ADHERENCE OF HEAD AND NECK CANCER PATIENTS TO LASER PHOTOBIOMODULATION IN A PUBLIC HEALTH SERVICE
Evaluate the adherence of patients with head and neck cancer who underwent radiotherapy or not associated with chemotherapy to the preventive laser photobiomodulation protocol in a public health service. This project was submitted and approved by the Human Ethics. All patients were informed about the treatment proposal and purpose, as well as the possible risks and benefits of the study, and signed the Informed Consent Form (ICF), which stated that they understood the purpose of the research and the proposed treatment, following the criteria of resolution 466/12 of the National Health Council. This was a cross-sectional study whose population sample who had not yet started cancer treatment, through free demand. The study included individuals with head and neck malignant tumors who had not initiated the proposed treatment protocol (radiotherapy with or without chemotherapy), with a minimum age of 18 at the beginning of the study and who had previous staging and tumor grade in their medical records. Data were collected regarding the type of cancer, its graduation and staging, patient’s proposed treatment, dose and number of sessions. A preventive laser photobiomodulation protocol was performed from the first session of radiotherapy. In order to monitor the development of oral mucositis, a form was given to patients so that they could make notes of the initial clinical manifestations. Once reported and verified the appearance of the first lesion, the patients continued to be attended by the Dental Service for laser application. Laser photobiomodulation used in the present study was a semiconductor diode, Twin Flex® (MM Optics, São Carlos, Brazil), 86.7 mW, device’s active tip area of 0.1256 cm2, 660 nm, which was applied at specific and equidistant points throughout the oral mucosa. The dosimetry used at each application point is described in the literature (2J / cm2), through a period of 10 seconds (Zecha et al., 2015). Preventive laser photobiomodulation was performed in 28 equidistant points in the oral cavity, excluding the tumor site. Patients presented 3 times a week, over a period of 3 weeks. In cases of development of grade III and IV mucositis, according WHO criteria, the laser protocol changed from preventive to curative. The same standard dosimetry was used. However, the active laser tip was directed to the ulcer edges so that the energy density was distributed at equidistant points throughout the contour of this lesion. For data collection and analysis, Microsoft Excel software was used to develop a spreadsheet, built specifically for the study. Regarding the qualitative variables (gender, origin, medical and dental history and frequency of attendance at photobiomodulatory therapy sessions), the data were obtained from a one-dimensional frequency table, from which their respective percentages were identified. Pearson's Chi-Square and Fisher's exact tests were used. The significance level considered for this study was p <0.05.