Left–right differences in oral function and QOL of patients who underwent tongue resection

Left–right differences in oral function and QOL of patients who underwent tongue resection | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Left–right differences in oral function and QOL of patients who underwent tongue resection Yuka Harada, Yoshiaki Ihara, Tomoki Tamai, Yuichi Tashimo, Shinji Nozue, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4311367/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract In this study, we investigated the effect of left–right differences on oral function and QOL in patients with TC underwent tongue resection. Forty patients with TC underwent resection smaller than hemiglossectomy were divided into left (LG) and right (RG) tongue groups. The evaluation items were evaluated at baseline and 1, 3, and 6 months posttreatment. Maximum tongue pressure and lip-closure force were measured for oral function evaluation. Peak expiratory flow was used to evaluate the respiratory function. The Functional Oral Intake Scale was used to evaluate the feeding functions. The QOL was assessed using the European Organization for Research and Treatment of Cancer QOL Questionnaires: QLQ-C30, QLQ-H&N35. No significant differences in oral, respiratory, or feeding function between LG and RG were observed at all evaluation periods. However at 3 months, LG had a significantly higher QOL score than RG for swallowing and trouble with social eating. At 6 months, the LG had a significantly higher QOL than RG for global health status and physical function. The left–right differences in tongue function did not lead to functional impairment but significantly affected the QOL. This indicates the importance of considering these differences in postoperative care to address QOL concerns effectively. Biological sciences/Cancer Health sciences/Health care Oral function tongue resection tongue cancer Figures Figure 1 Introduction Head and neck cancer is the 15th most common type of cancer in Japan [ 1 ]. Tongue cancer (TC) is the most frequent type of head and neck cancer, accounting for approximately 25% of all head and neck cancers [ 2 ]. The rate of new TC cases was 3.6 per 100 000 men and women per year, and the rate of new TC cases increased by an average of 2.2% each year from 2010 to 2019 [ 3 ]. The treatment of head and neck cancers often causes various complications, and patients with head and neck cancers complain of oral complications caused by radiation, such as limited mouth opening (trismus), dry mouth (xerostomia), swallowing problems (dysphagia), and mucositis. In particular, treating TC leads to several oral dysfunctions, including swallowing and speech difficulties [ 4 , 5 ]. Previous studies have reported that the area of the tongue resected due to TC significantly affects swallowing and speech [ 6 ]. In particular, dysphagia has been reported in more than 40% of patients with TC who underwent tongue resection [ 7 , 8 ]. The resected area of the tongue has been reported to significantly affect patients’ oral function and quality of life (QOL) [ 9 , 10 ]. However, the left–right differences in oral function due to the resected tongue area remain unclear. In terms of limb function, there is a dominant side, such as the dominant hand or leg. The oral function has been reported to be non-uniform between the left and right sides. For example, laterality of stomatognathic function and habitual mastication have been reported [ 11 ]. In addition, it has been reported that lateral misarticulation in using the tongue between the left and right sides was observed even without organic abnormalities [ 12 ]. However, no reports exist on the left–right differences in the use of the tongue in swallowing. Thus, we aimed to investigate the differences in tongue function and its effect on patients’ QOL after surgical treatment of patients with TC who underwent tongue resection smaller than hemiglossectomy. Methods Patients This study included 40 patients with TC who were scheduled for surgical resection smaller than hemiglossectomy (partial glossectomy or hemiglossectomy) at the Head and Neck Oncology Center, Showa University Hospital, and were subsequently referred to the Department of Special Needs Dentistry, Division of Oral Rehabilitation Medicine, Showa University Dental Hospital, for rehabilitation. The participants were divided into groups with TC on the sides of the left (LG) and right (RG). The exclusion criteria were as follows: age < 20 years, inability to follow instructions, presence of other malignant tumors, and effect of other diseases on oral function. All measurements were performed at baseline (BL), 1 (1M), 3 (3M), and 6 (6M) months after treatment. This study was approved by the Ethics Committee of Showa University School of Medicine (approval no. 2355), and all participants received both oral and written instructions and signed an approved informed consent form before participating in the study. All procedures were performed in accordance with the World Medical Association Declaration of Helsinki (version 2002). Assessments All evaluations were performed by dentists from the Division of Oral Functional Rehabilitation Medicine, Department of Oral Health Management, School of Dentistry, Showa University, Japan. Data regarding age, sex, primary TC side, TMN classification, surgical method, and medical history were collected from the medical records. Maximum tongue pressure (MTP) and lip-closure force (LCF) were used to evaluate oral functions. Peak expiratory flow (PEF) was used to evaluate respiratory function. The Functional Oral Intake Scale (FOIS) was used to evaluate feeding function. The patient’s QOL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) QOL Questionnaires: QLQ-C30 and QLQ-H&N 35. Oral function The MTP was measured using a JMS tongue pressure measurement device (JMS Co., Ltd., Hiroshima, Japan). A tongue pressure probe with a balloon tip was placed behind the upper front teeth. The participants were instructed to press the balloon against their palate. The participants pressed the balloon for 5 s, and the maximum pressure inside the balloon was measured. The measurements were performed 10 times, and the average value was calculated as the participant’s MTP score (13). There was at least 1 min to recover from fatigue. The LCF was measured using a lip-force measuring device (Lip de Cum model LDC-110R, Cosmo-Instruments Co., Ltd., Tokyo, Japan). The lip pads of the instruments were inserted between the upper and lower lips. The participants were instructed to close their upper and lower lips, and the maximum LCF was recorded. The measurements were performed five times, and the average value was calculated as the participant’s LCF score [ 14 ]. There was at least 1 min to recover from fatigue. Respiratory function PEF was measured using a peak flow meter (Mini Wright®, Clement Clarke International Ltd., U.K.). The participants were instructed to take a deep breath, fill their lungs, place the mouthpiece in their mouth, and blast the air out as hard and fast as possible with a single blow. Subsequently, the number of peak flows was determined. The measurements were performed five times, and the average value was calculated as the participant’s PEF score. Feeding function The FOIS measured the participants’ feeding (eating) status [ 15 ]. The FOIS is a valid and reliable tool for documenting functional eating abilities. A 7-point ordinal scale was used to describe the functional oral intake of patients with dysphagia (from 0: nothing by month to 7: total oral diet with no restrictions). QOL measurements The participants’ QOL was assessed using the EORTC QLQ-C30 version 3.0 and QLQ-H&N35 questionnaires Japanese version. The scores were calculated according to the EORTC scoring manual (16). The EORTC QLQ-C30 consisted of single- and multiple-item scales and included a global health status/QOL, five functional, three symptom, and six single-item scales. Each multi-item scale contained different items; no item appeared on multiple scales. The scores for all scales and single-item scales ranged from 0 to 100. Higher scores indicated higher response levels. For the functional scale, a high score represented a high/healthy level of functioning, and a high score for the global health status/QOL represented a high QOL. However, a high symptom scale/item score represented more symptoms or problems. The EORTC QLQ-H&N35 included pain, swallowing, sensation (taste and smell), language, social diet, social contact, and sexuality and incorporated seven multi-item scales that assessed social contact and sexuality. Eleven individual items were included in this study. All scales and single items ranged from 0 to 100. Higher scores indicated more problems for all items and scales. Rehabilitation All participants in this study received indirect or direct training as needed. After the pain in the surgical region subsided, the participants underwent rehabilitation, such as massage for surgical scarring, oral motor exercises, including lingual exercises, and direct training using various food materials as needed. Rehabilitation was performed by a dentist or speech-language pathologist. Statistical analysis Bivariate analyses with t-tests, χ2 and Fisher’s exact tests were used to compare the two groups for age, sex, oral function measurements, feeding function, and QOL measurements. All statistical analyses were performed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). All p-values were two-sided, and p-values less than 0.05 were considered significant. Results Participants Forty patients (25 men and 15 women) participated in this study. The mean age was 59.93 years (standard deviation [SD]: 14.50 years). Based on the primary side of TC, 23 and 17 participants were classified as LG and RG, respectively. The LG included 13 participants with T1N0M0, 6 with T1N1M0, 6 with T2N0M0, 2 with T2N0M0, and 2 with T3N0M0. The RG included eight participants with T1N0M0, seven with T2N0M0, one with T3N0M0, and one with T3N1M0. Regarding the surgical treatment methods for TC, the LG group included 19 and 4 participants who underwent partial glossectomy and hemiglossectomy, respectively. The RG included 15 and 2 participants who underwent partial glossectomy and hemiglossectomy, respectively. The characteristics of each group are presented in Table 1 . Table 1 Characteristics of participants TC in the left side of the tongue group (LG) TC in the right side of the tongue group (RG) Sex (Male: Female) 14: 9 11: 6 Age in years, Mean (SD) 56.87 (14.83) 64.06 (13.36) Methods of surgical treatment Partial glossectomy : hemi-glossectomy 19 : 4 15 : 2 TNM classification T1N0M0 13 8 T1N1M0 1 0 T2N0M0 6 7 T2N1M0 1 0 T3N0M0 2 1 T3N1M0 0 1 Oral function MTP At BL, the mean MTP of LG was 24.87 kPa (SD = 8.33), and that of RG was 22.27 kPa (SD = 12.72). At 1M, the mean MTP of LG was 22.93 kPa (SD = 1.98), and that of RG was 21.78 kPa (SD = 12.73). At 3M, the mean MTP of LG was 30.38 kPa (SD = 10.13), and that of RG was 24.57 kPa (SD = 12.44). At 6M, the mean MTP of LG was 32.41 kPa (SD = 8.68), and that of RG was 29.00 kPa (SD = 8.89). There were no significant differences between LG and RG at any evaluation period (BL, p = 0.538; 1M, p = 0.760; 3M, p = 0.139; 6M, p = 0.346) (Fig. 1 a). LCF At BL, the mean LCF of LG was 13.38 N (SD = 3.94), and that of RG was 11.83 N (SD = 2.56). At 1M, the mean LCF of LG was 12.15 N (SD = 3.05), and that of RG was 10.34 N (SD = 2.82). At 3M, the mean LCF of LG was 12.94 N (SD = 3.67), and that of RG was 11.62 N (SD = 2.53). At 6M, the mean LCF of LG was 13.62 N (SD = 3.69), and that of RG was 11.76 N (SD = 2.28). There were