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Supportive Care in Cancer

Published in:

01-03-2014 | Original Article

Oral health conditions affect functional and social activities of terminally ill cancer patients

Authors: D. J. Fischer, J. B. Epstein, Y Yao, D. J. Wilkie

Published in: Supportive Care in Cancer | Issue 3/2014

Abstract

Purpose

Oral conditions are established complications in terminally ill cancer patients. Yet despite significant morbidity, the characteristics and impact of oral conditions in these patients are poorly documented. The study objective was to characterize oral conditions in terminally ill cancer patients to determine the presence, severity, and the functional and social impact of these oral conditions.

Methods

This was an observational clinical study including terminally ill cancer patients (2.5–3-week life expectancy). Data were obtained via the Oral Problems Scale (OPS) that measures the presence of subjective xerostomia, orofacial pain, taste change, and the functional/social impact of oral conditions and a demographic questionnaire. A standardized oral examination was used to assess objective salivary hypofunction, fungal infection, mucosal erythema, and ulceration. Regression analysis and t test investigated the associations between measures.

Results

Of 104 participants, most were ≥50 years of age, female, and high-school educated; 45 % were African American, 43 % Caucasian, and 37 % married. Oral conditions frequencies were: salivary hypofunction (98 %), mucosal erythema (50 %), ulceration (20 %), fungal infection (36 %), and other oral problems (46 %). Xerostomia, taste change, and orofacial pain all had significant functional impact; p < .001, p = .042 and p < .001, respectively. Orofacial pain also had a significant social impact (p < .001). Patients with oral ulcerations had significantly more orofacial pain with a social impact than patients without ulcers (p = .003). Erythema was significantly associated with fungal infection and with mucosal ulceration (p < .001).

Conclusions

Oral conditions significantly affect functional and social activities in terminally ill cancer patients. Identification and management of oral conditions in these patients should therefore be an important clinical consideration.

Aldred MJ, Addy M, Bagg J, Finlay I (1991) Oral health in the terminally ill: a cross-sectional pilot survey. Spec Care Dentist 11:59–62PubMedCrossRef

Anderson F, Downing GM, Hill J, Casorso L, Lerch N (1996) Palliative performance scale (PPS): a new tool. J Palliat Care 12:5–11PubMed

Bagg J, Sweeney MP, Lewis MA, Jackson MS, Coleman D, Al MA, Baxter W, McEndrick S, McHugh S (2003) High prevalence of non-albicans yeasts and detection of anti-fungal resistance in the oral flora of patients with advanced cancer. Palliat Med 17:477–481PubMedCrossRef

Chaushu G, Bercovici M, Dori S, Waller A, Taicher S, Kronenberg J, Talmi YP (2000) Salivary flow and its relation with oral symptoms in terminally ill patients. Cancer 88:984–987PubMedCrossRef

Cleeland CS, Ryan KM (1994) Pain assessment: global use of the brief pain inventory. Ann Acad Med Singapore 23:129–138PubMed

Collins LM, Schafer JL, Kam CM (2001) A comparison of inclusive and restrictive strategies in modern missing data procedures. Psychol Methods 6:330–351PubMedCrossRef

Davies AN, Brailsford S, Broadley K, Beighton D (2002) Oral yeast carriage in patients with advanced cancer. Oral Microbiol Immunol 17:79–84PubMedCrossRef

Davies AN, Brailsford SR, Beighton D (2006) Oral candidosis in patients with advanced cancer. Oral Oncol 42:698–702PubMedCrossRef

Davies AN, Brailsford SR, Beighton D, Shorthose K, Stevens VC (2008) Oral candidosis in community-based patients with advanced cancer. J Pain Symptom Manage 35:508–514PubMedCrossRef

10.

Davies AN, Broadley K, Beighton D (2001) Xerostomia in patients with advanced cancer. J Pain Symptom Manage 22:820–825PubMedCrossRef

11.

Del Rio MI, Shand B, Bonati P, Palma A, Maldonado A, Taboada P, Nervi F (2012) Hydration and nutrition at the end of life: a systematic review of emotional impact, perceptions, and decision-making among patients, family, and health care staff. Psychooncology 21:913–921PubMedCrossRef

12.

Epstein JB, Emerton S, Kolbinson DA, Le ND, Phillips N, Stevenson-Moore P, Osoba D (1999) Quality of life and oral function following radiotherapy for head and neck cancer. Head Neck 21:1–11PubMedCrossRef

13.

Epstein JB, Thariat J, Bensadoun RJ, Barasch A, Murphy BA, Kolnick L, Popplewell L, Maghami E (2012) Oral complications of cancer and cancer therapy: from cancer treatment to survivorship. CA Cancer J Clin 62:400–422PubMedCrossRef

14.

Fox PC, Busch KA, Baum BJ (1987) Subjective reports of xerostomia and objective measures of salivary gland performance. J Am Dent Assoc 115:581–584PubMed

15.

Gerdin EW, Einarson S, Jonsson M, Aronsson K, Johansson I (2005) Impact of dry mouth conditions on oral health-related quality of life in older people. Gerodontology 22:219–226PubMedCrossRef

16.

Gordon SR, Berkey DB, Call RL (1985) Dental need among hospice patients in Colorado: a pilot study. Gerodontics 1:125–129PubMed

17.

