Post-radiotherapy xerostomia and quality of life in head and neck cancer patients

PURPOSE: Radiotherapy for head and neck cancer frequently results in radiation-induced xerostomia, a chronic symptom that can persist long-term and compromise oral function and survivorship. METHODS: A cross-sectional, non-interventional survey was conducted using a mixed recruitment approach (department-based and nationwide online dissemination). Xerostomia prevalence, symptom characteristics, coping strategies, and oral health-related quality of life (OHRQoL) were assessed using a study-specific xerostomia questionnaire and the validated OHIP-G14 instrument. Overall, 253 questionnaires were returned (202 complete and 51 partial), including 163 completed online via LimeSurvey and 39 completed on paper during routine follow-up visits at the tumour clinic of the department. RESULTS: Xerostomia was reported by 90% of respondents; 53.1% described the daily burden as strong/very strong. Patients with xerostomia had significantly worse OHRQoL than those without (mean OHIP-G14 26.7 vs. 17.3; p < 0.001), corresponding to a clinically relevant mean difference of 9.4 points. In multivariable linear regression, xerostomia remained independently associated with worse OHRQoL (B = 8.86, p < 0.001). Functional impairment and oral pain were more pronounced than psychosocial or aesthetic domains, and perceived xerostomia severity correlated with OHIP scores. Commonly used coping strategies included frequent water intake (81%), sugar-free gum/lozenges (46%), saliva substitutes (43%), and home remedies (e.g., oil or tea) (33%); prescription sialogogues were infrequently used (15%) and perceived as less effective. CONCLUSION: Post-radiotherapy xerostomia is highly prevalent and independently associated with clinically meaningful OHRQoL impairment, underscoring the need for optimized counselling and structured supportive care. Management was dominated by low-threshold behavioural strategies, while prescription sialogogues were used by only a minority of respondents and were rated less effective in terms of perceived benefit.