WASHINGTONAbout one-third of patients who undergo cancer
chemotherapy and/or radiation treatments suffer serious oral
complications, many of which could be mitigated. Four federal health
agencies have joined together in a national campaign to make
oncologists and other health care providers more aware of the problem
and how to deal with it.
The aim of the campaign, Oral Health, Cancer Care, and You:
Fitting the Pieces Together, is to generate a team approach
that unites oncologists, oncology nurses, primary care physicians,
dentists, dental hygienists, and others who treat cancer patients in
an effort to blunt the debilitating oral impact of cancer therapies.
These oral complications can be minimized, reduced, or in some
cases even prevented, Harold Slavkin, DDS, director of the
National Institute of Dental and Craniofacial Research (NIDCR), said
at a press conference that kicked off the campaign.
Oral Complications of Cancer Treatment
In addition, the campaign seeks to educate patients about the need
for oral care, before, during, and after their cancer therapies.
Most people dont know that they can do a lot to prevent
oral complications or, if they occur, to keep them from becoming
severe, said Deborah McGuire, PhD, RN, who holds the Honeycutt
Chair in Oncology Nursing at the Nell Hodgson Woodruff School of
Nursing, Emory University.
NIDCR is the primary funding source for the new effort, with
additional support coming from the National Cancer Institute, the
National Institute of Nursing Research, and the Centers for Disease
Control and Prevention.
The message of this campaign is that when oral health care is
part of the cancer management plan, this can prevent or minimize oral
complications and in the process, enhance the patients survival
and quality of life, said Patricia Sheridan, director of
NIDCRs National Oral Health Information Clearinghouse.
The risk of oral complications varies with the type and intensity of
cancer treatment. Patients who receive mildly myelosuppressive
chemotherapeutic drugs have a low risk, and those treated with a
single agent are at moderate risk. The highest risk patients are
those receiving stomatotoxic chemotherapy that results in prolonged
myelosuppression and those who undergo radiotherapy for oral and
Indeed, almost all patients who receive radiation treatments for head
and neck cancers suffer adverse oral side effects, according to
NIDCR, as do more than 75% of bone marrow transplant recipients and
nearly 40% of all cancer chemotherapy patients.
Oral complications can be either acute or life-long. The more common
include painful, inflamed gums; mouth ulcers; bleeding; infection;
and salivary gland dysfunction, which can result in dry mouth,
rampant tooth decay, and loss of the sense of taste. Oral side
effects can also be the source of systemic infections that may
interfere with cancer therapy and even threaten patient survival, the
Oral complications, when severe enough, may cause oncologists
to reduce treatment dosage, alter treatment schedules, and even make
it necessary to stop treatment altogether, said Philip Fox,
DDS, former NIDCR clinical director and now director of research and
development for Amarillo Biosciences. If you have a
complication that leads to a reduction in the delivered dose of
cancer treatment, you certainly have the potential for less success.
A patients quality of life can be severely affected in other
ways. When people have oral complications, they experience
difficulties with the main functions of the mouththeir ability
to communicate and to feed themselvesand that can have
tremendous impact on their ability to function in the world,
Dr. Fox commented.
Gerry Barker, RDH, coordinator of the Oncology Dental Support Clinic
at the University of Missouri-Kansas City, noted that a dental
evaluation and medically necessary oral care before cancer therapy,
as well as supportive oral care during therapy, enables the patient
to proceed through treatment with the threat of such problems minimized.
NIDCR urges oncologists to encourage their patients to have an oral
evaluation by a knowledgeable dentist before they begin their cancer
treatments. This should include a thorough examination of hard and
soft tissues and x-rays to detect trauma and possible sources of infection.
Treatment of Oral Problems
Treatment should include therapy for existing infections, problem
teeth, and tissue damage; removal of orthodontic bands that are in
the radiation field or if highly stomatotoxic chemotherapy is
planned; and teeth extractions in certain circumstances, the NIDCR says.
Patients should also be instructed on oral hygiene, nutrition, and
the need to avoid tobacco and alcohol. During their cancer
treatments, patients should also receive periodic oral exams.
Planning and communication between the oncology and dental
teams can minimize the risk of oral complications and maximize the
efficacy of dental and supportive care, a brochure for
oncol-ogists states (see box for ordering information on materials
for oncologists and patients).
Guides to Oral Health Available
The National Institute of Dental and Craniofacial Research (NIDCR),
The collection comprises four items for patients and six for
The materials can be ordered by fax at 301-907-8830, by calling