Jensen SB, Pedersen AM, Vissink A, Andersen E, Brown CG, Davies AN, Dutilh J, Fulton JS, Jankovic L, Lopes NN, Mello AL, Muniz LV, Murdoch-Kinch CA, Nair RG, Napenas JJ, Nogueira-Rodrigues A, Saunders D, Stirling B, von Bultzingslowen I, Weikel DS, Elting LS, Spijkervet FK, Brennan MT (2010) A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer 18:1061–1079PubMedCrossRef

18.

Jobbins J, Bagg J, Finlay IG, Addy M, Newcombe RG (1992) Oral and dental disease in terminally ill cancer patients. BMJ 304:1612PubMedCrossRef

19.

Lalla RV, Latortue MC, Hong CH, Ariyawardana A, D'Amato-Palumbo S, Fischer DJ, Martof A, Nicolatou-Galitis O, Patton LL, Elting LS, Spijkervet FK, Brennan MT (2010) A systematic review of oral fungal infections in patients receiving cancer therapy. Support Care Cancer 18:985–992PubMedCentralPubMedCrossRef

20.

Locker D, Clarke M, Payne B (2000) Self-perceived oral health status, psychological well-being, and life satisfaction in an older adult population. J Dent Res 79:970–975PubMedCrossRef

21.

Locker D, Matear D, Stephens M, Lawrence H, Payne B (2001) Comparison of the GOHAI and OHIP-14 as measures of the oral health-related quality of life of the elderly. Community Dent Oral Epidemiol 29:373–381PubMedCrossRef

22.

Marin Caro MM, Laviano A, Pichard C (2007) Nutritional intervention and quality of life in adult oncology patients. Clin Nutr (Edinburgh, Scotland) 26:289–301CrossRef

23.

Narhi TO (1994) Prevalence of subjective feelings of dry mouth in the elderly. J Dent Res 73:20–25PubMedCrossRef

24.

Navazesh M, Christensen C, Brightman V (1992) Clinical criteria for the diagnosis of salivary gland hypofunction. J Dent Res 71:1363–1369PubMedCrossRef

25.

Omlin A, Blum D, Wierecky J, Haile SR, Ottery FD, Strasser F (2013) Nutrition impact symptoms in advanced cancer patients: frequency and specific interventions, a case-control study. J Cachexia Sarcopenia Muscle 4:55–61PubMedCentralPubMedCrossRef

26.

Pai S, Ghezzi EM, Ship JA (2001) Development of a visual analogue scale questionnaire for subjective assessment of salivary dysfunction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91:311–316PubMedCrossRef

27.

Prevost V, Grach MC (2012) Nutritional support and quality of life in cancer patients undergoing palliative care. Eur J Cancer Care 21:581–590CrossRef

28.

Rohr Y, Adams J, Young L (2010) Oral discomfort in palliative care: results of an exploratory study of the experiences of terminally ill patients. Int J Palliat Nurs 16:439–444PubMed

29.

Ship JA, Fischer DJ (1997) The relationship between dehydration and parotid salivary gland function in young and older healthy adults. J Gerontol A Biol Sci Med Sci 52:M310–319PubMedCrossRef

30.

Slade GD, Spencer AJ (1994) Development and evaluation of the oral health impact profile. Community Dent Health 11:3–11PubMed

31.

Smidt D, Torpet LA, Nauntofte B, Heegaard KM, Pedersen AM (2010) Associations between labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol 38:422–435PubMedCrossRef

32.

Sonis ST, Eilers JP, Epstein JB, LeVeque FG, Liggett WH Jr, Mulagha MT, Peterson DE, Rose AH, Schubert MM, Spijkervet FK, Wittes JP (1999) Validation of a new scoring system for the assessment of clinical trial research of oral mucositis induced by radiation or chemotherapy. Mucositis Study Group. Cancer 85:2103–2113PubMedCrossRef

33.

Sweeney MP, Bagg J, Baxter WP, Aitchison TC (1998) Oral disease in terminally ill cancer patients with xerostomia. Oral Oncol 34:123–126PubMedCrossRef

34.

Taskos G, Sabbah W, Chandola T, Newton T, Kawachi I, Aida J, Sheiham A, Marmot MG, Watt RG (2013) Social relationships and oral health among adults aged 60 years or older. Psychom Med 75:178–186CrossRef

35.

Team (2011) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria

36.

Walsch NP, Montague JC, Callo N, Rowlands AV (2004) Saliva flow rate, total protein concentration and osmolality as potential markers of whole body hydration status during progressive acute dehydration in humans. Arch Oral Biol 49:149–154CrossRef

37.

Weng LC, Huang HL, Wilkie DJ, Hoenig NA, Suarez ML, Marschke M, Durham J (2009) Predicting survival with the Palliative Performance Scale in a minority-serving hospice and palliative care program. J Pain Symptom Manag 37:642–648CrossRef

38.

Wiseman MA (2000) Palliative care dentistry. Gerodontology 17:49–51PubMedCrossRef

Title: Oral health conditions affect functional and social activities of terminally ill cancer patients
Authors: D. J. Fischer
J. B. Epstein
Y Yao
D. J. Wilkie
Publication date: 01-03-2014
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 3/2014
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-013-2037-7

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Purpose

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Conclusions

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