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Caring for Mouth Cancer Patients
Oral cancers have a significant impact on our patients both mentally and physically. Vinod Joshi, Consultant in Restorative Dentistry, explains the process they're likely to go through and explains the help available to them
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Mouth cancer is relatively rare in the United Kingdom. Currently, about 4,000 people will be diagnosed and treated for oral, pharyngeal, lip, or salivary gland tumours. The majority of these patients will be registered with a dentist who will have referred them to the hospital for investigation of a suspicious lesion.
At the hospital, after due investigation and confirmation of the diagnosis, treatment options will be discussed with a multi-disciplinary cancer team. The treatment options for people with oral and oropharyngeal cancers are surgery, radiation therapy, and chemotherapy – either alone or in combination, depending on the stage of the tumour.
A substantial number will suffer clinically significant short- and long-term oral adverse effects from the treatment. Severe problems in the mouth can occur after radiation therapy for head and neck cancer. Oral complications can also arise from chemotherapy for other cancers. Oral problems related to radiation therapy may make it difficult for a patient to receive all of his or her cancer treatment. Sometimes treatment must be stopped completely.
The most important risk factors of oral complications of cancer therapy are oral or dental disease that already exists, poor oral care during cancer therapy, and any factor that affects the mouth tissues. Oral problems that already exist, such as periodontitis, caries, failing restorative work (such as crowns, or fillings), and dentures may increase the risk of infection. Areas where the gums or tissues are irritated can lead to ulceration in the mouth.
As the status of the oral cavity in the cancer patient is no different from that found in the general population, some will have poorly maintained dentitions, moderate to advanced periodontal disease, ill-fitting denture prostheses, and related soft-tissue pathologies associated with tobacco and alcohol use and nutritional and/or general hygiene neglect (1). Some of these patients will not have a dentist.
These patients require urgent dental care before and after cancer treatment. By starting preventive measures before and during early cancer therapy, it is possible to reduce the occurrence and the problems associated with cancer treatment. If this is done, it can significantly improve oral physiologic and social functioning (2).
By ensuring that the diagnosed patient receives any urgent dental care before treatment, the dentist will help reduce the oral complications associated with cancer treatment. Prevention of oral sequela is much preferred to repair, both on a social and an economic basis. The patient’s oral care and function is an important contributor to post-treatment social adaptation and life quality. The Calman report on cancer care emphasised the need to focus treatment and management regimens on both longevity and quality of life (3).
Ideally, comprehensive dental care for these patients should be available. The clinical guidelines published by the Royal Colleges of Surgeons of England state that a clear pathway of care is necessary to prevent or minimise oral complications (4).
Ideally, head and neck cancer patients should be referred to a well-staffed specialist dental oncology unit for their appropriate care and treatment planning. However, the lack of manpower means that comprehensive dental care may be unavailable. It is unfortunate that this occurs. It is hoped that funding for well-staffed dental-oncology clinics at cancer centres or host hospitals will be planned for. Until then, the service will need to depend upon follow-up care delivered by the general dental practitioner in collaboration with the hospital consultant. Ideally, comprehensive dental care should also be available for these patients following their cancer treatment. However, this is an exception rather than the rule. To improve the current situation, dentists need to be encouraged to give priority to these patients and be provided with the information they need to play a bigger role in the oral care of their cancer patients.
At the Restorative Dental Oncology Clinic at St Luke’s Hospital, Bradford, and at Pinderfields Hospital, Wakefield, oral care and advice before, during and after cancer treatment is provided. A dental assessment and initial dental treatment plan is made for these patients. Prophylactic oral health measures are explained. Arrangements are made for teeth requiring extraction and a hygienist treatment is given. Due to the need for rapid-care delivery, routine dental care is arranged through the patient’s dentist. Follow-up oral care is arranged.
I have created the RDOC website to increase awareness of the oral complications of cancer treatments and to help patients, dentists and doctors find free information on oral cancer easily. The site includes first-hand patient accounts of their experiences. When things look there worst, nothing is more inspiring than reading about how other patients have survived against the odds and coped with their situations. I believe these personal stories are the only way a newly diagnosed patient can find out what the journey is like as most, if not all, of us advisors do not have first-hand experience. I also believe there is a sense of well being gained by the writer in communicating the trauma involved. The writers also gain self-esteem in being able to help someone else in distress. There is also a discussion forum for patients, carers and interested members of the public where they can ask questions, help others, share ideas and opinions, and learn about other people’s experiences dealing with oral cancer. I hope my dental colleagues will find the site useful.
Our health and lives cannot be taken for granted. Misfortune is a part of our humanity. Together, we can summon the strength needed to face misfortune. This strength is also part of our humanity. It is easier to face our hardships when we know that there are others who care. Dentists are the oral carers for the cancer patient.
References
1. Toth BB et al. Minimizing Oral complications of Cancer Treatment. Oncology, 1995; 9, No 9 (September 1995)
2. Feber T. Management of mucositis in oral irradiation. Clin Oncol (Royal College of Radiologists) 1996; 8:106-11.
3. Calman, K., Hine, D. A Policy Framework for Commissioning Cancer Services. Dept. of Health, April 1995.
4. Clinical Guidelines: The Oral Management of Oncology Patients, Faculty of Dental Surgery, Royal College of Surgeons of England.
About the author
Dr Vinod K Joshi, BDS DRDRCS FDSRCPS FICOI is a Consultant in Restorative Dentistry, is the specialist maxillo-facial prosthodontist and specialist periodontist for the Restorative Dentistry Oncology Clinics held at St Luke’s Hospital, Bradford and at Pinderfields Hospital, Wakefield.
Helpful addresses
Restorative Dentistry Oncology Clinic, Maxillofacial Unit, St Luke's Hospital, Bradford, BD5 0NA
Restorative Dentistry Oncology Clinic, Oral & Facial Specialties, Pinderfields Hospital, Wakefield, WF1 4DG Tel/Fax: 01924 212410 Email: info@rdoc.org.uk
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