研究背景：頭頸癌死亡率為全球十大死因之第七位，而鼻咽癌為頭頸癌相關癌症之一，好發於亞洲地區華人。因鼻咽癌主要以放射線或同步化學放射線治療為主，是故，容易於治療後出現口乾、吞嚥困難等症狀，進而限制營養攝取，更增加吸入性肺炎發生率及死亡率。目前仍缺乏探討治療期間口乾程度與吞嚥功能變化之觀察研究。
研究目的：了解鼻咽癌病人接受放射線治療或同步化學放射線治療期間口乾程度變化及吞嚥功能之影響。
研究設計：採前瞻性世代追蹤研究設計。以放射腫瘤科及腫瘤內科門診於2024年4月至2025年2月期間共18位初診斷鼻咽癌病人於治療前(T0)、治療後1-6週(T1-T6)，治療結束週(T7)與結束後一個月(T8)、三個月(T9)進行10次評估及分析。以斯皮爾曼等級相關性檢定(Spearman correlation)分析口乾與吞嚥功能影響相關性；廣義估計方程式(Generalized estimating equations, GEE)測量口乾變化與吞嚥功能關係，以多變項邏輯式迴歸於控制其他變項後，分析口乾對吞嚥功能之影響。
研究結果：共有18位鼻咽癌病人納入分析，平均56.3歲，治療前皆無明顯口乾與吞嚥功能問題。治療後第一週即觀察到唾液分泌量明顯下降，平均減少約50%；至治療後一個月，病人口乾症狀更為嚴重。吞嚥功能則於治療後第四週顯著惡化，雖於治療後一個月略有回復，但病人仍明顯感受到吞嚥固體食物困難與食物殘留於喉部的不適感。統計結果顯示，唾液量與主觀口乾程度間存在中度負相關(T4: r = -0.348；T8: r = -0.413)，而唾液量與吞嚥困難呈顯著負相關性(T4: r = -0.392；T8: r = -0.485，p < .05)。此外，主觀口乾感與吞嚥困難在治療後第四週(T4: r = 0.528，p < .05）與三個月(T8: r = 0.486，p < .05)皆呈顯著正相關，顯示病人自覺口乾越嚴重，其吞嚥困難程度亦越高。
結論：鼻咽癌病人於放射線治療期間口乾為顯著影響吞嚥功能的相關因子。為改善鼻咽癌接受同步化學、放射線治療期間吞嚥困難，建議在病人接受治療前即應對唾液腺介入保護措施，降低細胞損傷程度，過程持續追蹤吞嚥功能變化，口乾程度較高者，個別性提供口腔衛教衛教，以預防以及改善吞嚥困難。

Head and neck cancer remains a significant contributor to global cancer mortality, ranking among the leading causes of cancer-related death worldwide. Nasopharyngeal carcinoma (NPC), a subtype of head and neck malignancies, is particularly prevalent among Asian and ethnic Chinese populations. Radiotherapy or concurrent chemoradiotherapy constitutes the primary curative treatment modality for NPC; however, radiation-induced damage to the salivary glands frequently results in xerostomia and swallowing dysfunction. These complications may restrict nutritional intake, increase the risk of aspiration pneumonia, and subsequently contribute to elevated morbidity and mortality. Despite the clinical importance of these symptoms, limited longitudinal evidence exists regarding the temporal changes in xerostomia severity and swallowing function throughout the treatment course. Therefore, this prospective cohort study investigated the dynamic changes in xerostomia and swallowing function and examined their associations among patients with NPC receiving radiotherapy or concurrent chemoradiotherapy.