no significant differences between LG and RG at any evaluation period (BL, p = 0.186, 1M; p = 0.072, 3M; p = 0.203, 6M; p = 0.074) (Fig. 1 b). Respiratory function At BL, the mean PEF of LG was 464.33 L/min (SD = 120.07), and that of RG was 430.46 L/min (SD = 74.52). At 1M, the mean PEF of LG was 427.30 L/min (SD = 124.12), and that of the RG was 430.43 L/min (SD = 66.21). At 3M, the mean PEF of LG was 440.76 L/min (SD = 116.61), and that of RG was 432.27 L/min (SD = 76.94). At 6M, the mean PEF of LG was 455.63 L/min (SD = 117.62), and that of RG was 433.71 L/min (SD = 102.96). There were no significant differences between LG and RG at any evaluation period (BL, p = 0.342, 1M; p = 0.921, 3M; p = 0.794, 6M; p = 0.565) (Fig. 1 c). Feeding function At BL, the mean FOIS score of LG was 6.70 (SD = 0.70), and that of RG was 6.88 (SD = 0.33). At 1M, the mean FOIS score of LG was 6.00 (SD = 1.56), and that of RG was 6.25 (SD = 0.87). At 3M, the mean FOIS score of LG was 6.86 (SD = 0.64), and that of RG was 6.69 (SD = 0.60). At 6M, the mean FOIS score of LG was 6.83 (SD = 0.65), and that of RG was 6.76 (SD = 0.14). There were no significant differences between LG and RG at any evaluation period (BL, p = 0.272, 1M; p = 0.564, 3M; p = 0.392, 6M; p = 0.751) (Fig. 1 d). QOL measurements EORTC QLQ-C30 Table 2 presents the results of the EORTC QLQ C-30. At BL, there were no significant differences between LG and RG (global health status, p = 0.422; physical functioning, p = 0.610; role functioning, p = 0.273; emotional functioning, p = 0.340; cognitive functioning, p = 0.424; social functioning, p = 0.289; fatigue, p = 0.726; nausea and vomiting, p = 0.341; pain, p = 0.957; dyspnea, p = 0.334; sleep, p = 0.405; appetite loss, p = 0.832; constipation, p = 0.743; diarrhea, p = 0.912; financial difficulties; p = 0.200). Table 2 Result of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. BL 1M 3M 6M Mean (SD) Mean (SD) Mean (SD) Mean (SD) Global health status LG 64.58 (24.25) 78.97 (18.56) 79.37 (16.38) 81.14 (18.81)* RG 71.15 (19.13) 68.89 (21.47) 77.22 (17.10) 65.69 (18.37) Physical functioning LG 98.67 (3.74) 94.92 (8.67) 97.14 (4.51) 96.51 (5.82)* RG 98.97 (3.70) 93.33 (9.06) 88.44 (16.23) 89.80 (12.05) Role functioning LG 98.89 (4.30) 88.10 (3.28) 96.03 (8.98) 96.83 (8.53) RG 89.74 (28.50) 88.10 (4.43) 87.78 (23.96) 96.08 (9.37) Emotional functioning LG 80.56 (16.86) 88.89 (13.52) 94.05 (9.18) 90.35 (12.50) RG 87.88 (6.09) 87.18 (5.94) 87.78 (21.33) 83.33 (24.40) Cognitive functioning LG 90.00 (15.17) 92.06 (13.56) 92.86 (11.27) 88.60 (15.77) RG 81.82 (9.12) 91.67 (12.66) 82.22 (27.79) 82.14 (32.33) Social functioning LG 92.22 (12.39) 90.48 (17.14) 98.41 (7.27) 97.37 (8.36) RG 81.82 (8.83) 85.71 (18.32) 97.78 (8.61) 91.67 (19.34) Fatigue LG 14.07 (14.22) 20.11 (22.67) 12.70 (15.43) 15.79 (14.49) RG 16.16 (15.21) 17.46 (17.82) 24.44 (28.54) 15.08 (22.48) Nausea and vomiting LG 0.00 (0) 1.59 (5.01) 0.79 (3.63) 3.17 (14.55) RG 1.52 (5.03) 1.19 (4.54) 0.00 (0.00) 0.00 (0.00) Pain LG 23.33 (25.04) 15.87 (17.85) 8.73 (14.55) 8.33 (14.29) RG 22.73 (30.07) 12.82 (16.88) 20.00 (32.24) 6.41 (16.01) Dyspnea LG 2.22 (8.61) 1.59 (7.27) 1.59 (7.27) 4.76 (11.95) RG 0.00 (0) 2.38 (8.91) 15.56 (9.12) 4.76 (17.82) Sleep LG 20.00 (24.56) 11.11 (16.10) 4.76 (11.95) 5.00 (16.31) RG 12.12 (6.78) 15.38 (22.01) 15.56 (24.77) 0.00 (0.00) Appetite loss LG 2.22 (8.61) 6.35 (17.06) 1.59 (7.27) 4.76 (21.82) RG 3.03 (10.05) 9.53 (4.18) 13.33 (35.19) 4.76 (17.82) Constipation LG 11.11 (24.12) 6.35 (13.41) 6.35 (17.06) 4.76 (11.95) RG 15.15 (34.52) 21.43 (30.96) 0.00 (0.00) 4.76 (12.10) Diarrhea LG 6.67 (13.80) 7.94 (17.97) 3.17 (10.03) 12.96 (25.92) RG 6.06 (13.48) 0.00 (0.00) 8.89 (15.26) 2.56 (9.25) Financial difficulties LG 11.11 (20.57) 11.11 (24.34) 4.76 (21.82) 7.41 (24.40) RG 3.03 (10.05) 7.69 (14.62) 6.67 (13.80) 0.00 (0.00) At 1M, there was no significant difference between LG and RG (global health status, p = 0.154; physical functioning, p = 0.610; role functioning, p = 1.000; emotional functioning, p = 0.800; cognitive functioning, p = 0.930; social functioning, p = 0.446; fatigue, p = 0.703; nausea and vomiting, p = 0.808; pain, p = 0.620; dyspnea, p = 0.784; sleep, p = 0.551; appetite loss, p = 0.575; constipation, p = 0.105; diarrhea, p = 0.066; financial difficulties, p = 0.612). At 3M, there was no significant difference between LG and RG (global health status, p = 0.709; physical functioning, p = 0.061; role functioning, p = 0.221; emotional functioning, p = 0.299; cognitive functioning, p = 0.179; social functioning, p = 0.818; fatigue, p = 0.163; nausea and vomiting, p = 0.329; pain, p = 0.222; dyspnea, p = 0.153; sleep, p = 0.135; appetite loss, p = 0.222; constipation, p = 0.104; diarrhea, p = 0.218; financial difficulties, p = 0.751). At 6M, the mean global health status and physical functioning scores of LG were significantly higher than those of RG (global health status, p = 0.018; physical functioning, p = 0.047). Other scores were not significantly different between LG and RG (role functioning, p = 0.801; emotional functioning, p = 0.323; cognitive functioning, p = 0.500; social functioning, p = 0.316; fatigue, p = 0.919; nausea and vomiting, p = 0.329; pain, p = 0.733; dyspnea, p = 1.000; sleep, p = 0.186; appetite loss, p = 1.000; constipation, p = 1.000; diarrhea, p = 0.131; financial difficulties, p = 0.215). EORTC QLQ-H&N35 Table 3 presents the results of EORTC QLQ H&N35. At BL, there was no significant difference between LG and RG (pain, p = 0.870; swallowing, p = 0.823; sense problem, p = 0.189; speech problems, p = 0.456; trouble with social eating, p = 0.671; trouble with social contact, p = 0.916; less sexuality, p = 0.726; teeth, p = 0.926; mouth opening, p = 0.072; dry mouth, p = 0.158; sticky saliva, p = 0.347; coughing, p = 0.892; feeling ill, p = 0.396; pain killers, p = 0.620; nutritional supplements, p = 0.082; feeding tube, p = 0.341; weight loss, p = 0.912; weight gain, p = 0.445). Table 3 Result of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N 35. BL 1M 3M 6M Mean (SD) Mean (SD) Mean (SD) Mean (SD) Pain LG 19.44 (14.32) 11.51 (8.93) 5.95 (9.55) 4.58 (6.88) RG 18.18 (22.00) 8.33 (10.21) 5.00 (6.90) 2.99 (7.39) Swallowing LG 18.89 (23.46) 10.32 (14.65) 3.17 (7.67)* 3.33 (7.84) RG 16.67 (25.55) 14.10 (21.89) 10.00 (10.06) 4.49 (8.75) Senses problems LG 3.33 (9.34) 3.97 (8.98) 0.79 (3.64) 2.50 (6.11) RG 0.00 (0.00) 6.41 (12.80) 10.00 (23.40) 2.56 (6.26) Speech problems LG 15.56 (22.93) 16.40 (12.48) 6.88 (10.23) 6.67 (6.88) RG 9.09 (20.38) 25.64 (24.17) 17.78 (23.68) 8.12 (16.45) Trouble with social eating LG 22.78 (19.28) 25.40 (21.81) 12.30 (13.34)* 12.70 (10.41) RG 26.52 (23.52) 25.00 (21.25) 20.56 (7.63) 18.59 (12.80) Trouble with social contact LG 7.14 (12.11) 8.89 (12.88) 2.22 (6.09) 1.67 (4.78) RG 7.88 (19.96) 14.44 (15.26) 8.44 (14.79) 1.54 (3.99) Less sexuality LG 15.38 (23.04) 14.17 (25.52) 0.00 (0.00) 24.07 (30.90) RG 19.70 (34.01) 6.94 (16.60) 7.69 (14.62) 10.71 (18.03) Teeth LG 11.11 (20.57) 3.17 (14.55) 6.35 (17.06) 7.94 (20.83) RG 12.12 (30.81) 7.14 (14.19) 2.22 (8.61) 2.38 (8.91) Opening mouth LG 26.67 (25.82) 12.70 (22.30) 3.17 (10.03) 1.59 (7.27) RG 9.09 (21.56) 14.29 (17.12) 6.67 (13.80) 9.52 (20.37) Dry mouth LG 24.44 (32.04) 23.81 (28.17) 15.87 (27.12) 12.70 (16.59) RG 9.09 (21.56) 14.29 (21.54) 33.33 (37.80) 16.67 (21.68) Sticky saliva LG 26.67 (28.73) 15.87 (20.05) 6.35 (22.65) 7.94 (14.55) RG 15.15 (31.14) 16.67 (31.35) 20.00 (24.56) 14.29 (17.12) Coughing LG 11.11 (20.57) 9.52 (15.43) 6.35 (17.06) 7.94 (14.55) RG 12.12 (16.82) 7.14 (14.19) 8.89 (15.26) 2.38 (8.91) Felt ill LG 24.44 (26.63) 12.70 (19.65) 7.94 (23.34) 7.94 (14.55) RG 15.15 (27.34) 26.19 (29.75) 15.56 (24.77) 19.05 (17.12) Pain killers LG 8.89 (15.26) 7.94 (14.55) 3.17 (10.03) 1.59 (7.27) RG 12.12 (16.82) 11.90 (16.57) 2.22 (8.61) 0.00 (0.00) Nutritional supplements LG 6.67 (13.80) 3.17 (10.03) 4.76 (11.95) 6.34 (13.41) RG 0.00 (0.00) 4.76 (12.10) 0.00 (0.00) 2.38 (8.91) Feeding tube LG 0.00 (0.00) 0.00 (0.00) 0.00 (0.00) 0.00 (0.00) RG f 3.03 (10.05) 0.00 (0.00) 0.00 (0.00) 0.00 (0.00) Weight loss LG 6.67 (13.80) 6.35 (13.41) 3.17 (10.03) 3.17 (10.03) RG 6.06 (13.48) 7.69 (14.62) 6.67 (13.80) 2.38 (8.91) Weight gain LG 6.67 (13.80) 15.87 (17.06) 11.11 (16.10) 9.52 (15.43) RG 3.03 (10.05) 10.26 (16.01) 20.00 (16.90) 16.67 (17.30) LG: TC in the left side of the tongue group. RG: TC in the right side of the tongue group. At 1M, there was no significant difference between LG and RG (pain, p = 0.365; swallowing, p = 0.588; senses problem, p = 0.554; speech problems, p = 0.220; trouble with social eating, p = 0.959; trouble with social contact, p = 0.301; less sexuality, p = 0.340; teeth, p = 0.429; mouth opening, p = 0.814; dry mouth, p = 0.267; sticky saliva, p = 0.934; coughing, p = 0.642; feeling ill, p = 0.151; pain killers, p = 0.473; nutritional supplements, p = 0.688; feeding tube, p = 1.000; weight loss, p = 0.791; weight gain, p = 0.341). At 3M, the mean swallowing and trouble with social eating scores of LG were significantly lower than those of RG (swallowing, p = 0.037; trouble with social eating, p = 0.025). Other scores did not indicate significant differences between LG and RG (pain, p = 0.731; sensory problems, p = 0.152; speech problems, p = 0.112; trouble with social contact, p = 0.142; less sexuality, p = 0.082; teeth, p = 0.349; mouth opening, p = 0.412; dry mouth, p = 0.139; sticky saliva, p = 0.100; coughing, p = 0.643; feeling ill, p = 0.359; pain killers, p = 0.762; nutritional supplements, p = 0.083; feeding tube, p = 1.000; weight loss, p = 0.412; weight gain, p = 0.123). At 6M, there was no significant difference between LG and RG (pain, p = 0.540; swallowing, p = 0.703; senses problem, p = 0.977; speech problems, p = 0.775; trouble with social eating, p = 0.176; trouble with social contact, p = 0.934; less sexuality, p = 0.137; teeth, p = 0.288; mouth opening, p = 0.181; dry mouth, p = 0.567; sticky saliva, p = 0.265; coughing, p = 0.171; feeling ill, p = 0.057; pain killers, p = 0.329; nutritional supplements, p = 0.301; feeding tube, p = 1.000; weight loss, p = 0.808; weight gain, p = 0.223). Discussion This study's results indicated no significant differences in functional measurements between LG and RG at any assessment period. In contrast, the QOL assessments indicated no significant difference till 1M; however, after 3M, some QOL assessments showed significantly lower RG scores than LG. This study measured MTP using a balloon at the tip of a probe behind the upper front teeth. This indicates that the balloon was located near the midline of the palate. A previous study reported that a small TC surgical area does not affect tongue function [ 17 , 18 ]. In this study, 34 (85%) participants underwent partial glossectomy, meaning most participants had limited tongue movement. Thus, the groups had no significant differences in the MTP or feeding function. The participants in this study underwent rehabilitation after surgical treatment. Tongue rehabilitation, such as motor training, has been reported to improve tongue pressure in patients undergoing TC treatment [ 9 ]. This could help improve the participants’ MTP. Moreover, a previous study reported that a small area of tongue resection did not affect the LCF [ 9 ]. Similarly, the participants in this study underwent a small surgical treatment for TC, such as partial glossectomy or hemiglossectomy, indicating no effect on LCF. Thus, there were no significant differences between the groups. Based on QOL measurements, there was no significant difference between LG and RG at baseline and 1M; however, there were significant differences at 3M and 6M. At baseline, the participants were not affected by scarring resulting from the surgical treatment for TC. However, some of the participants likely experienced cancer pain. Cancer pain has a significant effect on the patient’s QOL. Both EORTC QLQ-C30 and H&N35 include pain-related assessment (EORTC QLQ C30, pain; H&N35, pain killer), and it has been reported that cancer pain is noted more frequently in advanced cancer than in early-stage cancer [ 19 ]. It is likely that the participants included in this study had early-stage TC (T1 or T2) and that their cancer pain was localized. Therefore, the effect on cancer pain was considered small with or without the use of painkillers. One possible reason for the lack of a significant difference between LG and RG might be the effects of the surgical treatment for TC. Generally, it takes more than 1 month for wound healing to be completed after surgical treatment for TC [ 20 ]. Thus, the participants were presumably aware of pain and postoperative dysfunction, regardless of the surgical area. The results of this study indicated a significant difference between LG and RG in QOL measurements at 3M and 6M; however, there were no significant differences in functional measurements. These results suggest that participants who received right-sided TC treatment still experienced discomfort, such as difficulty in swallowing, compared to participants who received left-sided TC treatment. No previous study has investigated the left–right difference in tongue function during swallowing. Regarding mastication, it has been reported that there is a left–right difference called habitual mastication [ 21 , 22 ], and left–right differences in tongue function have been reported [ 12 ]. Both the dominant hand and habitual masticatory side have been reported to be more common on the right side [ 21 , 23 ], and the same might be true for tongue function. Therefore, the function of the tongue may not be the same on the left and right sides, and there may be a dominant side. This might be one of the reasons why RG had a lower QOL score than LG, although this was not noted in the functional measurements. However, this study did not investigate the participants’ dominant hand and habitual masticatory side, and it is necessary to investigate the relationship between these factors. A previous study reported that approximately 30% of patients with early-stage HNC did not return to their QOL, especially global health status, 12 months after treatment, although their oral function returned before treatment [ 6 ]. This study did not compare the changes in QOL measurements over time. However, LG tended to have a higher global health status score at 6M than at BL. On the other hand, RG tended to have a lower global health status score at 6M than at BL. One of the possible reasons for only the global health status indicating a significant difference at 6M might be that the global health status reflected the results of multiple questions compared to other items. The participants did not show a significant functional decline at 6M, and it might be possible that this was not a significant change in subjective symptoms. It is necessary to compare the details of these changes over time in future studies. Limitations This prospective cohort study included a small sample size with a further reduction in cases due to patient withdrawal during the study. Patient dropout during a prospective HNC study due to cancer recurrence and change of residence is often noted [ 24 , 25 ]. Furthermore, we did not assess the patients’ speech function. Moreover, we investigated only the left–right difference and did not investigate the anteroposterior position. It has been reported that the anteroposterior tongue position differs in speech and eating function [ 26 , 27 ]. Therefore, it is necessary to assess the speech function and differences in the anteroposterior area of the tongue in future studies. Conclusions No functional impairment of the tongue was observed on the left and right sides of the surgical site after partial glossectomy or hemiglossectomy. However, the patients’ QOL after treatment was significantly lower on the right side than on the left. This suggests that the left–right difference in the primary site should be considered in postoperative care. Declarations Ethics approval and consent to participate: This study was approved by the Ethics Committee of Showa University School of Medicine (approval no. 2355). Informed consent was obtained from all participants included in the study. Research involving Human Participants and/or Animals: This study was approved by the Ethics Committee of Showa University School of Medicine (Approval no. 2355). Informed consent: Informed consent was obtained from all participants in the study. Availability of data and materials The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests: The authors declare that they have no conflicts of interest. Funding: This work was supported by JSPS KAKENHI Grant Number 22K17311. Authors' contributions: Yuka Harada: draft of the work. Yoshiaki Ihara: design of the work, draft of the work. Tomoki Tamai: acquisition, analysis. Yuichi Tashimo, Shinji Nozue: interpretation of data. Toshikazu Shimane: design of the work. Acknowledgements We would like to thank Editage (www.editage.com) for English language editing. References Head and Neck cancers statistics (Cancer Research UK, 2022). https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/head-and-neck-cancers#:~ :text=Nearly%201%20in%2096%20UK,in%20the%20UK%20are%20preventable. Katanoda, K. et al . Short-term projection of cancer incidence in Japan using an age-period interaction model with spline smoothing. Jpn. J. Clin. Oncol. 44, 36–41 (2014). Cancer Stat Facts & National Cancer Institute, (2022). https://seer.cancer.gov/statfacts/ Raj, P., Gupta, D. K., Samuel, S. & Singh, S. K. Evaluation of swallowing dysfunction in cases of locally advanced squamous cell carcinoma oral cavity pre and post treatment. Int. J. Otorhinolaryngol. Head Neck Surg. 5 (2019). Ihara, Y. et al . Dysphagia and oral morbidities in chemoradiation-treated head and neck cancer patients. Dysphagia 33, 739–748 (2018). Ihara, Y. et al . 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, 293 (2022). Suzuki, K. et al . Comparison of quality of life and psychological distress in patients with tongue cancer undergoing a total/subtotal glossectomy or extended hemiglossectomy and free flap transfer: a prospective evaluation. Int. J. Oral Maxillofac. Surg. 52, 621–629 (2023). Pezdirec, M., Strojan, P. & Boltezar, I. H. Swallowing disorders after treatment for head and neck cancer. Radiol. Oncol. 53, 225–230 (2019). Ihara, Y. et al . Changes in oral function and quality of life in tongue cancer patients based on resected area. Asian Pac. J. Cancer Prev. 22, 2549–2557 (2021). Kazi, R. et al . Predictors of speech and swallowing function following primary surgery for oral and oropharyngeal cancer. Clin. Otolaryngol. 31, 83 (2006). Rovira-Lastra, B., Flores-Orozco, E. I., Ayuso-Montero, R., Peraire, M. & Martinez-Gomis, J. Peripheral, functional and postural asymmetries related to the preferred chewing side in adults with natural dentition. J. Oral Rehabil. 43, 279–285 (2016). Takei, Y. et al . Electropalatographic study of connected speech in lateral misarticulation. Oral Sci. Int. 20, 18–27 (2023). Hasegawa, Y. et al . Change in tongue pressure in patients with head and neck cancer after surgical resection. Odontology 105, 494–503 (2017). Morisaki, N., Miura, H. & Hara, S. [Relationship between the nutritional status and the oral function among community-dwelling dependent elderly persons]. Nihon Ronen Igakkai Zasshi 52, 233–242 (2015). in Japanese. Crary, M. A., Mann, G. D. & Groher, M. E. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch. Phys. Med. Rehabil. 86, 1516–1520 (2005). Aaronson, N. K. et al . The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J. Natl Cancer Inst. 85, 365–376 (1993). Huang, Z. S., Chen, W. L., Huang, Z. Q. & Yang, Z. H. Dysphagia in tongue cancer patients before and after surgery. J. Oral Maxillofac. Surg. 74, 2067–2072 (2016). Wu, K., Zhang, S. & Wu, H. J. A precise glossectomy for tongue cancer adjacent to or crossing the midline: a novel anatomical unit resection surgery. Int. J. Oral Maxillofac. Surg. 52, 725–734 (2023). Bagan, J., Sarrion, G. & Jimenez, Y. Oral cancer: clinical features. Oral Oncol. 46, 414–417 (2010). Tashimo, Y. et al. Acute stage longitudinal change of quality of life from Pre- to 3 months after surgical treatment in head and neck cancer patients. Asian Pac. J. Cancer Prev. 20, 3129–3136 (2019). Ozaki, H. Laterality of stomatognathic function and reliability of determination of preferred chewing side. J. Hiroshima Univ. Dent. Soc. 34, 48–59 (2002). in Japanese. Sasaki, M., Yoshikawa, K. & Hosoi, T. A study on the chewing side preference in normal dentate subjects. J. Jpn. Soc. Masticatory Sci. Health Promot. 12, 43–48 (2002). Lancer, H. & Drake-Lee, A. Laterality and otorhinolaryngology: a review. J. Laryngol. Otol. 138, 2–6 (2024). Rademaker, A. W. et al . Eating ability in head and neck cancer patients after treatment with chemoradiation: a 12-month follow-up study accounting for dropout. Head Neck 25, 1034–1041 (2003). Shinn, E. H. et al . Adherence to preventive exercises and self-reported swallowing outcomes in post-radiation head and neck cancer patients. Head Neck 35, 1707–1712 (2013). Hiiemae, K. M. & Palmer, J. B. Tongue movements in feeding and speech. Crit. Rev. Oral Biol. Med. 14, 413–429 (2003). Hiiemae, K. M. et al. Hyoid and tongue surface movements in speaking and eating. Arch. Oral Biol. 47, 11–27 (2002). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4311367","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":297540380,"identity":"b237c2b3-8462-4c27-a1c4-0be5d6ba60aa","order_by":0,"name":"Yuka Harada","email":"","orcid":"","institution":"Showa University","correspondingAuthor":false,"prefix":"","firstName":"Yuka","middleName":"","lastName":"Harada","suffix":""},{"id":297540382,"identity":"221b3599-be68-4d1f-92c2-f1ee5b4dfccc","order_by":1,"name":"Yoshiaki Ihara","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYBACNh42IFnBDOYwI0sQ0HKGGayGOC0MIC2MbZhacAM+nmNp0oXzrOXM5RuYPxdUHJZnkEhg/PCDgS8Pp8N4245Jz9yWbmzZxsAmPePMYcMGiQRmyR4GtmKcWvjZ26R5tx1O3HCMgY2Zt+024/4bCQzSQInEBrxa5hyuB2ph/gzUYg+y5TdeLSCH8TYcTjA4xsAgDdSSCNTCht8WnmPJ1jzH0g03HEtsk+Y58z+5gedhm2WPAW6/yPekGd7mqbGWNzh8+PBnnoo02wb25MM3flQcwxliSICxAYlhcCyBCC2ooIZ0LaNgFIyCUTBcAQCOvUk9I/dJ6AAAAABJRU5ErkJggg==","orcid":"","institution":"Showa University","correspondingAuthor":true,"prefix":"","firstName":"Yoshiaki","middleName":"","lastName":"Ihara","suffix":""},{"id":297540384,"identity":"734299ba-f6a4-43e8-b7e4-17d28672e908","order_by":2,"name":"Tomoki Tamai","email":"","orcid":"","institution":"Showa University Graduate School of Dentistry","correspondingAuthor":false,"prefix":"","firstName":"Tomoki","middleName":"","lastName":"Tamai","suffix":""},{"id":297540386,"identity":"480f81d7-3c9f-4c32-90eb-82dd30bc5026","order_by":3,"name":"Yuichi Tashimo","email":"","orcid":"","institution":"Showa University","correspondingAuthor":false,"prefix":"","firstName":"Yuichi","middleName":"","lastName":"Tashimo","suffix":""},{"id":297540387,"identity":"db8cee20-7de5-4cbc-a8c4-992b575cd386","order_by":4,"name":"Shinji Nozue","email":"","orcid":"","institution":"Showa University","correspondingAuthor":false,"prefix":"","firstName":"Shinji","middleName":"","lastName":"Nozue","suffix":""},{"id":297540389,"identity":"352c67d4-45d5-4558-8f14-645f7dde2e0a","order_by":5,"name":"Toshikazu Shimane","email":"","orcid":"","institution":"Showa University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Toshikazu","middleName":"","lastName":"Shimane","suffix":""}],"badges":[],"createdAt":"2024-04-23 10:39:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4311367/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4311367/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55763591,"identity":"67b862b5-4712-4e54-8891-653661318b5a","added_by":"auto","created_at":"2024-05-02 19:42:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":452920,"visible":true,"origin":"","legend":"\u003cp\u003eThe results of measurements. a: Results of maximum tongue pressure. b: Results of lip closure force. c: Results of peak expiratory flow. d: Results of the functional oral intake scale. There was no significant difference between the groups in all measurements.