Quality of life issues in head and neck cancer

General dental practitioners' views of managing dental disease in adults who have been previously treated with head and neck radiotherapy: a qualitative study

OBJECTIVES

To determine the views of General Dental Practitioners on management of head and neck cancer patients in primary care, following radiotherapy treatment.

METHODS

A sample of fifteen general dental practitioners (GDPs) were recruited to undergo a semi-structured interview with a qualitative researcher using a topic guide. The collected data was then analysed using a thematic analysis.

RESULTS

Data was categorised into four major themes- 'Experience and expectations', 'Importance of Communication', 'Preventive Care' and 'Concerns around Dental Extractions'. Providing preventative care and undertaking dental extractions were of most concern to the GDPs. Participants reported feeling isolated and emphasised the importance of effective communication regarding the care of this patient group. A lack of awareness of clinical guidelines and variability in preventative care further compound these difficulties.

CONCLUSION

GDPs highlighted barriers to caring for post radiotherapy patients including limited experience, financial disincentives, and inadequate communication from the multidisciplinary hospital-based teams. Addressing these issues through improved communication pathways, enhanced clinical training, and systemic workforce reforms may optimise care delivery for this high-risk patient population.

CLINICAL SIGNIFICANCE

The findings of this study underscore the need for enhanced clinical training and clearer guidelines to equip GDPs with the skills required for the effective management of post radiotherapy patients in primary care. These resources may help mitigate barriers to care, ultimately reducing the risk of dental complications such as osteoradionecrosis and improving patient outcomes.

Matrix-based molecular mechanisms, targeting and diagnostics in oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is a head and neck cancer (HNC) with a high mortality rate. OSCC is developed in the oral cavity and it is triggered by many etiologic factors and can metastasize both regionally and distantly. Recent research advances in OSCC improved our understanding on the molecular mechanisms involved in and the initiation of OSCC metastasis. The key roles of the extracellular matrix (ECM) in OSCC are an emerging area of intensive research as the ECM macromolecular network is actively involved in events that regulate cellular morphological and functional properties, transcription and cell signaling mechanisms in invasion and metastasis. The provisional matrix that is formed by cancer cells is profoundly different in composition and functions as compared with the matrix of normal tissue. Fibroblasts are mainly responsible for matrix production and remodeling, but in cancer, the tumor matrix in the tumor microenvironment (TME) also originates from cancer cells. Even though extensive research has been conducted on the role of ECM in regulating cancer pathogenesis, its role in modulating OSCC is less elucidated since there are several issues yet to be fully understood. This critical review is focused on recent research as to present and discuss on the involvement of ECM macromolecular effectors (i.e., proteoglycans, integrins, matrix metalloproteinases) in OSCC development and progression.

Availability and use of web-based interventions for patients with head and neck cancer: a scoping review

PURPOSE

To identify and review the nature, scope and use of web-based interventions for patients with head and neck cancer (HNC).

METHOD

A scoping review guided by the methodological framework described by the Joanna Briggs Institute was performed to review empirical studies and websites. Seven electronic databases (CINAHL, Medline, Scopus, Embase, Cochrane, PubMed and PsycInfo) were searched from 2010 to 2020, data extracted and synthesised using thematic analysis. The Google search engine was employed, identifying the first 100 websites, using the search term head and neck cancer. Websites meeting eligibility criteria were assessed using the QUEST analysis tool, and descriptively summarised.

RESULTS

Thirteen empirical studies and 32 websites were included. As identified by empirical studies, web-based interventions were developed to provide (1) patient information on HNC and related treatments, (2) advice and support during treatment and (3) management strategies promoting adjustment to life with and beyond HNC. The reviewed websites provided minimal information to aid shared decision-making and facilitate preparedness for treatment, with few utilising patient narratives. Web-based interventions for HNC patients were mainly text based and focused on survivorship.

CONCLUSIONS

There is a paucity of theory-based, co-designed web-based interventions using patient narratives.

IMPLICATIONS FOR CANCER SURVIVORS

As patients increasingly look to the internet for advice and support, healthcare professionals are in a position to provide high-quality web-based interventions. There is an opportunity to rigorously develop a web-based intervention, containing narratives of peoples' lives before and after HNC treatment, aiding decision-making, preparedness for treatment and self-management.

Upper aerodigestive tract cancer and oral health status before radiotherapy: A cross-sectional study of 154 patients

OBJECTIVES

We aimed to determine primarily the oral health status of patients with upper aerodigestive tract cancer before radiotherapy, and secondarily the prevalence of risk factors for poor oral status.

METHODS

A cross-sectional study was conducted in Marseille University hospital. Assessment criteria were the Decay, Missing and Filled (DMF) Index and periodontal status.

RESULTS

One hundred and fifty-four patients, mean age 60.9years, were included. The most common sites of primary tumors were the larynx (28.6%) and oral cavity (26.6%). Current or past smokers accounted for 80.5% of patients and 67% were alcohol abusers. Most patients (83.8%) did not have xerostomia. They ate three meals a day (61%), with sugar consumption in 40%. The median number of daily tooth brushings was 2, with a manual toothbrush (81.2%). Few patients used dental floss or interproximal brushes. Individual DMF index was 17.6 (D=2.3, M=9.3, F=6.0) and was higher in patients with xerostomia and alcohol abusers (P=0.01). Osseous level was 62.3% and 57.8% of patients had osseous infections, which were more common with poor hygiene (P=0.04). Most patients (85.7%) had periodontal disease, but incidence did not significantly differ according to risk factors.

DISCUSSION

The DMF index was higher in presence of periodontal disease and osseous infections. Alcohol and xerostomia were associated with a high individual DMF index and osseous infections were more frequent in patients with poor hygiene. Patients with upper aerodigestive tract cancer are at high risk of osteoradionecrosis if they do not receive dental treatment before radiotherapy.

Among Patients Undergoing Ablative Treatment for Oral Cancer, Does the Provision of Oral Rehabilitation Improve the Quality of Life? A Review of the Current Literature

PURPOSE

The impact of oral cancer and its treatment is well documented; therefore, oral rehabilitation (OH; eg, with prosthetics, osseointegrated implants, etc) can be indicated to restore some level of form, function, and well-being. The purpose of this study was to review the current literature and evaluate the impact of OH on quality of life (QoL) after ablative surgery.

MATERIALS AND METHODS

A systematic literature search was conducted using EMBASE, MEDLINE, and PsychINFO. The study population was composed of all articles published from 2000 to 2015. To be included, studies had to use validated, specific head and neck QoL measurements (European Organization for Research and Treatment of Cancer QoL Head and Neck Module or University of Washington QoL Questionnaire). Only 8 articles met these inclusion criteria. In this review, OH was the primary predictor variable and QoL was the primary outcome variable.

RESULTS

The 8 articles reviewed used a range of designs, including 1 randomized controlled trial, 3 prospective cohort studies, 3 case series, and 1 single-measurement cross-sectional descriptive study. Sample sizes were small (n = 26 to 102), and there was limited randomization and control of intervention and comparator groups. The overall level of evidence was weak. All studies showed a link between OH and QoL, but the results varied in significance (P < .01 to P = .95).

CONCLUSION

Overall, there appears to be improvement in QoL to varying degrees after OH. However, a more systematic use of QoL measurements is needed before any definitive conclusions can be drawn.