衛生福利部統計處2023，6月12日）．111年國人死因統計結果。https://www.mohw.gov.tw/cp-16-74869-1.html
衛生福利部國民健康署部（2023，6月12日）．五癌篩檢有篩有保庇。https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=4705&pid=16974
王宜斌、游翔博（2016)．口乾症與唾液腺機能不足之診斷與處置－文獻回顧．中華民國家庭牙醫學雜誌，11(3)，4-16。https://doi.org/10.6566/jfd/2016.11(3).4
李怡珍、許雅娟（2016）．口腔癌術後口腔問題．彰化護理，23(1)，9-11。https://doi.org/10.6647/cn.23.01.04
李怡珍、許雅娟、江惠英（2017）．建構口腔癌術後病人口腔評估表．護理雜誌，64(2)，66-75。https://doi.org/10.6224/JN.000025
李晏廷、戴世光（2023）．頸部淋巴廓清術在口腔癌的應用．臨床醫學月刊，91(1)，21-26。https://doi.org/10.6666/ClinMed.202301_91(1).0005
林明毅、張雅慧（2009）．口乾症．臺灣醫界，52(7)，338-343。https://doi.org/10.30044/tmj.200907.0015
林雅婷、唐秀治（2010）．頭頸部癌症病人接受放射線治療後口腔合併症之嚴重度變化．源遠護理，4(2)，34-41。https://doi.org/10.6530/YYN.2010.4(2).05
周孫鴻（2018）．吞嚥困難相關藥物使用評估．長期照護雜誌，22(3)，245-257。https://doi.org/10.6317/ltc.201812_22(3).0003
范綱行、林倩伃、張東杰（2015）．口腔癌的放射治療．台灣癌症醫學雜誌，2（2），117-126．https://doi.org/10.6323/jcrp.2015.2.2.02
陳妙言、林麗嬋（2010）．吞嚥障礙之概念分析．護理雜誌，57(1)，100-105。https://doi.org/10.6224/jn.57.1.100
賴怡君、王桂芸、陳金彌（2010）．吞嚥困難之概念分析．源遠護理，5(2)，56-62。https://doi.org/10.6530/yyn.2011.5(2).08
Alnaeem,M.M., Darwish, S. K., & Nashwan, A. J. 2025).Radiation-induced xerostomia in head and neck cancers: a comprehensive review for burden and impact on nutrition, sleep, and quality of life. Discover Medicine, 2(1), 143.
Anastasia, Y. A., Dewi, Y. A., & Lasminingrum, L. (2023). Nasopharyngeal Carcinoma: Understanding Anatomy and Radiotherapy Side Effects. In Proceedings of the 19th Otorhinolaryngology Head and Neck Surgery National Congress (PERHATIKL 2022) (pp. 261-265). https://doi.org/10.2991/978-94-6463-280-4_47
Anderson, C., & Saunders, D. (2025). Oral Mucositis in Head and Neck Cancer Patients. Seminars in radiation oncology,
Antohi, C., Haba, D., Concita, A. C., Popescu, R., Cernei, R. E., & Salceanu, M. (2024). THE SIDE EFFECTS OF RADIOTHERAPY IN THE PATIENT WITH ENT CANCER. Romanian Journal of Oral Rehabilitation, 16(3).
Belafsky, P. C., Mouadeb, D. A., Rees, C. J., Pryor, J. C., Postma, G. N., Allen, J., & Leonard, R. J. (2008). Validity and reliability of the Eating Assessment Tool (EAT-10). Annals of Otology, Rhinology & Laryngology, 117(12), 919-924.
Blanchard, P., Biau, J., Huguet, F., Racadot, S., Berthold, C., Wong-Hee-Kam, S., Biston, M.-C., & Maingon, P. (2022). Radiotherapy for nasopharyngeal cancer. Cancer/Radiothérapie, 26(1-2), 168-173.
Bofill-Soler, N., Guillen-Sola, A., Marco, E., Nieto-Cadalso, S., Barrera, M. C., Pera-Cegarra, O., Membrive, I., Duran, X., & Foro, P. (2021). Is EAT-10 Useful to Assess Swallowing during the Chemo-Radiotherapy Phase in Patients with Head and Neck Cancer? A Pilot Study. Ann Otol Rhinol Laryngol, 130(7), 689-698. https://doi.org/10.1177/0003489420966625
Brook, I. (2021). Early side effects of radiation treatment for head and neck cancer. Cancer Radiother, 25(5), 507-513. https://doi.org/10.1016/j.canrad.2021.02.001
Cantu, G. (2023). Nasopharyngeal carcinoma. A "different" head and neck tumour. Part A: from histology to staging. Acta Otorhinolaryngol Ital, 43(2), 85-98. https://doi.org/10.14639/0392-100X-N2222
Cao, S. (2023). The epidemiology of nasopharyngeal carcinoma. In. Springer.
