INTRODUCTION The total burden of cancer across the globe is estimated to be 1 around 22 million. Cancer has become one of the ten leading causes of death in India. Cancers especially those of oral cavity and lungs among men and cervix and breast among 2women account for over 50% of all cancer deaths in India. Radiotherapy either by itself or in combination with surgery or chemotherapy plays an essential role in the treatment of head 3and neck cancer. The common side effects of head and neck radiation therapy include skin reactions, fatigue, nutritional 4 effects and alterations in mouth and pharynx. It is estimated that oral mucositis affects 40% of the patients undergoing chemotherapy, 75% of the patients undergoing high dose chemotherapy and bone marrow transplantation and more than 90% of the patients undergoing radiotherapy for head 5and neck cancer. Honey is a source of carbohydrates, containing 80% natural sugar mostly fructose and glucose, 18% water, 2% minerals, vitamins, and protein. Laboratory studies and clinical trials have shown that honey is an effective broad spectrum antibacterial agent. The data shows that the wound healing properties of honey include stimulation of tissue growth, enhanced epithelialisation, and minimized scar formation. These effects are ascribed to honey's acidity, hydrogen peroxide content, osmotic effect, nutritional and antioxidant contents, stimulation of immunity, and to unidentied compounds. Prostaglandins and nitric oxide play a major role in inammation, microbial killing, and the healing process. Honey was found to lower prostaglandin levels and elevate nitric oxide end products. These properties help to explain some biological and therapeutic properties of honey, 6particularly as an antibacterial agent or wound healer. The investigator after reviewing related literatures came to know that the interventions like regular oral cavity assessment, proper oral care and application of honey have good effect in reducing oral complications among head and neck cancer patients undergoing radiation METHODOLOGY A true experimental pre test post test control group design with quantitative research approach was used for this study. The study was conducted in radiotherapy department at Govt. Medical College Hospital, Kottayam. Population of the study consisted of patients with head and neck malignancies, undergoing radiation therapy. Sample include sixty patients undergoing radiation therapy for head and neck malignancies at Govt. Medical College Hospital, Kottayam; thirty in experimental group and thirty in control group. The tools used to collect the data were socio personal data sheet, clinical data sheet and oral assessment tool. The data collection process extended over a period of 8 weeks. Samples were selected from their rst day of radiation therapy using simple random sampling technique. After obtaining informed consent from the patients, socio personal data and clinical data were collected. Assessment of oral cavity is done by using oral assessment tool. Subjects in the experimental group received one to one teaching program of 15 minutes duration and are provided the information booklet describing self care practices to be followed by the patients including daily oral examination, dental care, mouth washing, lip care, hydration and diet. Patients in the experimental group received oral application of 10 ml of Ag mark honey before and after 15 minutes of radiation therapy and 6 hours thereafter in every days of radiation therapy, and instructed them to rinse the honey in the mouth, swish it around for one minute duration, and slowly swallow. Post test was performed at the end of rst, second and third week of radiation therapy (day 5, day 10 and day 15 respectively). RESULTS Socio personal and clinical data of patients undergoing radiation therapy for head and neck malignancies Ÿ Among the 60 samples 46.7% of patients in the control group and 50% of patients in the experimental group were belonged to the age group of 61- 75 years. Ÿ Majority of the patients in the control (73.3%) and experimental group (83.3%) were males. Ÿ While considering the education 46.7% of patients in the control group and 70% of patients in the experimental group had secondary education. Ÿ With regards to occupation 53.3% of the patients in the control group and 46.7% of patients in the experimental group were daily wages. Ÿ Among the 60 samples 36.7% of the patients in the control group and 53.3% of patients in the experimental group had history of both smoking and alcoholism. Ÿ Majority of the patients in the control group (96.7%) and the experimental group (96.7%) were taking non vegetarian diet. Ÿ Majority of the patients in the control group (53.3%) and the experimental group (70%) had no family history of cancer. EFFECTIVENESS OF AN INTERVENTION PACKAGE ON REDUCTION OF ORAL COMPLICATIONS AMONG PATIENTS UNDERGOING RADIATION THERAPY FOR HEAD AND NECK MALIGNANCIES Original Research Paper Melvi K Benny Lecturer, Little Lourdes College of Nursing, Kidangoor. X 41GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Nursing The present study investigated the effectiveness of an intervention package on reduction of oral complications among patients undergoing radiation therapy for head and neck malignancies. A true experimental pre test post test control group design with quantitative research approach was used for this study. The objectives of the study were to assess the levels of oral complications, determine the effectiveness of an intervention package on reduction of oral complications. A total of 60 patients undergoing radiation therapy for head and neck malignancies at Govt. Medical College Hospital, Kottayam, were assigned to control (n=30) and experimental (n=30) group using simple random sampling technique. Socio personal data sheet, clinical data sheet and oral assessment tool were used for collecting data. The data was analyzed using descriptive and inferential statistics. The result of analysis revealed that the intervention package was effective in reducing oral complications (p<0.001) among patients undergoing radiation therapy for head and neck malignancies. ABSTRACT KEYWORDS : Head and neck malignancies; Radiation therapy; Oral complications; Intervention package; Information booklet. Sr. Rose Abraham* Associate professor, Government college of nursing Kottayam. *Corresponding Author VOLUME-8, ISSUE-11, NOVEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra 42 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Ÿ Among the group majority of the patients in the control group (53.3%) and 43.3% of patients in the experimental group had malignancy in the oral cavity. Ÿ Majority of patients in the control group (56.8%) and the experimental group (46.7%) received a dose per fraction of 176-200 cGy. Ÿ Majority of patients in the control group (70%) and experimental group (73.3%) had normal weight (BMI 18.5- 24.9). Chi square value shows that there was no statistically signicant difference between control and experimental group in terms of age, gender, education, occupation, adverse health habits, diet and family history of cancer, site of malignancy, dose per fraction of radiation and BMI and hence groups were homogenous in nature. Oral complication of patients undergoing radiation therapy for head and neck malignancies Table 1: Frequency distribution and percentage of levels of oral complications in patients undergoing radiation therapy for head and neck malignancies based on rst, second and third post test score (n = 60) From the table, it is evident that after completion of one week radiation therapy (on D5), 100% of patients in control group and 66.7% of patients in the experimental group developed mild oral complication. Remaining 33.3% of patients in experimental group had no oral complications. After completion of second week radiation therapy (on D10), 66.7% of patients in the control group had mild oral complications and 33.3% of patients developed moderate oral complication but in experimental group 100% of patients developed only mild oral complications. After completion of third week radiation therapy (on D15), 100% of patients in control group and 30% of patients in the experimental group developed moderate oral complications and remaining 70% of patients in experimental group had only mild oral complications. Effectiveness of intervention package on oral complications among patients undergoing radiation therapy for head and neck malignancies Table 2: Mean and standard deviation of pre test and post test oral complications scores of patients undergoing radiation therapy for head and neck malignancie (n =60) Table 2 shows that mean pre intervention oral complications assessment score of patients undergoing radiation therapy for head and neck malignancies were 7.2 for control group and 7.13 for experimental group. The mean rst post test oral complication assessment score in the control group was 9.1 and in the experimental group were 7.9. The mean second post test oral complication assessment score in the control group were 13.63 and in the