\u003c/p\u003e","description":"","filename":"FIg.1.png","url":"https://assets-eu.researchsquare.com/files/rs-4311367/v1/5e188b7331ceed1a8f01e095.png"},{"id":64752497,"identity":"218074b6-2911-42e8-8c48-63540f5e474a","added_by":"auto","created_at":"2024-09-18 10:59:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":760696,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4311367/v1/0e157cab-b052-4a4e-a507-f51041046262.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Left–right differences in oral function and QOL of patients who underwent tongue resection","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHead and neck cancer is the 15th most common type of cancer in Japan [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Tongue cancer (TC) is the most frequent type of head and neck cancer, accounting for approximately 25% of all head and neck cancers [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The rate of new TC cases was 3.6 per 100 000 men and women per year, and the rate of new TC cases increased by an average of 2.2% each year from 2010 to 2019 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The treatment of head and neck cancers often causes various complications, and patients with head and neck cancers complain of oral complications caused by radiation, such as limited mouth opening (trismus), dry mouth (xerostomia), swallowing problems (dysphagia), and mucositis. In particular, treating TC leads to several oral dysfunctions, including swallowing and speech difficulties [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Previous studies have reported that the area of the tongue resected due to TC significantly affects swallowing and speech [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In particular, dysphagia has been reported in more than 40% of patients with TC who underwent tongue resection [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The resected area of the tongue has been reported to significantly affect patients\u0026rsquo; oral function and quality of life (QOL) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, the left\u0026ndash;right differences in oral function due to the resected tongue area remain unclear. In terms of limb function, there is a dominant side, such as the dominant hand or leg. The oral function has been reported to be non-uniform between the left and right sides. For example, laterality of stomatognathic function and habitual mastication have been reported [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In addition, it has been reported that lateral misarticulation in using the tongue between the left and right sides was observed even without organic abnormalities [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, no reports exist on the left\u0026ndash;right differences in the use of the tongue in swallowing. Thus, we aimed to investigate the differences in tongue function and its effect on patients\u0026rsquo; QOL after surgical treatment of patients with TC who underwent tongue resection smaller than hemiglossectomy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003e This study included 40 patients with TC who were scheduled for surgical resection smaller than hemiglossectomy (partial glossectomy or hemiglossectomy) at the Head and Neck Oncology Center, Showa University Hospital, and were subsequently referred to the Department of Special Needs Dentistry, Division of Oral Rehabilitation Medicine, Showa University Dental Hospital, for rehabilitation. The participants were divided into groups with TC on the sides of the left (LG) and right (RG).\u003c/p\u003e \u003cp\u003eThe exclusion criteria were as follows: age\u0026thinsp;\u0026lt;\u0026thinsp;20 years, inability to follow instructions, presence of other malignant tumors, and effect of other diseases on oral function. All measurements were performed at baseline (BL), 1 (1M), 3 (3M), and 6 (6M) months after treatment.\u003c/p\u003e \u003cp\u003e This study was approved by the Ethics Committee of Showa University School of Medicine (approval no. 2355), and all participants received both oral and written instructions and signed an approved informed consent form before participating in the study. All procedures were performed in accordance with the World Medical Association Declaration of Helsinki (version 2002).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eAssessments\u003c/h2\u003e \u003cp\u003eAll evaluations were performed by dentists from the Division of Oral Functional Rehabilitation Medicine, Department of Oral Health Management, School of Dentistry, Showa University, Japan. Data regarding age, sex, primary TC side, TMN classification, surgical method, and medical history were collected from the medical records. Maximum tongue pressure (MTP) and lip-closure force (LCF) were used to evaluate oral functions. Peak expiratory flow (PEF) was used to evaluate respiratory function. The Functional Oral Intake Scale (FOIS) was used to evaluate feeding function. The patient\u0026rsquo;s QOL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) QOL Questionnaires: QLQ-C30 and QLQ-H\u0026amp;N 35.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eOral function\u003c/h2\u003e \u003cp\u003eThe MTP was measured using a JMS tongue pressure measurement device (JMS Co., Ltd., Hiroshima, Japan). A tongue pressure probe with a balloon tip was placed behind the upper front teeth. The participants were instructed to press the balloon against their palate. The participants pressed the balloon for 5 s, and the maximum pressure inside the balloon was measured. The measurements were performed 10 times, and the average value was calculated as the participant\u0026rsquo;s MTP score (13). There was at least 1 min to recover from fatigue.\u003c/p\u003e \u003cp\u003eThe LCF was measured using a lip-force measuring device (Lip de Cum model LDC-110R, Cosmo-Instruments Co., Ltd., Tokyo, Japan). The lip pads of the instruments were inserted between the upper and lower lips. The participants were instructed to close their upper and lower lips, and the maximum LCF was recorded. The measurements were performed five times, and the average value was calculated as the participant\u0026rsquo;s LCF score [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. There was at least 1 min to recover from fatigue.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eRespiratory function\u003c/h2\u003e \u003cp\u003ePEF was measured using a peak flow meter (Mini Wright\u0026reg;, Clement Clarke International Ltd., U.K.). The participants were instructed to take a deep breath, fill their lungs, place the mouthpiece in their mouth, and blast the air out as hard and fast as possible with a single blow. Subsequently, the number of peak flows was determined. The measurements were performed five times, and the average value was calculated as the participant\u0026rsquo;s PEF score.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eFeeding function\u003c/h2\u003e \u003cp\u003eThe FOIS measured the participants\u0026rsquo; feeding (eating) status [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The FOIS is a valid and reliable tool for documenting functional eating abilities. A 7-point ordinal scale was used to describe the functional oral intake of patients with dysphagia (from 0: nothing by month to 7: total oral diet with no restrictions).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eQOL measurements\u003c/h2\u003e \u003cp\u003eThe participants\u0026rsquo; QOL was assessed using the EORTC QLQ-C30 version 3.0 and QLQ-H\u0026amp;N35 questionnaires Japanese version. The scores were calculated according to the EORTC scoring manual (16). The EORTC QLQ-C30 consisted of single- and multiple-item scales and included a global health status/QOL, five functional, three symptom, and six single-item scales. Each multi-item scale contained different items; no item appeared on multiple scales. The scores for all scales and single-item scales ranged from 0 to 100. Higher scores indicated higher response levels. For the functional scale, a high score represented a high/healthy level of functioning, and a high score for the global health status/QOL represented a high QOL. However, a high symptom scale/item score represented more symptoms or problems. The EORTC QLQ-H\u0026amp;N35 included pain, swallowing, sensation (taste and smell), language, social diet, social contact, and sexuality and incorporated seven multi-item scales that assessed social contact and sexuality. Eleven individual items were included in this study. All scales and single items ranged from 0 to 100. Higher scores indicated more problems for all items and scales.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eRehabilitation\u003c/h2\u003e \u003cp\u003eAll participants in this study received indirect or direct training as needed. After the pain in the surgical region subsided, the participants underwent rehabilitation, such as massage for surgical scarring, oral motor exercises, including lingual exercises, and direct training using various food materials as needed. Rehabilitation was performed by a dentist or speech-language pathologist.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eBivariate analyses with t-tests, χ2 and Fisher\u0026rsquo;s exact tests were used to compare the two groups for age, sex, oral function measurements, feeding function, and QOL measurements. All statistical analyses were performed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). All p-values were two-sided, and p-values less than 0.05 were considered significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eForty patients (25 men and 15 women) participated in this study. The mean age was 59.93 years (standard deviation [SD]: 14.50 years). Based on the primary side of TC, 23 and 17 participants were classified as LG and RG, respectively. The LG included 13 participants with T1N0M0, 6 with T1N1M0, 6 with T2N0M0, 2 with T2N0M0, and 2 with T3N0M0. The RG included eight participants with T1N0M0, seven with T2N0M0, one with T3N0M0, and one with T3N1M0. Regarding the surgical treatment methods for TC, the LG group included 19 and 4 participants who underwent partial glossectomy and hemiglossectomy, respectively. The RG included 15 and 2 participants who underwent partial glossectomy and hemiglossectomy, respectively. The characteristics of each group are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTC in the left side of the tongue group (LG)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTC in the right side of the tongue group (RG)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (Male: Female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14: 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11: 6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years, Mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56.87 (14.