Campaign Seeks to Ease Oral Impact of Cancer Therapy

WASHINGTON—About 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

General

Mucositis/stomatitis

Xerostomia/salivary gland dysfunction

Infection

Dental demineralization

Taste alterations

Nutritional compromise

Functional disabilities

Abnormal dental development in children

Treatment Specific

Chemotherapy

Neurotoxicity

Bleeding

Radiation caries

Trismus/tissue fibrosis

Osteoradionecrosis (ORN)

In addition, the campaign seeks to educate patients about the need for oral care, before, during, and after their cancer therapies. “Most people don’t 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 patient’s survival and quality of life,” said Patricia Sheridan, director of NIDCR’s 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 pharyngeal cancer.

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 NIDCR noted.

“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 patient’s quality of life can be severely affected in other ways. “When people have oral complications, they experience difficulties with the main functions of the mouth—their ability to communicate and to feed themselves—and 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), through its National Oral Health Information Clearinghouse (NOHIC), is making available a series of publications as part of its national oral health awareness campaign.

The collection comprises four items for patients and six for professionals, including a fact sheet written for oncology professionals (order number OCCT-2) and an oncology reference guide to oral health printed on a laminated card (OCCT-4). Ask for OCCT-10 to order a sample kit that includes all patient publications and materials for the oncology professional.

The materials can be ordered by fax at 301-907-8830, by calling toll-free 877-216-1019, or via the Internet at the campaign’s website at http://www.aerie.com/nohicweb.