Cavallo, A., Iacovelli, N. A., Facchinetti, N., Rancati, T., Alfieri, S., Giandini, T., Cicchetti, A., Fallai, C., Ingargiola, R., Licitra, L., Locati, L., Cavalieri, S., Pignoli, E., Romanello, D. A., Valdagni, R., & Orlandi, E. (2021). Modelling Radiation-Induced Salivary Dysfunction during IMRT and Chemotherapy for Nasopharyngeal Cancer Patients. Cancers (Basel), 13(16). https://doi.org/10.3390/cancers13163983
Chen, Y. P., Chan, A. T. C., Le, Q. T., Blanchard, P., Sun, Y., & Ma, J. (2019). Nasopharyngeal carcinoma. Lancet, 394(10192)394(10192),64-80.https://doi.org/10.1016/S0140-6736(19)30956-0
Chiu, Y. H., Tseng, W. H., Ko, J. Y., & Wang, T. G. (2022). Radiation-induced swallowing dysfunction in patients with head and neck cancer: A literature review. J Formos Med Assoc, 121(1 Pt 1), 3-13. https://doi.org/10.1016/j.jfma.2021.06.020
Chow, L. Q. M. (2020). Head and Neck Cancer. N Engl J Med, 382(1), 60-72. https://doi.org/10.1056/NEJMra1715715
Dwipa, L., Wardhani, R., Setiani, T., Sufiawati, I., Pratiwi, Y. S., Susandi, E., Huang, I., Moenardi, V. N., & Thomson, W. (2023). Summated Xerostomia Inventory to detect both xerostomia and salivary gland hypofunction. European Review for Medical & Pharmacological Sciences, 27(2).
da Silva, J., Marques, R., Nunes, F., Lima, A., Heller, D., Stefani, C., & Dame-Teixeira, N. (2025). What Is the Normal Salivary Flow Rate in Healthy Adults? A Systematic Review with Meta-Analyses. JDR Clinical & Translational Research, 23800844251336205.
Elad, S., Cheng, K. K. F., Lalla, R. V., Yarom, N., Hong, C., Logan, R. M., Bowen, J., Gibson, R., Saunders, D. P., & Zadik, Y. (2020). MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer, 126(19), 4423-4431.
Fallon, B. S., Chase, T. J., Cooke, E. M., Ghazitabatabaei, A., Naylor, N. O., Cutshall, J. J., Trump, B. G., & Weller, M. L. (2021). The use of BokaFlo™ instrument to measure salivary flow. BMC Oral Health, 21, 1-7.
Fitzmaurice, C., Allen, C., Barber, R. M., Barregard, L., Bhutta, Z. A., Brenner, H., Dicker, D. J., Chimed-Orchir, O., Dandona, R., & Dandona, L. (2017). Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA oncology, 3(4), 524-548.
Florie, M., Pilz, W., Kremer, B., Verhees, F., Waltman, G., Winkens, B., Winter, N., & Baijens, L. (2021). EAT‐10 scores and fiberoptic endoscopic evaluation of swallowing in head and neck cancer patients. The Laryngoscope, 131(1), E45-E51.
Fong, R., Ward, E. C., & Rumbach, A. F. (2020). Dysphagia after chemo-radiation for nasopharyngeal cancer: A scoping review. World J Otorhinolaryngol Head Neck Surg, 6(1), 10-24. https://doi.org/10.1016/j.wjorl.2020.02.005
Frowen, J., Hughes, R., & Skeat, J. (2020). The prevalence of patient-reported dysphagia and oral complications in cancer patients. Support Care Cancer, 28(3), 1141-1150. https://doi.org/10.1007/s00520-019-04921-y
G, M. M., S, B., N, O., M, D., A, E. O., & M, K. (2024). Study of Risk Factors for Nasopharyngeal Carcinoma: About 214 Cases. SAS Journal of Medicine, 12(08), 804-807. https://doi.org/10.36347/sasjm.2024.v10i08.018
Guo, R., Mao, Y.-P., Tang, L.-L., Chen, L., Sun, Y., & Ma, J. (2019). The evolution of nasopharyngeal carcinoma staging. The British journal of radiology, 92(1102), 20190244.