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.06 (13.36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMethods of surgical treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartial glossectomy : hemi-glossectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 : 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 : 2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTNM classification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1N0M0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1N1M0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2N0M0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2N1M0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3N0M0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3N1M0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eOral function\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eMTP\u003c/h2\u003e \u003cp\u003eAt BL, the mean MTP of LG was 24.87 kPa (SD\u0026thinsp;=\u0026thinsp;8.33), and that of RG was 22.27 kPa (SD\u0026thinsp;=\u0026thinsp;12.72). At 1M, the mean MTP of LG was 22.93 kPa (SD\u0026thinsp;=\u0026thinsp;1.98), and that of RG was 21.78 kPa (SD\u0026thinsp;=\u0026thinsp;12.73). At 3M, the mean MTP of LG was 30.38 kPa (SD\u0026thinsp;=\u0026thinsp;10.13), and that of RG was 24.57 kPa (SD\u0026thinsp;=\u0026thinsp;12.44). At 6M, the mean MTP of LG was 32.41 kPa (SD\u0026thinsp;=\u0026thinsp;8.68), and that of RG was 29.00 kPa (SD\u0026thinsp;=\u0026thinsp;8.89). There were no significant differences between LG and RG at any evaluation period (BL, p\u0026thinsp;=\u0026thinsp;0.538; 1M, p\u0026thinsp;=\u0026thinsp;0.760; 3M, p\u0026thinsp;=\u0026thinsp;0.139; 6M, p\u0026thinsp;=\u0026thinsp;0.346) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLCF\u003c/h2\u003e \u003cp\u003eAt BL, the mean LCF of LG was 13.38 N (SD\u0026thinsp;=\u0026thinsp;3.94), and that of RG was 11.83 N (SD\u0026thinsp;=\u0026thinsp;2.56). At 1M, the mean LCF of LG was 12.15 N (SD\u0026thinsp;=\u0026thinsp;3.05), and that of RG was 10.34 N (SD\u0026thinsp;=\u0026thinsp;2.82). At 3M, the mean LCF of LG was 12.94 N (SD\u0026thinsp;=\u0026thinsp;3.67), and that of RG was 11.62 N (SD\u0026thinsp;=\u0026thinsp;2.53). At 6M, the mean LCF of LG was 13.62 N (SD\u0026thinsp;=\u0026thinsp;3.69), and that of RG was 11.76 N (SD\u0026thinsp;=\u0026thinsp;2.28). There were no significant differences between LG and RG at any evaluation period (BL, p\u0026thinsp;=\u0026thinsp;0.186, 1M; p\u0026thinsp;=\u0026thinsp;0.072, 3M; p\u0026thinsp;=\u0026thinsp;0.203, 6M; p\u0026thinsp;=\u0026thinsp;0.074) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eb).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eRespiratory function\u003c/h2\u003e \u003cp\u003eAt BL, the mean PEF of LG was 464.33 L/min (SD\u0026thinsp;=\u0026thinsp;120.07), and that of RG was 430.46 L/min (SD\u0026thinsp;=\u0026thinsp;74.52). At 1M, the mean PEF of LG was 427.30 L/min (SD\u0026thinsp;=\u0026thinsp;124.12), and that of the RG was 430.43 L/min (SD\u0026thinsp;=\u0026thinsp;66.21). At 3M, the mean PEF of LG was 440.76 L/min (SD\u0026thinsp;=\u0026thinsp;116.61), and that of RG was 432.27 L/min (SD\u0026thinsp;=\u0026thinsp;76.94). At 6M, the mean PEF of LG was 455.63 L/min (SD\u0026thinsp;=\u0026thinsp;117.62), and that of RG was 433.71 L/min (SD\u0026thinsp;=\u0026thinsp;102.96). There were no significant differences between LG and RG at any evaluation period (BL, p\u0026thinsp;=\u0026thinsp;0.342, 1M; p\u0026thinsp;=\u0026thinsp;0.921, 3M; p\u0026thinsp;=\u0026thinsp;0.794, 6M; p\u0026thinsp;=\u0026thinsp;0.565) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ec).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFeeding function\u003c/h2\u003e \u003cp\u003eAt BL, the mean FOIS score of LG was 6.70 (SD\u0026thinsp;=\u0026thinsp;0.70), and that of RG was 6.88 (SD\u0026thinsp;=\u0026thinsp;0.33). At 1M, the mean FOIS score of LG was 6.00 (SD\u0026thinsp;=\u0026thinsp;1.56), and that of RG was 6.25 (SD\u0026thinsp;=\u0026thinsp;0.87). At 3M, the mean FOIS score of LG was 6.86 (SD\u0026thinsp;=\u0026thinsp;0.64), and that of RG was 6.69 (SD\u0026thinsp;=\u0026thinsp;0.60). At 6M, the mean FOIS score of LG was 6.83 (SD\u0026thinsp;=\u0026thinsp;0.65), and that of RG was 6.76 (SD\u0026thinsp;=\u0026thinsp;0.14). There were no significant differences between LG and RG at any evaluation period (BL, p\u0026thinsp;=\u0026thinsp;0.272, 1M; p\u0026thinsp;=\u0026thinsp;0.564, 3M; p\u0026thinsp;=\u0026thinsp;0.392, 6M; p\u0026thinsp;=\u0026thinsp;0.751) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ed).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eQOL measurements\u003c/h2\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003eEORTC QLQ-C30\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the results of the EORTC QLQ C-30. At BL, there were no significant differences between LG and RG (global health status, p\u0026thinsp;=\u0026thinsp;0.422; physical functioning, p\u0026thinsp;=\u0026thinsp;0.610; role functioning, p\u0026thinsp;=\u0026thinsp;0.273; emotional functioning, p\u0026thinsp;=\u0026thinsp;0.340; cognitive functioning, p\u0026thinsp;=\u0026thinsp;0.424; social functioning, p\u0026thinsp;=\u0026thinsp;0.289; fatigue, p\u0026thinsp;=\u0026thinsp;0.726; nausea and vomiting, p\u0026thinsp;=\u0026thinsp;0.341; pain, p\u0026thinsp;=\u0026thinsp;0.957; dyspnea, p\u0026thinsp;=\u0026thinsp;0.334; sleep, p\u0026thinsp;=\u0026thinsp;0.405; appetite loss, p\u0026thinsp;=\u0026thinsp;0.832; constipation, p\u0026thinsp;=\u0026thinsp;0.743; diarrhea, p\u0026thinsp;=\u0026thinsp;0.912; financial difficulties; p\u0026thinsp;=\u0026thinsp;0.200).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResult of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1M\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3M\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6M\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGlobal health status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.58 (24.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.97 (18.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79.37 (16.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e81.14 (18.81)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.15 (19.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.89 (21.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77.22 (17.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e65.69 (18.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePhysical functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.67 (3.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94.92 (8.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97.14 (4.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e96.51 (5.82)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.97 (3.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.33 (9.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88.44 (16.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89.80 (12.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRole functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.89 (4.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.10 (3.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96.03 (8.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e96.83 (8.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89.74 (28.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.10 (4.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87.78 (23.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e96.08 (9.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmotional functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.56 (16.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.89 (13.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.05 (9.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e90.35 (12.50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.88 (6.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.18 (5.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87.78 (21.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e83.33 (24.40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCognitive functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.00 (15.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.06 (13.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92.86 (11.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e88.60 (15.77)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.82 (9.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91.67 (12.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82.22 (27.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82.14 (32.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSocial functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.22 (12.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.48 (17.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98.41 (7.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e97.37 (8.36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.82 (8.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.71 (18.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97.78 (8.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e91.67 (19.34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.07 (14.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.11 (22.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.70 (15.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.79 (14.49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.16 (15.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.46 (17.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.44 (28.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.08 (22.48)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNausea and vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.59 (5.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.79 (3.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.17 (14.55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.52 (5.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.19 (4.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.33 (25.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.87 (17.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.73 (14.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.33 (14.29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.73 (30.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.82 (16.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.00 (32.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.41 (16.01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.22 (8.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.59 (7.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.59 (7.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.76 (11.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.38 (8.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.56 (9.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.76 (17.82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.00 (24.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.11 (16.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.76 (11.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.00 (16.31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.12 (6.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.38 (22.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.56 (24.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAppetite loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.22 (8.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.35 (17.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.59 (7.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.76 (21.82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.03 (10.