Interventions for mucositis during radio(chemotherapy) for head and neck cancer treatment. Survey

Question Title

* 1. Demographic information

Surname and name (optional)

Centre *

Town *

e-mail: (optional)

Question Title

* 2. How many patients with head and neck cancer are treated in your Centre each year?

less than 50

51-100

101-150

more than 150

Question Title

* 3. Are you

Medical Oncologist?

Radiation Oncologist?

Other specialist

Question Title

* 4. Mucositis assessment: which scale do you use?

- NCI CTCAE

- WHO

- RTOG

Other (please specify)

Question Title

* 5. Mean percentage of pts developing

	less than 10%	10-20%	21-30%	31-40%	41-50%	51-60%	61-70%	81-90%	91-100%
- all grade mucositis	- all grade mucositis less than 10%	- all grade mucositis 10-20%	- all grade mucositis 21-30%	- all grade mucositis 31-40%	- all grade mucositis 41-50%	- all grade mucositis 51-60%	- all grade mucositis 61-70%	- all grade mucositis 81-90%	- all grade mucositis 91-100%
- grade 3-4 mucositis	- grade 3-4 mucositis less than 10%	- grade 3-4 mucositis 10-20%	- grade 3-4 mucositis 21-30%	- grade 3-4 mucositis 31-40%	- grade 3-4 mucositis 41-50%	- grade 3-4 mucositis 51-60%	- grade 3-4 mucositis 61-70%	- grade 3-4 mucositis 81-90%	- grade 3-4 mucositis 91-100%

Question Title

* 6. How do you score the following patient-related risk factors for mucositis development, measured before treatment start? Please score from 1 (less important risk factor) to 10 (most important)

	1	2	3	4	5	6	7	8	9	10
- Active exposure to oral stressors (smoke, alcohol) and/or low oral hygiene	- Active exposure to oral stressors (smoke, alcohol) and/or low oral hygiene 1	- Active exposure to oral stressors (smoke, alcohol) and/or low oral hygiene 2	- Active exposure to oral stressors (smoke, alcohol) and/or low oral hygiene 3	- Active exposure to oral stressors (smoke, alcohol) and/or low oral hygiene 4	- Active exposure to oral stressors (smoke, alcohol) and/or low oral hygiene 5	- Active exposure to oral stressors (smoke, alcohol) and/or low oral hygiene 6	- Active exposure to oral stressors (smoke, alcohol) and/or low oral hygiene 7	- Active exposure to oral stressors (smoke, alcohol) and/or low oral hygiene 8	- Active exposure to oral stressors (smoke, alcohol) and/or low oral hygiene 9	- Active exposure to oral stressors (smoke, alcohol) and/or low oral hygiene 10
- Weight loss	- Weight loss 1	- Weight loss 2	- Weight loss 3	- Weight loss 4	- Weight loss 5	- Weight loss 6	- Weight loss 7	- Weight loss 8	- Weight loss 9	- Weight loss 10
- Low nutritional profile and/or basal PCR value	- Low nutritional profile and/or basal PCR value 1	- Low nutritional profile and/or basal PCR value 2	- Low nutritional profile and/or basal PCR value 3	- Low nutritional profile and/or basal PCR value 4	- Low nutritional profile and/or basal PCR value 5	- Low nutritional profile and/or basal PCR value 6	- Low nutritional profile and/or basal PCR value 7	- Low nutritional profile and/or basal PCR value 8	- Low nutritional profile and/or basal PCR value 9	- Low nutritional profile and/or basal PCR value 10
- Metabolic comorbidities (e.g. diabetes)	- Metabolic comorbidities (e.g. diabetes) 1	- Metabolic comorbidities (e.g. diabetes) 2	- Metabolic comorbidities (e.g. diabetes) 3	- Metabolic comorbidities (e.g. diabetes) 4	- Metabolic comorbidities (e.g. diabetes) 5	- Metabolic comorbidities (e.g. diabetes) 6	- Metabolic comorbidities (e.g. diabetes) 7	- Metabolic comorbidities (e.g. diabetes) 8	- Metabolic comorbidities (e.g. diabetes) 9	- Metabolic comorbidities (e.g. diabetes) 10
- Genetic susceptibility (e.g. polymorphism in detoxifying enzymes)	- Genetic susceptibility (e.g. polymorphism in detoxifying enzymes) 1	- Genetic susceptibility (e.g. polymorphism in detoxifying enzymes) 2	- Genetic susceptibility (e.g. polymorphism in detoxifying enzymes) 3	- Genetic susceptibility (e.g. polymorphism in detoxifying enzymes) 4	- Genetic susceptibility (e.g. polymorphism in detoxifying enzymes) 5	- Genetic susceptibility (e.g. polymorphism in detoxifying enzymes) 6	- Genetic susceptibility (e.g. polymorphism in detoxifying enzymes) 7	- Genetic susceptibility (e.g. polymorphism in detoxifying enzymes) 8	- Genetic susceptibility (e.g. polymorphism in detoxifying enzymes) 9	- Genetic susceptibility (e.g. polymorphism in detoxifying enzymes) 10
- Performance status	- Performance status 1	- Performance status 2	- Performance status 3	- Performance status 4	- Performance status 5	- Performance status 6	- Performance status 7	- Performance status 8	- Performance status 9	- Performance status 10
- planned radiotherapy dose on superior pharyngeal constrinctor muscles	- planned radiotherapy dose on superior pharyngeal constrinctor muscles 1	- planned radiotherapy dose on superior pharyngeal constrinctor muscles 2	- planned radiotherapy dose on superior pharyngeal constrinctor muscles 3	- planned radiotherapy dose on superior pharyngeal constrinctor muscles 4	- planned radiotherapy dose on superior pharyngeal constrinctor muscles 5	- planned radiotherapy dose on superior pharyngeal constrinctor muscles 6	- planned radiotherapy dose on superior pharyngeal constrinctor muscles 7	- planned radiotherapy dose on superior pharyngeal constrinctor muscles 8	- planned radiotherapy dose on superior pharyngeal constrinctor muscles 9	- planned radiotherapy dose on superior pharyngeal constrinctor muscles 10
- planned radiotherapy dose on mucosa of oral cavity and oropharynx	- planned radiotherapy dose on mucosa of oral cavity and oropharynx 1	- planned radiotherapy dose on mucosa of oral cavity and oropharynx 2	- planned radiotherapy dose on mucosa of oral cavity and oropharynx 3	- planned radiotherapy dose on mucosa of oral cavity and oropharynx 4	- planned radiotherapy dose on mucosa of oral cavity and oropharynx 5	- planned radiotherapy dose on mucosa of oral cavity and oropharynx 6	- planned radiotherapy dose on mucosa of oral cavity and oropharynx 7	- planned radiotherapy dose on mucosa of oral cavity and oropharynx 8	- planned radiotherapy dose on mucosa of oral cavity and oropharynx 9	- planned radiotherapy dose on mucosa of oral cavity and oropharynx 10
- radiotherapy in postoperative setting	- radiotherapy in postoperative setting 1	- radiotherapy in postoperative setting 2	- radiotherapy in postoperative setting 3	- radiotherapy in postoperative setting 4	- radiotherapy in postoperative setting 5	- radiotherapy in postoperative setting 6	- radiotherapy in postoperative setting 7	- radiotherapy in postoperative setting 8	- radiotherapy in postoperative setting 9	- radiotherapy in postoperative setting 10
- concurrent use of radiosensitizing chemotherapy	- concurrent use of radiosensitizing chemotherapy 1	- concurrent use of radiosensitizing chemotherapy 2	- concurrent use of radiosensitizing chemotherapy 3	- concurrent use of radiosensitizing chemotherapy 4	- concurrent use of radiosensitizing chemotherapy 5	- concurrent use of radiosensitizing chemotherapy 6	- concurrent use of radiosensitizing chemotherapy 7	- concurrent use of radiosensitizing chemotherapy 8	- concurrent use of radiosensitizing chemotherapy 9	- concurrent use of radiosensitizing chemotherapy 10

Question Title

* 7. In which percentage of patients do you suggest gastrostomy insertion before treatment start?

less than 10%

10-20%

21-30%

31-40%

41-50%

51-60%

61-70%

81-90%

91-100%

Question Title

* 8. Which are the main determinants that guide decision on gastrostomy placement before therapy (multiple choices allowed)?

- planned radiotherapy dose on superior pharyngeal constrinctor muscles

- planned radiotherapy dose on mucosa of oral cavity and oropharynx

- radiotherapy in postoperative setting

- concurrent use of radiosensitizing chemotherapy

- weight loss before treatment start

- low biochemical profile

- lack of caregivers

- patient preference

Other

Question Title

* 9. In which percentage of patients do you place nasogastric feeding tube during radio(chemo)therapy?

less than 10%

10-20%

21-30%

31-40%

41-50%

51-60%

61-70%

81-90%

91-100%

Question Title

* 10. Do you usually prescribe antimicotic/antibiotic drugs as preventive measures?

Yes