He, S. L., Wang, J. H., & Li, M. (2013). Validation of the Chinese version of the Summated Xerostomia Inventory (SXI). Qual Life Res, 22(10), 2843-2847. https://doi.org/10.1007/s11136-013-0420-y
Ihara, Y., Kato, H., Tashimo, Y., Iizumi, Y., Fukunishi, Y., Sato, H., Shimane, T., & Takahashi, K. (2022). Changes in oral function, swallowing function, and quality of life in patients with head and neck cancer: a prospective cohort study. BMC Oral Health, 22(1), 293. https://doi.org/10.1186/s12903-022-02329-5
Iovoli, A. J., Turecki, L., Qiu, M. L., Khan, M., Smith, K., Yu, H., Ma, S. J., Farrugia, M. K., & Singh, A. K. (2023). Severe oral mucositis after intensity-modulated radiation therapy for head and neck cancer. JAMA Network Open, 6(10), e2337265-e2337265.
Jiromaru, R., Nakagawa, T., & Yasumatsu, R. (2022). Advanced Nasopharyngeal Carcinoma: Current and Emerging Treatment Options. Cancer Manag Res, 14, 2681-2689. https://doi.org/10.2147/CMAR.S341472
Karlsson, C., Bohm, N., Andersson, J. S., Finizia, C., & Almståhl, A. (2024). Prospective study on health-related quality of life, oral mucositis and oral health on during treatment of head and neck cancer. BMC Oral Health, 24(1), 697.
Lee, A., Chow, J. C. H., & Lee, N. Y. (2020). Treatment Deescalation Strategies for Nasopharyngeal Cancer: A Review. JAMA Oncol. https://doi.org/10.1001/jamaoncol.2020.6154
Li, X., Fu, G. F., Huang, Y. Y., Jiang, Q. Y., Huang, X. Y., Zhang, J. T., & Qu, S. H. (2023). Symptom clusters after chemoradiotherapy in discharged nasopharyngeal carcinoma patients. Front Oncol, 13, 920889. https://doi.org/10.3389/fonc.2023.920889
Likhterov, I., Ru, M., Ganz, C., Urken, M. L., Chai, R., Okay, D., Liu, J., Stewart, R., Culliney, B., Palacios, D., & Lazarus, C. L. (2018). Objective and subjective hyposalivation after treatment for head and neck cancer: Long-term outcomes. Laryngoscope, 128(12), 2732-2739. https://doi.org/10.1002/lary.27224
Liu, J., & Zeng, M.-S. (2024). Pathogenesis and Etiology of Nasopharyngeal Carcinoma. In. Springer.
Logemann, J. A., Smith, C. H., Pauloski, B. R., Rademaker, A. W., Lazarus, C. L., Colangelo, L. A., Mittal, B., MacCracken, E., Gaziano, J., & Stachowiak, L. (2001). Effects of xerostomia on perception and performance of swallow function. Head & neck, 23(4), 317-321.
Lovelace, T. L., Fox, N. F., Sood, A. J., Nguyen, S. A., & Day, T. A. (2014). Management of radiotherapy-induced salivary hypofunction and consequent xerostomia in patients with oral or head and neck cancer: meta-analysis and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol, 117(5), 595-607. https://doi.org/10.1016/j.oooo.2014.01.229
MACEDO, D. R., & ANJOS, A. C. Y. d. (2019). Experience of radiotherapy in head and neck. RGO-Revista Gaúcha de Odontologia, 67, e20190026.
