Radiotherapy (RT) is often the choice of treatment for head and neck cancers (HNC), as well as for lung cancer.1,2 The most common complications experienced by patients treated with RT are oral mucositis (OM), dry mouth, taste changes, pain in the mouth/throat, dysphagia, odynophagia, loss of appetite, nausea, vomiting, and emotional disturbances, such as anxiety, depression, fear, stress, loneliness, and vertigo.3, 4, 5 Among these complications, OM probably has the highest incidence, with a rate of >90% in HNC patients undergoing RT.1,2,5.6 RT-induced esophagitis is a common side effect in lung cancer patients; its etiology and onset time are similar to OM.7 Severe esophagitis develops in 18% of patients receiving chemoradiotherapy.6 Mucositis is defined as inflammatory and/or ulcerative lesions in the oral and/or gastrointestinal tract.6,8 It occurs in the form of erythema and ulceration, especially 7 to 10 days after the commencement of treatment.9, 10, 11 It prevents the patient from eating, drinking liquids, swallowing food, and speaking, and it may lead to malnutrition, severe pain, and opportunistic infections, thus increasing the need for parenteral nutrition and use of narcotic medication to control the pain.9,12,13 In addition, as the radiation dose applied to the patient increases, the severity of radiation-induced OM increases.11,14 It is considered a dose-limiting side effect of cancer therapy, as one-third of patients may choose to forfeit the treatment due to severity of the condition.6,15,16 In some cases, complications caused by OM also cause missed treatment days or reduction in the doses required for effective treatment, thus increasing mortality, morbidity, and health care costs,14, 15, 16, 17, 18 as well as severely impairing the patient's quality of life.14,15

For the prevention of OM, the guidelines updated by the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO) in 2019 recommend implementing a basic oral care protocol in patients receiving chemotherapy (CT) and RT for HNC.17 This protocol involves professional oral care, brushing with a soft toothbrush, changing the toothbrush at regular intervals, use of dental floss, mouth-washing and moistening with soft solutions, and use of saline and sodium bicarbonate.15,17 It also encourages an interdisciplinary approach, the implementation of a regular and systematic oral care regimen, and patient education.17 The use of chlorhexidine (Level of Evidence: III) and the use of sucralfate (Level of Evidence: II) are not recommended to prevent OM in patients undergoing RT for HCT. On the other hand, benzydamine mouthwash is recommended in patients receiving moderate-dose RT (up to 50 Gy) (Level of Evidence: I), along with oral glutamine (Level of Evidence: II) and low-level laser therapy.15,17

However, no measure of quality in cancer care is more important than recognizing the patient's beliefs and core values related to health and then devising a care plan accordingly.19 The subjective perception of an individual may differ from the clinical perception, which further complicates the evaluation of OM's impact.5 Therefore, a multidisciplinary team and collaboration are required in the prevention and treatment of mucositis. In this context, nurses, who play a key role in such a team, can play a unique role in identifying and eliminating mucositis risk factors (eg, poor oral health habits, smoking, and malnutrition).2,20, 21, 22 In a previous study, it was determined that only 25.3% of cancer patients received guidance from nurses about OM self-care during their treatment, and it was stated that nursing interventions in this regard were insufficient.12 Patients expect health care professionals to understand their ideals, beliefs, and values ​​and to design a treatment plan in line with those perceptions,19 so RT nurses should inevitably provide regular counseling and screening along with evidence-based care. The study aimed to evaluate the impact of nurse-led mucositis management on the health outcomes of patients receiving RT for HNC and lung cancer.