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.53 (4.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.33 (35.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.76 (17.82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eConstipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.11 (24.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.35 (13.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.35 (17.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.76 (11.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.15 (34.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.43 (30.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.76 (12.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.67 (13.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.94 (17.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.17 (10.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.96 (25.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.06 (13.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.89 (15.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.56 (9.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFinancial difficulties\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.11 (20.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.11 (24.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.76 (21.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.41 (24.40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.03 (10.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.69 (14.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.67 (13.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAt 1M, there was no significant difference between LG and RG (global health status, p\u0026thinsp;=\u0026thinsp;0.154; physical functioning, p\u0026thinsp;=\u0026thinsp;0.610; role functioning, p\u0026thinsp;=\u0026thinsp;1.000; emotional functioning, p\u0026thinsp;=\u0026thinsp;0.800; cognitive functioning, p\u0026thinsp;=\u0026thinsp;0.930; social functioning, p\u0026thinsp;=\u0026thinsp;0.446; fatigue, p\u0026thinsp;=\u0026thinsp;0.703; nausea and vomiting, p\u0026thinsp;=\u0026thinsp;0.808; pain, p\u0026thinsp;=\u0026thinsp;0.620; dyspnea, p\u0026thinsp;=\u0026thinsp;0.784; sleep, p\u0026thinsp;=\u0026thinsp;0.551; appetite loss, p\u0026thinsp;=\u0026thinsp;0.575; constipation, p\u0026thinsp;=\u0026thinsp;0.105; diarrhea, p\u0026thinsp;=\u0026thinsp;0.066; financial difficulties, p\u0026thinsp;=\u0026thinsp;0.612).\u003c/p\u003e \u003cp\u003eAt 3M, there was no significant difference between LG and RG (global health status, p\u0026thinsp;=\u0026thinsp;0.709; physical functioning, p\u0026thinsp;=\u0026thinsp;0.061; role functioning, p\u0026thinsp;=\u0026thinsp;0.221; emotional functioning, p\u0026thinsp;=\u0026thinsp;0.299; cognitive functioning, p\u0026thinsp;=\u0026thinsp;0.179; social functioning, p\u0026thinsp;=\u0026thinsp;0.818; fatigue, p\u0026thinsp;=\u0026thinsp;0.163; nausea and vomiting, p\u0026thinsp;=\u0026thinsp;0.329; pain, p\u0026thinsp;=\u0026thinsp;0.222; dyspnea, p\u0026thinsp;=\u0026thinsp;0.153; sleep, p\u0026thinsp;=\u0026thinsp;0.135; appetite loss, p\u0026thinsp;=\u0026thinsp;0.222; constipation, p\u0026thinsp;=\u0026thinsp;0.104; diarrhea, p\u0026thinsp;=\u0026thinsp;0.218; financial difficulties, p\u0026thinsp;=\u0026thinsp;0.751).\u003c/p\u003e \u003cp\u003eAt 6M, the mean global health status and physical functioning scores of LG were significantly higher than those of RG (global health status, p\u0026thinsp;=\u0026thinsp;0.018; physical functioning, p\u0026thinsp;=\u0026thinsp;0.047). Other scores were not significantly different between LG and RG (role functioning, p\u0026thinsp;=\u0026thinsp;0.801; emotional functioning, p\u0026thinsp;=\u0026thinsp;0.323; cognitive functioning, p\u0026thinsp;=\u0026thinsp;0.500; social functioning, p\u0026thinsp;=\u0026thinsp;0.316; fatigue, p\u0026thinsp;=\u0026thinsp;0.919; nausea and vomiting, p\u0026thinsp;=\u0026thinsp;0.329; pain, p\u0026thinsp;=\u0026thinsp;0.733; dyspnea, p\u0026thinsp;=\u0026thinsp;1.000; sleep, p\u0026thinsp;=\u0026thinsp;0.186; appetite loss, p\u0026thinsp;=\u0026thinsp;1.000; constipation, p\u0026thinsp;=\u0026thinsp;1.000; diarrhea, p\u0026thinsp;=\u0026thinsp;0.131; financial difficulties, p\u0026thinsp;=\u0026thinsp;0.215).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eEORTC QLQ-H\u0026amp;N35\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the results of EORTC QLQ H\u0026amp;N35. At BL, there was no significant difference between LG and RG (pain, p\u0026thinsp;=\u0026thinsp;0.870; swallowing, p\u0026thinsp;=\u0026thinsp;0.823; sense problem, p\u0026thinsp;=\u0026thinsp;0.189; speech problems, p\u0026thinsp;=\u0026thinsp;0.456; trouble with social eating, p\u0026thinsp;=\u0026thinsp;0.671; trouble with social contact, p\u0026thinsp;=\u0026thinsp;0.916; less sexuality, p\u0026thinsp;=\u0026thinsp;0.726; teeth, p\u0026thinsp;=\u0026thinsp;0.926; mouth opening, p\u0026thinsp;=\u0026thinsp;0.072; dry mouth, p\u0026thinsp;=\u0026thinsp;0.158; sticky saliva, p\u0026thinsp;=\u0026thinsp;0.347; coughing, p\u0026thinsp;=\u0026thinsp;0.892; feeling ill, p\u0026thinsp;=\u0026thinsp;0.396; pain killers, p\u0026thinsp;=\u0026thinsp;0.620; nutritional supplements, p\u0026thinsp;=\u0026thinsp;0.082; feeding tube, p\u0026thinsp;=\u0026thinsp;0.341; weight loss, p\u0026thinsp;=\u0026thinsp;0.912; weight gain, p\u0026thinsp;=\u0026thinsp;0.445).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResult of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H\u0026amp;N 35.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1M\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3M\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6M\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.44 (14.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.51 (8.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.95 (9.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.58 (6.88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.18 (22.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.33 (10.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.00 (6.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.99 (7.39)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSwallowing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.89 (23.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.32 (14.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.17 (7.67)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.33 (7.84)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.67 (25.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.10 (21.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.00 (10.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.49 (8.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSenses problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.33 (9.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.97 (8.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.79 (3.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.50 (6.11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.41 (12.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.00 (23.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.56 (6.26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSpeech problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.56 (22.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.40 (12.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.88 (10.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.67 (6.88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.09 (20.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.64 (24.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.78 (23.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.12 (16.45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTrouble with social eating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.78 (19.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.40 (21.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.30 (13.34)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.70 (10.41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.52 (23.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.00 (21.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.56 (7.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.59 (12.80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTrouble with social contact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.14 (12.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.89 (12.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.22 (6.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.67 (4.78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.88 (19.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.44 (15.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.44 (14.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.54 (3.99)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLess sexuality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.38 (23.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.17 (25.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24.07 (30.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.70 (34.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.94 (16.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.69 (14.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.71 (18.03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTeeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.11 (20.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.17 (14.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.35 (17.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.94 (20.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.12 (30.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.14 (14.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.22 (8.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.38 (8.91)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOpening mouth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.67 (25.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.70 (22.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.17 (10.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.59 (7.27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.09 (21.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.29 (17.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.67 (13.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.52 (20.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDry mouth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.44 (32.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.81 (28.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.87 (27.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.70 (16.59)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.09 (21.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.29 (21.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.33 (37.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.67 (21.68)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSticky saliva\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.67 (28.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.87 (20.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.35 (22.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.94 (14.55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.15 (31.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.67 (31.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.00 (24.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.29 (17.12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCoughing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.11 (20.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.52 (15.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.35 (17.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.94 (14.55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.12 (16.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.14 (14.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.89 (15.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.38 (8.91)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFelt ill\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.44 (26.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.70 (19.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.94 (23.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.94 (14.55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.15 (27.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.19 (29.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.56 (24.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.05 (17.12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePain killers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.89 (15.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.94 (14.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.17 (10.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.59 (7.27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.12 (16.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.90 (16.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.22 (8.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNutritional supplements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.67 (13.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.17 (10.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.76 (11.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.34 (13.41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.76 (12.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.38 (8.91)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFeeding tube\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.03 (10.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWeight loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.67 (13.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.35 (13.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.17 (10.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.17 (10.03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.06 (13.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.69 (14.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.67 (13.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.38 (8.91)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWeight gain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.67 (13.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.87 (17.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.11 (16.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.52 (15.43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.03 (10.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.26 (16.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.00 (16.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.67 (17.30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eLG: TC in the left side of the tongue group. RG: TC in the right side of the tongue group.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAt 1M, there was no significant difference between LG and RG (pain, p\u0026thinsp;=\u0026thinsp;0.365; swallowing, p\u0026thinsp;=\u0026thinsp;0.588; senses problem, p\u0026thinsp;=\u0026thinsp;0.554; speech problems, p\u0026thinsp;=\u0026thinsp;0.220; trouble with social eating, p\u0026thinsp;=\u0026thinsp;0.959; trouble with social contact, p\u0026thinsp;=\u0026thinsp;0.301; less sexuality, p\u0026thinsp;=\u0026thinsp;0.340; teeth, p\u0026thinsp;=\u0026thinsp;0.429; mouth opening, p\u0026thinsp;=\u0026thinsp;0.814; dry mouth, p\u0026thinsp;=\u0026thinsp;0.267; sticky saliva, p\u0026thinsp;=\u0026thinsp;0.934; coughing, p\u0026thinsp;=\u0026thinsp;0.642; feeling ill, p\u0026thinsp;=\u0026thinsp;0.151; pain killers, p\u0026thinsp;=\u0026thinsp;0.473; nutritional supplements, p\u0026thinsp;=\u0026thinsp;0.688; feeding tube, p\u0026thinsp;=\u0026thinsp;1.000; weight loss, p\u0026thinsp;=\u0026thinsp;0.791; weight gain, p\u0026thinsp;=\u0026thinsp;0.341).\u003c/p\u003e \u003cp\u003eAt 3M, the mean swallowing and trouble with social eating scores of LG were significantly lower than those of RG (swallowing, p\u0026thinsp;=\u0026thinsp;0.037; trouble with social eating, p\u0026thinsp;=\u0026thinsp;0.025). Other scores did not indicate significant differences between LG and RG (pain, p\u0026thinsp;=\u0026thinsp;0.731; sensory problems, p\u0026thinsp;=\u0026thinsp;0.152; speech problems, p\u0026thinsp;=\u0026thinsp;0.112; trouble with social contact, p\u0026thinsp;=\u0026thinsp;0.142; less sexuality, p\u0026thinsp;=\u0026thinsp;0.082; teeth, p\u0026thinsp;=\u0026thinsp;0.349; mouth opening, p\u0026thinsp;=\u0026thinsp;0.412; dry mouth, p\u0026thinsp;=\u0026thinsp;0.139; sticky saliva, p\u0026thinsp;=\u0026thinsp;0.100; coughing, p\u0026thinsp;=\u0026thinsp;0.643; feeling ill, p\u0026thinsp;=\u0026thinsp;0.359; pain killers, p\u0026thinsp;=\u0026thinsp;0.762; nutritional supplements, p\u0026thinsp;=\u0026thinsp;0.083; feeding tube, p\u0026thinsp;=\u0026thinsp;1.000; weight loss, p\u0026thinsp;=\u0026thinsp;0.412; weight gain, p\u0026thinsp;=\u0026thinsp;0.123).\u003c/p\u003e \u003cp\u003eAt 6M, there was no significant difference between LG and RG (pain, p\u0026thinsp;=\u0026thinsp;0.540; swallowing, p\u0026thinsp;=\u0026thinsp;0.703; senses problem, p\u0026thinsp;=\u0026thinsp;0.977; speech problems, p\u0026thinsp;=\u0026thinsp;0.775; trouble with social eating, p\u0026thinsp;=\u0026thinsp;0.176; trouble with social contact, p\u0026thinsp;=\u0026thinsp;0.934; less sexuality, p\u0026thinsp;=\u0026thinsp;0.137; teeth, p\u0026thinsp;=\u0026thinsp;0.288; mouth opening, p\u0026thinsp;=\u0026thinsp;0.181; dry mouth, p\u0026thinsp;=\u0026thinsp;0.567; sticky saliva, p\u0026thinsp;=\u0026thinsp;0.265; coughing, p\u0026thinsp;=\u0026thinsp;0.171; feeling ill, p\u0026thinsp;=\u0026thinsp;0.057; pain killers, p\u0026thinsp;=\u0026thinsp;0.329; nutritional supplements, p\u0026thinsp;=\u0026thinsp;0.301; feeding tube, p\u0026thinsp;=\u0026thinsp;1.000; weight loss, p\u0026thinsp;=\u0026thinsp;0.808; weight gain, p\u0026thinsp;=\u0026thinsp;0.223).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study's results indicated no significant differences in functional measurements between LG and RG at any assessment period. In contrast, the QOL assessments indicated no significant difference till 1M; however, after 3M, some QOL assessments showed significantly lower RG scores than LG.\u003c/p\u003e \u003cp\u003eThis study measured MTP using a balloon at the tip of a probe behind the upper front teeth. This indicates that the balloon was located near the midline of the palate. A previous study reported that a small TC surgical area does not affect tongue function [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In this study, 34 (85%) participants underwent partial glossectomy, meaning most participants had limited tongue movement. Thus, the groups had no significant differences in the MTP or feeding function. The participants in this study underwent rehabilitation after surgical treatment. Tongue rehabilitation, such as motor training, has been reported to improve tongue pressure in patients undergoing TC treatment [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This could help improve the participants\u0026rsquo; MTP. Moreover, a previous study reported that a small area of tongue resection did not affect the LCF [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Similarly, the participants in this study underwent a small surgical treatment for TC, such as partial glossectomy or hemiglossectomy, indicating no effect on LCF. Thus, there were no significant differences between the groups.\u003c/p\u003e \u003cp\u003eBased on QOL measurements, there was no significant difference between LG and RG at baseline and 1M; however, there were significant differences at 3M and 6M.\u003c/p\u003e \u003cp\u003eAt baseline, the participants were not affected by scarring resulting from the surgical treatment for TC. However, some of the participants likely experienced cancer pain. Cancer pain has a significant effect on the patient\u0026rsquo;s QOL. Both EORTC QLQ-C30 and H\u0026amp;N35 include pain-related assessment (EORTC QLQ C30, pain; H\u0026amp;N35, pain killer), and it has been reported that cancer pain is noted more frequently in advanced cancer than in early-stage cancer [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It is likely that the participants included in this study had early-stage TC (T1 or T2) and that their cancer pain was localized. Therefore, the effect on cancer pain was considered small with or without the use of painkillers. One possible reason for the lack of a significant difference between LG and RG might be the effects of the surgical treatment for TC. Generally, it takes more than 1 month for wound healing to be completed after surgical treatment for TC [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Thus, the participants were presumably aware of pain and postoperative dysfunction, regardless of the surgical area.\u003c/p\u003e \u003cp\u003eThe results of this study indicated a significant difference between LG and RG in QOL measurements at 3M and 6M; however, there were no significant differences in functional measurements. These results suggest that participants who received right-sided TC treatment still experienced discomfort, such as difficulty in swallowing, compared to participants who received left-sided TC treatment. No previous study has investigated the left\u0026ndash;right difference in tongue function during swallowing. Regarding mastication, it has been reported that there is a left\u0026ndash;right difference called habitual mastication [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and left\u0026ndash;right differences in tongue function have been reported [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Both the dominant hand and habitual masticatory side have been reported to be more common on the right side [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and the same might be true for tongue function. Therefore, the function of the tongue may not be the same on the left and right sides, and there may be a dominant side. This might be one of the reasons why RG had a lower QOL score than LG, although this was not noted in the functional measurements. However, this study did not investigate the participants\u0026rsquo; dominant hand and habitual masticatory side, and it is necessary to investigate the relationship between these factors.\u003c/p\u003e \u003cp\u003eA previous study reported that approximately 30% of patients with early-stage HNC did not return to their QOL, especially global health status, 12 months after treatment, although their oral function returned before treatment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This study did not compare the changes in QOL measurements over time. However, LG tended to have a higher global health status score at 6M than at BL. On the other hand, RG tended to have a lower global health status score at 6M than at BL. One of the possible reasons for only the global health status indicating a significant difference at 6M might be that the global health status reflected the results of multiple questions compared to other items. The participants did not show a significant functional decline at 6M, and it might be possible that this was not a significant change in subjective symptoms. It is necessary to compare the details of these changes over time in future studies.