Mathlin, J., Courtier, N., & Hopkinson, J. (2023). Taste changes during radiotherapy for head and neck cancer. Radiography, 29(4), 746-751.
McCarty, E. B., & Chao, T. N. (2021). Dysphagia and Swallowing Disorders. Med Clin North Am, 105(5), 939-954. https://doi.org/10.1016/j.mcna.2021.05.013
Messing, B. P., Ward, E. C., Lazarus, C., Ryniak, K., Maloney, J., Thompson, C. B., & Kramer, E. (2021). Longitudinal comparisons of a whole‐mouth taste test to clinician‐rated and patient‐reported outcomes of dysgeusia postradiotherapy in patients with head and neck cancer and associations with oral intake. Head & Neck, 43(7), 2159-2177.
Mody, M. D., Rocco, J. W., Yom, S. S., Haddad, R. I., & Saba, N. F. (2021). Head and neck cancer. Lancet, 398(10318), 2289-2299. https://doi.org/10.1016/S0140-6736(21)01550-6
Nagarajan, H., & Gunasekaran, T. (2021). Xerostomia diagnosis and management. International Journal of Community Dentistry, 9(2). https://doi.org/10.4103/ijcd.ijcd_9_22
Navazesh, M., & Kumar, S. K. (2008). Measuring salivary flow: challenges and opportunities. The Journal of the American Dental Association, 139, 35S-40S.
Ng, W. T., Chow, J. C. H., Beitler, J. J., Corry, J., Mendenhall, W., Lee, A. W. M., Robbins, K. T., Nuyts, S., Saba, N. F., Smee, R., Stokes, W. A., Strojan, P., & Ferlito, A. (2022). Current Radiotherapy Considerations for Nasopharyngeal Carcinoma. Cancers (Basel), 14(23). https://doi.org/10.3390/cancers14235773
Nicita, R. A., Afshari, P. J., Bahramizadeh, M., Yousefi, R. N., & Ciodaro, F. (2023). Evaluation of dysphagia severity in patients with nasopharyngeal carcinoma undergoing radiotherapy. Adv Med Psychol Public Health, 2(3), 157-165.
Palmieri, M., Sarmento, D. J. S., Falcao, A. P., Martins, V. A. O., Brandao, T. B., Morais-Faria, K., Ribeiro, A. C. P., Hasseus, B., Giglio, D., & Braz-Silva, P. H. (2021). Frequency and Evolution of Acute Oral Complications in Patients Undergoing Radiochemotherapy Treatment for Head and Neck Squamous Cell Carcinoma. Ear Nose Throat J, 100(5_suppl), 449S-455S. https://doi.org/10.1177/0145561319879245
Parsons, A., & Dewan, K. (2024). Dysphagia and Dysphonia After Head and Neck Cancer. Oral Diseases.
Rades, D., Warwas, B., Gerull, K., Pries, R., Leichtle, A., Bruchhage, K. L., Hakim, S. G., Schild, S. E., & Cremers, F. (2022). Prognostic factors for complete recovery from xerostomia after radiotherapy of head-and-neck cancers. in vivo, 36(4), 1795-1800.
Sardellitti, L., Bortone, A., Filigheddu, E., Serralutzu, F., & Milia, E. P. (2023). Xerostomia: From Pharmacological Treatments to Traditional Medicine-An Overview on the Possible Clinical Management and Prevention Using Systemic Approaches. Curr Oncol, 30(5), 4412-4426. https://doi.org/10.3390/curroncol30050336
Schindler, A., Alvite, M. d. F. L., Robles-Rodriguez, W. G., Barcons, N., & Clavé, P. (2023). History and science behind the eating assessment tool-10 (Eat-10): lessons learned. The Journal of nutrition, health and aging, 27(8), 597-606.
Sellstrom, D., Patterson, J. M., Finch, T., O’Hara, J., & Haighton, C. (2025). Late radiation-associated dysphagia following treatment for head and neck cancer: a scoping review. Supportive Care in Cancer, 33(6), 1-12.
Singla, V., Nautiyal, V., Gupta, M., Kumar, V., Mehra, S., & Ahmad, M. (2021). Study of dosimetry and clinical factors for assessment of xerostomia in head and neck squamous cell carcinoma treated by intensity-modulated radiotherapy: A prospective study. J Carcinog, 20, 14. https://doi.org/10.4103/jcar.JCar_5_21
Snider, J. W., 3rd, & Paine, C. C., 2nd. (2020). Sticky stuff: xerostomia in patients undergoing head and neck radiotherapy-prevalence, prevention, and palliative care. Ann Palliat Med, 9(3), 1340-1350. https://doi.org/10.21037/apm.2020.02.36
Staruch, M., Speth, M. M., Neyer, P., Riesterer, O., Aebersold, D. M., & Stieb, S. (2024). Radiation-associated changes in saliva composition of head and neck cancer patients: A systematic review. Radiotherapy and Oncology, 110279.
Struder, D., Ebert, J., Kalle, F., Schraven, S. P., Eichhorst, L., Mlynski, R., & Grossmann, W. (2023). Head and Neck Cancer: A Study on the Complex Relationship between QoL and Swallowing Function. Curr Oncol, 30(12), 10336-10350. https://doi.org/10.3390/curroncol30120753
Tang, L. L., Chen, Y. P., Chen, C. B., Chen, M. Y., Chen, N. Y., Chen, X. Z., Du, X. J., Fang, W. F., Feng, M., & Gao, J. (2021). The Chinese Society of Clinical Oncology (CSCO) clinical guidelines for the diagnosis and treatment of nasopharyngeal carcinoma. Cancer Communications, 41(11), 1195-1227.
Thomson, W. M., van der Putten, G. J., de Baat, C., Ikebe, K., Matsuda, K., Enoki, K., Hopcraft, M. S., & Ling, G. Y. (2011). Shortening the xerostomia inventory. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 112(3), 322-327. https://doi.org/10.1016/j.tripleo.2011.03.024
Wang, R., & Kang, M. (2021). Guidelines for radiotherapy of nasopharyngeal carcinoma. Precision Radiation Oncology, 5(3), 122-159.
Westgaard, K. L., Hynne, H., Amdal, C. D., Young, A., Singh, P. B., Chen, X., Rykke, M., Hove, L. H., Aqrawi, L. A., & Utheim, T. P. (2021). Oral and ocular late effects in head and neck cancer patients treated with radiotherapy. Scientific reports, 11(1), 4026.
Willemsen, A. C. H., Pilz, W., Hoeben, A., Hoebers, F. J. P., Schols, A., & Baijens, L. W. J. (2023). Oropharyngeal dysphagia and cachexia: Intertwined in head and neck cancer. Head Neck, 45(4), 783-797. https://doi.org/10.1002/hed.27288
Wong, K. C., Hui, E. P., Lo, K.-W., Lam, W. K. J., Johnson, D., Li, L., Tao, Q., Chan, K. C. A., To, K.-F., & King, A. D. (2021). Nasopharyngeal carcinoma: an evolving paradigm. Nature reviews Clinical oncology, 18(11), 679-695.
Yuan, Y., Ye, F., Wu, J. H., Fu, X. Y., Huang, Z. X., & Zhang, T. (2023). Early screening of nasopharyngeal carcinoma. Head Neck, 45(10), 2700-2709. https://doi.org/10.1002/hed.27466
Zhang, Y., Rumgay, H., Li, M., Cao, S., & Chen, W. (2023). Nasopharyngeal cancer incidence and mortality in 185 countries in 2020 and the projected burden in 2040: Population-based global epidemiological profiling. JMIR public health and surveillance, 9(1), e49968.
Zhou, J., Wang, L., Qiu, T., Gao, H., Wang, L., Huang, S., He, X., & Wu, L. (2024). Long-term follow-up of protective effects on salivary and swallowing structures and improvement of late xerostomia and dysphagia by level IIb optimisation in clinical target volume of nasopharyngeal carcinoma. BMC Cancer, 24(1), 648. https://doi.org/10.1186/s12885-024-12391-7