experimental group were 10.3. The mean third post test oral complication assessment score in the control group were 17.53 and in the experimental group were 13.9. Table 3: Summary of ANCOVA of oral complications in patients undergoing radiation therapy for head and neck malignancies in the control and experimental group (n=60) ***signicant at 0.001 level. Table 3 shows that F value of ANCOVA is signicant at 0.001 levels in post test 1, post test 2 and post test 3. Hence the null hypothesis is rejected and it is inferred that there is a signicant difference in the post assessment scores of oral complications among patients undergoing radiation therapy for head and neck malignancies in control and experimental group in post test 1, post test 2 and post test 3. DISCUSSION The study nding revealed that there was a signicant difference in the post assessment scores of oral complications among patients undergoing radiation therapy for head and neck malignancies in the control and experimental group in post test 1, post test 2 and post test 3. It can be concluded that the intervention package was effective in reducing severity of radiation induced oral complications in patients undergoing radiation therapy for head and neck malignancies. The result of the present study also comparable to a study done on topical application of honey in the management of radiation mucositis in Malaysia. Fourty patients diagnosed with head and neck cancer undergoing radiation therapy were selected. Honey application was given to the experimental group and no interventions were given to the control group. The study result showed that topical application of honey was effective in reducing severity of 7radiation induced oral mucositis (p<0.001). CONCLUSION Adequate knowledge regarding self care practices to be followed by the patients including daily oral examination, dental care, mouth washing, lip care, hydration, diet and application of honey helps to reduce the oral complications. Thus the morbidity and mortality due to oral complications can be reduced in patients receiving radiation therapy for head and neck malignancies. REFERENCES 1. WHO. World cancer report 2014 [Internet].2015 Feb [cited 2015 Feb 15]. Available from: http://www.who.int/mediacentre/factsheets/fs297/en/cancer 2. Mishra A, Meherotra R. Head and neck cancer: global burden and regional trends in India. Asian Pacic Journal of Cancer Prevention [Internet]. 2014 [cited 2014 Dec 15];15 (2): 537-50. Available from: http://dx.doi.org/10.7314/ APJCP.2014.15.2.537 3. Yeh S. Radiotherapy for head and neck cancer. Semin Plast Surg [Internet]. 2010 May [cited 2015 Sep19]; 24(2):127–36. Available from:http:// www. ncbi.nlm.nih.gov/pmc/articles/PMC3324252/ 4. Bowman VB. Head and neck cancers. In: Langhorne ME, Fulton JS, Otto SC, editors. Oncology nursing. US: Mosby elsvier; 2007. p. 213-31. 5. Herrstedt J. Prevention and management of mucositis in patients with cancer. Int J Antimicrob Agents [Internet]. 2000 [cited 2015 Nov 2];16(2):161-3. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/ 11053801? dopt=Abstract 6. Al-Waili N, Salom K, Al-Ghamdi AA. Honey for wound healing, ulcers, and VOLUME-8, ISSUE-11, NOVEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Levels of oral complicati ons Post test 1 (day- 5) Post test (day- 10) Post test 3 (day- 15) Control n=30 Experi mental n=30 Control n=30 Experi mental n=30 Control n=30 E x p e r i mental n=30 f % f % f % f % f % f % Normal (1- 7) 0 0 10 33.3 0 0 0 0 0 0 0 0 Mild (8-14) 30 100 20 66.7 20 66.7 30 100 0 0 21 70 Moderate (15-21) 0 0 0 0 10 33.3 0 0 30 100 09 30 Control group (n=30) Experimental group (n=30) Oral complications Mean SD Mean SD Pre test 7.2 0.41 7.13 0.35 Post test 1 9.1 1.52 7.9 0.92 Post test 2 13.63 2.09 10.3 1.45 Post test 3 17.53 2.01 13.9 1.27 Group Sum of squares df Mean square F Post test 1 22.36 1 22.36 14.14*** Post test 2 170.98 1 170.98 56.45*** Post test 3 205.07 1 205.07 76.63*** burns; data supporting its use in clinical practice. ScienticWorldJournal [Internet]. 2011 Apr [cited 2015 Sep 21]; 11:766-87. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21479349 7. Biswal BM, Zakaria A, Ahmad NM. Topical application of honey in the management of radiation mucositis: A preliminary study. Supportive care in cancer [Internet]. 2003 Feb [Cited 2015 Apr 18]; 11(4):242-248. Available from: link.springer.com/article/ 10.1007/500520-003-0443-Y. X 43GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS VOLUME-8, ISSUE-11, NOVEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra