2020 Volume 34 Article ID: 34_okita_20200721
Aspiration pneumonia is a common complication during the management of head and neck cancer, especially with chemoradiotherapy. Once aspiration pneumonia develops, it can lead to forced interruption of therapy. The purpose of this study was to determine the process of patients undergoing chemoradiotherapy for head and neck cancer until they developed aspiration pneumonia. This was a retrospective study of 37 patients who underwent chemoradiotherapy for head and neck cancer. We collected data on treatment, physical symptoms and nursing care from medical and nursing records. The collected data were analyzed by qualitative description, and a category relation diagram was created for the aspiration pneumonia and control groups to clarify the features in the aspiration pneumonia group. There were six patients in the aspiration pneumonia group and 31 patients in the control group. We found that the processes from the category relation diagram for both groups were: “oral mucosal adverse event in the soft palate and tongue border” to “use of painkillers because of progression of pain symptoms” and “use of medical narcotics because of progression of pain symptoms.” The processes for the aspiration pneumonia group were: “repeated increase in medical narcotics dose due to pain relief,” “dealing with lowering of consciousness level because of onset of delirium’’ and “use of muscle relaxant agonists.” Patients who had “repeated increase in medical narcotics dose due to pain relief” against pain caused by progression of oral mucosal adverse events required “dealing with lowering of consciousness level because of onset of delirium” and psychotropic drugs used for delirium treatment. “Use of muscle relaxant” caused relaxation of the esophageal sphincter. It was thought that aspiration pneumonia developed. To prevent the occurrence of aspiration pneumonia, it is important to focus on pain control before shifting to the use of medical narcotics to prevent the occurrence of delirium.
