6-12.

Western Consortium for Cancer Nursing Research (WCCNR). (1998).

Assessing stomatitis: Refinement of the Western Consortium for

Cancer Nursing Research (WCCNR) stomatitis staging system.

Canadian Oncology Nursing Journal, 8(3),160-162.

Zerbe, M., Parkerson, S., Ortlieb, M., & Spitzer, T. (1992). Relationships

between oral mucositis and treatment variables in bone marrow

transplant patients. Cancer Nursing, 15(3), 196-205.


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