SURVEY OF EXPERIENCES AND BARRIERS TO DENTAL CARE POST HEAD AND NECK CANCER

Abstract

<h3>Objectives</h3> As the population of patients with head and neck cancer (HNC) treated with radiation therapy (RT) increases, along with increased longevity, the oral health of patients posttreatment merits increased attention. Patients with HNC experience changes to the oral cavity and surrounding structures, putting them at increased risk of oral disease, transiently or permanently, after RT. Thus, consistent, comprehensive dental care is crucial to maintaining oral health and to preventing or treating oral complications after RT treatment. Past studies reported about 50% of patients see a dentist post HNC. Prior surveys have assessed topics such as patient need for help with dental health, patients' unmet needs, treatment effects on quality of life, perception of financial impact, access to dentists, and oncologists' dental care awareness. Many of these surveys were done outside of the United States and included limited numbers of patients with HNC. This survey aims to investigate the experiences and barriers to dental care faced by patients in an established, multi-institutional U.S. HNC cohort. <h3>Study Design</h3> A literature review was performed and a survey was created by a resident (E.J.T.) and was reviewed by OraRad investigators and other oral medicine specialists. The survey was administered to patients at least 5 years post HNC in the OraRad cohort, a multicenter, prospective cohort study established through a cooperative agreement with National Institute of Dental and Craniofacial Research (NIDCR). The survey addressed patient knowledge of/beliefs about dental care post HNC, information/recommendations given to patients by a dentist/oncologist, perception of the dentist's understanding/knowledge of HNC, financial limitations to dental care, and physical symptoms. The research coordinators at each enrollment site in the OraRad Consortium contacted patients who had previously agreed to be contacted about future research projects related to HNC. The surveys were completed either by phone interview or physically completed and mailed by the patients. <h3>Results</h3> One hundred forty surveys have thus far been completed of 572 from the original cohort, which includes 421 participants who completed the final 24-month follow-up visit. Almost all respondents (n = 129; 92%) either strongly agreed (67%) or agreed (25%) that they understand the effects of cancer and its treatment on the teeth, mouth, and jaws. The majority (n = 107; 76.4%) verified that their cancer doctors have asked if they were seeing a dentist regularly after cancer treatment and almost all respondents (n = 138; 97%) had seen a dentist after cancer treatment, with 131 (95%) seeing a dentist 2 or more times per year. The majority (n = 110; 80%) either strongly agreed (51%) or agreed (29%) that their dentist provided them with information on how to keep teeth, mouth, and jaws healthy after cancer treatment. Nine participants (6%) reported that they declined or not sought dental care because it is too expensive and only 5 noted that transportation prevented or made it hard to get dental care. The majority reported dry mouth (n = 108; 77%). Other sequelae were problems swallowing (n = 52; 37%), limited opening (n = 41; 29%), dental caries (n = 33;24%), and difficulty keeping their mouth open during dental procedures (n = 25; 18%). Only 39 (28%) reported no symptoms. Only 3 participants (2%) had missed or canceled a dental appointment owing to symptoms. <h3>Conclusion</h3> The majority of post HNC OraRad patients who responded to this survey have an understanding of the oral sequelae of cancer and cancer treatment. Most were educated by their dentist and were compliant with routine dental care, contrasting with previous surveys that found likely insufficient patient education and speculated that patient misunderstanding of the importance of dental evaluation had led to canceling of appointments and dissatisfaction with dental care. Suspected barriers of transportation, finances, and symptoms post HNC are largely overcome or nonexistent in this dentally compliant HNC group. Further assessment will compare respondents to nonrespondents from the original OraRad cohort to determine baseline differences in socioeconomic status, because this can have a major impact on survey response. Seventy-seven percent of patients reported dry mouth at approximately 5 years post-RT, underscoring the chronic nature of this symptom.