\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis prospective cohort study included a small sample size with a further reduction in cases due to patient withdrawal during the study. Patient dropout during a prospective HNC study due to cancer recurrence and change of residence is often noted [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Furthermore, we did not assess the patients\u0026rsquo; speech function. Moreover, we investigated only the left\u0026ndash;right difference and did not investigate the anteroposterior position. It has been reported that the anteroposterior tongue position differs in speech and eating function [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Therefore, it is necessary to assess the speech function and differences in the anteroposterior area of the tongue in future studies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eNo functional impairment of the tongue was observed on the left and right sides of the surgical site after partial glossectomy or hemiglossectomy. However, the patients\u0026rsquo; QOL after treatment was significantly lower on the right side than on the left. This suggests that the left\u0026ndash;right difference in the primary site should be considered in postoperative care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate: \u003c/strong\u003eThis study was approved by the Ethics Committee of Showa University School of Medicine (approval no. 2355). Informed consent was obtained from all participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch involving Human Participants and/or Animals: \u003c/strong\u003eThis study was approved by the Ethics Committee of Showa University School of Medicine (Approval no. 2355).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent: \u003c/strong\u003eInformed consent was obtained from all participants in the study.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests: \u003c/strong\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: \u003c/strong\u003e This work was supported by JSPS KAKENHI Grant Number 22K17311.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions: \u003c/strong\u003eYuka Harada: draft of the work. Yoshiaki Ihara: design of the work, draft of the work. Tomoki Tamai: acquisition, analysis. Yuichi Tashimo, Shinji Nozue: interpretation of data. Toshikazu Shimane: design of the work. \u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Editage (www.editage.com) for English language editing.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHead and Neck cancers statistics (Cancer Research UK, 2022). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/head-and-neck-cancers#:~\u003c/span\u003e\u003cspan address=\"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/head-and-neck-cancers#:~\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e:text=Nearly%201%20in%2096%20UK,in%20the%20UK%20are%20preventable.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatanoda, K. \u003cem\u003eet al\u003c/em\u003e. Short-term projection of cancer incidence in Japan using an age-period interaction model with spline smoothing. Jpn. J. Clin. Oncol. 44, 36\u0026ndash;41 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCancer Stat Facts \u0026amp; National Cancer Institute, (2022). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://seer.cancer.gov/statfacts/\u003c/span\u003e\u003cspan address=\"https://seer.cancer.gov/statfacts/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaj, P., Gupta, D. K., Samuel, S. \u0026amp; Singh, S. K. Evaluation of swallowing dysfunction in cases of locally advanced squamous cell carcinoma oral cavity pre and post treatment. Int. J. Otorhinolaryngol. Head Neck Surg. 5 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIhara, Y. \u003cem\u003eet al\u003c/em\u003e. Dysphagia and oral morbidities in chemoradiation-treated head and neck cancer patients. Dysphagia 33, 739\u0026ndash;748 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIhara, Y. \u003cem\u003eet al\u003c/em\u003e. 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, 293 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuzuki, K. \u003cem\u003eet al\u003c/em\u003e. Comparison of quality of life and psychological distress in patients with tongue cancer undergoing a total/subtotal glossectomy or extended hemiglossectomy and free flap transfer: a prospective evaluation. Int. J. Oral Maxillofac. Surg. 52, 621\u0026ndash;629 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePezdirec, M., Strojan, P. \u0026amp; Boltezar, I. H. Swallowing disorders after treatment for head and neck cancer. Radiol. Oncol. 53, 225\u0026ndash;230 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIhara, Y. \u003cem\u003eet al\u003c/em\u003e. Changes in oral function and quality of life in tongue cancer patients based on resected area. Asian Pac. J. Cancer Prev. 22, 2549\u0026ndash;2557 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKazi, R. \u003cem\u003eet al\u003c/em\u003e. Predictors of speech and swallowing function following primary surgery for oral and oropharyngeal cancer. Clin. Otolaryngol. 31, 83 (2006).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRovira-Lastra, B., Flores-Orozco, E. I., Ayuso-Montero, R., Peraire, M. \u0026amp; Martinez-Gomis, J. Peripheral, functional and postural asymmetries related to the preferred chewing side in adults with natural dentition. J. Oral Rehabil. 43, 279\u0026ndash;285 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakei, Y. \u003cem\u003eet al\u003c/em\u003e. Electropalatographic study of connected speech in lateral misarticulation. Oral Sci. Int. 20, 18\u0026ndash;27 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHasegawa, Y. \u003cem\u003eet al\u003c/em\u003e. Change in tongue pressure in patients with head and neck cancer after surgical resection. Odontology 105, 494\u0026ndash;503 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorisaki, N., Miura, H. \u0026amp; Hara, S. [Relationship between the nutritional status and the oral function among community-dwelling dependent elderly persons]. Nihon Ronen Igakkai Zasshi 52, 233\u0026ndash;242 (2015). in Japanese.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrary, M. A., Mann, G. D. \u0026amp; Groher, M. E. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch. Phys. Med. Rehabil. 86, 1516\u0026ndash;1520 (2005).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAaronson, N. K. \u003cem\u003eet al\u003c/em\u003e. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J. Natl Cancer Inst. 85, 365\u0026ndash;376 (1993).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang, Z. S., Chen, W. L., Huang, Z. Q. \u0026amp; Yang, Z. H. Dysphagia in tongue cancer patients before and after surgery. J. Oral Maxillofac. Surg. 74, 2067\u0026ndash;2072 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu, K., Zhang, S. \u0026amp; Wu, H. J. A precise glossectomy for tongue cancer adjacent to or crossing the midline: a novel anatomical unit resection surgery. Int. J. Oral Maxillofac. Surg. 52, 725\u0026ndash;734 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBagan, J., Sarrion, G. \u0026amp; Jimenez, Y. Oral cancer: clinical features. Oral Oncol. 46, 414\u0026ndash;417 (2010).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTashimo, Y. \u003cem\u003eet al.\u003c/em\u003e Acute stage longitudinal change of quality of life from Pre- to 3 months after surgical treatment in head and neck cancer patients. Asian Pac. J. Cancer Prev. 20, 3129\u0026ndash;3136 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOzaki, H. Laterality of stomatognathic function and reliability of determination of preferred chewing side. J. Hiroshima Univ. Dent. Soc. 34, 48\u0026ndash;59 (2002). in Japanese.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSasaki, M., Yoshikawa, K. \u0026amp; Hosoi, T. A study on the chewing side preference in normal dentate subjects. J. Jpn. Soc. Masticatory Sci. Health Promot. 12, 43\u0026ndash;48 (2002).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLancer, H. \u0026amp; Drake-Lee, A. Laterality and otorhinolaryngology: a review. J. Laryngol. Otol. 138, 2\u0026ndash;6 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRademaker, A. W. \u003cem\u003eet al\u003c/em\u003e. Eating ability in head and neck cancer patients after treatment with chemoradiation: a 12-month follow-up study accounting for dropout. Head Neck 25, 1034\u0026ndash;1041 (2003).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShinn, E. H. \u003cem\u003eet al\u003c/em\u003e. Adherence to preventive exercises and self-reported swallowing outcomes in post-radiation head and neck cancer patients. Head Neck 35, 1707\u0026ndash;1712 (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHiiemae, K. M. \u0026amp; Palmer, J. B. Tongue movements in feeding and speech. Crit. Rev. Oral Biol. Med. 14, 413\u0026ndash;429 (2003).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHiiemae, K. M. \u003cem\u003eet al.\u003c/em\u003e Hyoid and tongue surface movements in speaking and eating. Arch. Oral Biol. 47, 11\u0026ndash;27 (2002).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Oral function, tongue resection, tongue cancer","lastPublishedDoi":"10.21203/rs.3.rs-4311367/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4311367/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e In this study, we investigated the effect of left\u0026ndash;right differences on oral function and QOL in patients with TC underwent tongue resection. Forty patients with TC underwent resection smaller than hemiglossectomy were divided into left (LG) and right (RG) tongue groups. The evaluation items were evaluated at baseline and 1, 3, and 6 months posttreatment. Maximum tongue pressure and lip-closure force were measured for oral function evaluation. Peak expiratory flow was used to evaluate the respiratory function. The Functional Oral Intake Scale was used to evaluate the feeding functions. The QOL was assessed using the European Organization for Research and Treatment of Cancer QOL Questionnaires: QLQ-C30, QLQ-H\u0026amp;N35. No significant differences in oral, respiratory, or feeding function between LG and RG were observed at all evaluation periods. However at 3 months, LG had a significantly higher QOL score than RG for swallowing and trouble with social eating. At 6 months, the LG had a significantly higher QOL than RG for global health status and physical function. The left\u0026ndash;right differences in tongue function did not lead to functional impairment but significantly affected the QOL. This indicates the importance of considering these differences in postoperative care to address QOL concerns effectively.\u003c/p\u003e","manuscriptTitle":"Left–right differences in oral function and QOL of patients who underwent tongue resection","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-02 19:42:20","doi":"10.21203/rs.3.rs-4311367/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6e91e0eb-cad9-4576-b860-deb2f106d21f","owner":[],"postedDate":"May 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":31386601,"name":"Biological sciences/Cancer"},{"id":31386602,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2024-09-18T10:50:57+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-02 19:42:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4311367","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4311367","identity":"rs-4311367","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}