Drs. Sonis and Fey are to be commended for their timely and thorough article on the oral complications of cancer therapies. It has been our experience that these side effects are not being adequately addressed in the clinical setting. This is especially true the further one is removed from large cancer treatment centers in urban areas.
The standard of care for this area of patient care was investigated and, in part, established at a 1989 National Institutes of Health (NIH) consensus development conference.[1] It was the recommendation of the participants that all patients receiving chemotherapy and head and neck irradiation be given a complete dental evaluation prior to the initiation of cancer treatment.
As clinicians, we are concerned that this is not done on a routine basis, especially because mucositis is the number 1 dose-limiting factor for both chemotherapy and head and neck irradiation. We see this as a window of opportunity that is being overlooked in the majority of patients in regard to the prevention of infection and pain, the ability to adequately maintain nutrition, and the establishment of a better quality of life as patients progress through cancer treatment.[1]
Neglected Aspect of Care
As reflected in this article, it is evident that great strides have been made in both chemotherapy and radiation therapy since 1989. How unfortunate it is for the majority of cancer patients that the recommendation of a pretreatment dental screening is not routinely followed. Although it is true that not all patients receiving cytotoxic treatments develop oral complications, the potential for such complications exists in 100% of these patients.
The condition of a patient’s oral health is a great predictor of whether or not oral side effects will occur.[2,3] For at least a quarter of a century, the thrust in both medicine and dentistry has been toward prevention. Why is it that this aspect of patient care, when applied to the cancer patient, is so neglected? Why is there not a greater cooperative effort being forged between the medical and dental communities for the benefit of this patient population?
The NIH recently reported that when a cancer patient dies from an infection, 54% of the time the causative organism originates in the oral cavity.[4] With this as a documented fact, it is unconscionable that a more proactive stance is not being taken with regard to prevention. Many excuses are given for not having patients schedule pretreatment dental screenings. However, even the reasoning that such a screening would seriously delay treatment is not valid, as a greater number of dentists are aware of the expediency of the protocol and of the treatments required. They stand ready and able to be a part of the patient’s treatment team.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
