Factors affecting the oral health of inpatients with advanced cancer in palliative care

Junichi Furuya,Rena Hidaka,Shunsuke Minakuchi,Yuko Motomatsu,Satoshi Miyake,Yuji Kabasawa,Yuji Sato,Nei Koshitani,Haruka Tohara,Hiroyuki Suzuki

doi:10.1007/s00520-021-06547-5

Abstract

PurposePatients with terminal cancer undergoing multidisciplinary palliative care often have oral health problems, but these details are still unclear. This cross-sectional study aimed to elucidate the oral health of patients with terminal-stage cancer who are inpatient recipients of acute-phase palliative care, and to unveil the factors affecting their oral health.MethodsParticipants were 121 patients with terminal-stage cancer (68 males, 53 females, mean age: 73.6 ± 11.1 years) and oral health complaints. They received palliative care at Tokyo Medical and Dental University Medical Hospital between April 2017 and August 2019. Their demographic and medical details were extracted, retrospectively, from their medical records, and their oral health status, such as the number of natural teeth, removable denture usage, Oral Health Assessment Tool (OHAT), and Dysphagia Severity Scale, were evaluated. All outcomes were assessed by a dentist from the palliative care team.ResultsThe problems with soft tissue, saliva, and oral cleanliness were observed. The absence of posterior occlusal support was common, and the use of removable dentures was often inadequate. In contrast, swallowing function was relatively well-conserved and 46.3% of the participants were capable of nutrition intake solely by mouth. Multiple regression analysis revealed a significant association between total OHAT score and age, consciousness level, prognostic level, and method of nutritional intake.ConclusionThe results revealed that the oral health of terminal cancer patients under palliative care declined despite receiving routine oral care from nurses, and suggest the importance of including dental professionals in multidisciplinary palliative care.

Highlights

Patients with terminal-stage cancer often receive palliative care through multidisciplinary collaboration that aims to prevent and alleviate distress through early and accurate evaluation and management of pain along with other physical, psychosocial, and spiritual problems [1]
Known to result in a high incidence of oral complications such as dry mouth [25], and lung cancer were common among the study participants, a wide range of primary cancer sites were observed, including bladder and kidney cancers
The consciousness level was relatively good in 87.6% of participants, 75.2% experienced some form of activities of daily living (ADL) limitation

Summary

Introduction

Patients with terminal-stage cancer often receive palliative care through multidisciplinary collaboration that aims to prevent and alleviate distress through early and accurate evaluation and management of pain along with other physical, psychosocial, and spiritual problems [1]. Alongside systemic symptoms, patients often develop various oral health disorders such as dry mouth, candidiasis, dysphagia, mucositis, dysgeusia, ulcers, dental caries, gingivitis, and tongue plaque [7]. These oral health problems are highly likely to have a major detrimental effect on QOL, both functionally, in terms of mastication, conversation, and eating difficulty, and psychologically, in terms of anxiety and depression [8]. The active participation of dentists and dental hygienists in the multidisciplinary collaborative practice of palliative care, to improve oral health through proper management of oral hygiene and function, is extremely important for maintaining and improving the QOL of patients with terminal-stage cancer [10]. A national survey of internists and nurses engaged in palliative care in Japan explored the need for dental intervention and revealed that despite almost all respondents recognizing the need for dental intervention, only limited dental intervention occurred [13]

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Results

Conclusion