Abstract
ObjectiveTo investigate current odontological care routines for patients treated for head and neck cancers in the county councils/regions (C/Rs) of Sweden.MethodsAn invitation to fill in a web‐based questionnaire was sent to dentists/dental hygienists working in dental clinics in the 12 C/Rs, treating and responsible for the odontological care of patients undergoing treatment for cancer of the head and neck. The questionnaire started with two mandatory and one non‐mandatory questions, followed by questions regarding routines before (n = 28), during (n = 23), and after (n = 9) treatment, plus two additional questions, totalling 65 questions.ResultsFour dental hygienists and six dentists in 10 of the 12 C/Rs answered the questionnaire. Three C/Rs stated that they measure both the unstimulated and stimulated salivary secretion rate, and another C/R stated that they measure the stimulated secretion rate only. Similar recommendations were given regarding oral hygiene, salivary stimulants and substitutes, and extra fluoride. However, great variations were seen regarding recommendations for preventing and relieving oral mucositis. There were also discrepancies regarding information about the importance of avoiding smoking and alcohol. In seven C/Rs, patients visited the dental hygienist once a week during cancer treatment.ConclusionThe results suggests that there are great variations in odontological care given to patients undergoing treatment for cancer of the head and neck region in different county councils/regions in Sweden. There is a need to develop and implement evidence‐based guidelines to decrease the risk of oral complications and increase both the quality of life and the quality of care.
Highlights
1,200 new cases of cancer of the head and neck region are diagnosed every year in Sweden (The Swedish National Board of Health and Welfare), with approximately 264,000 cases worldwide. (Jemal et al, 2011) Cancer of the head and neck region is twice as common among males compared with females. (Gupta, Johnson, & Kumar, 2016) Radiotherapy is a common treatment and is often combined with chemotherapy or surgery
80–100% of patients treated for cancer of the head and neck area are affected by oral mucositis. (Sroussi, Jessri, & Epstein, 2018; Trotti et al, 2003) Oral mucositis, corresponding to Grade 3 or Grade 4 on the World Health Organization scale, arises in a high proportion of patients treated with high dose radiotherapy, and especially when radiotherapy is combined with chemotherapy(Trotti et al, 2003)
In all C/Rs, a referral is sent to the dental clinic from the otorhinolaryngology clinic when a patient is planned to start cancer treatment
Summary
1,200 new cases of cancer of the head and neck region are diagnosed every year in Sweden (The Swedish National Board of Health and Welfare), with approximately 264,000 cases worldwide. (Jemal et al, 2011) Cancer of the head and neck region is twice as common among males compared with females. (Gupta, Johnson, & Kumar, 2016) Radiotherapy is a common treatment and is often combined with chemotherapy or surgery.The treatment of cancer can lead to many side effects, which can be either acute/early or late. Acute/early side effects occur during or immediately after the treatment and are, for example, pain in the head and neck region, (Epstein et al, 2010) trismus, (Scott, D'Souza, Perinparajah, Lowe, & Rogers, 2011) oral mucositis, (Sroussi, Epstein, & Bensadoun, 2017) and reduced salivary flow/xerostomia, (Burlage, Coppes, Meertens, Stokman, & Vissink, 2001) which in turn may cause difficulty to speak and swallow and may affect the sense of taste and smell. (Sroussi, Jessri, & Epstein, 2018; Trotti et al, 2003) Oral mucositis, corresponding to Grade 3 (severe) or Grade 4 (life-threatening) on the World Health Organization scale, arises in a high proportion of patients treated with high dose radiotherapy, and especially when radiotherapy is combined with chemotherapy(Trotti et al, 2003). The Swedish National Care Program for Head and neck cancer(Regional Cancer Centres, Sweden, 2015) is sparse regarding odontological care routines before, during, and after cancer treatment. Several review articles have been published suggesting means and methods before, during, and after cancer treatment to prevent and/or relieve oral complications especially oral mucositis. (Buglione et al, 2016a; Buglione et al, 2016b; De Sanctis et al, 2016; Jensen et al, 2013; Lalla et al, 2014; McGuire et al, 2013; Nicolatou-Galitis et al, 2013; Sroussi et al, 2017) as far as we know, no evidence-based standard protocol regarding the care of these patients exists, and routines for collaborations between different healthcare professions involved in the care of this patient category is sparse. (Lanzós, Herrera, Lanzós, & Sanz, 2015; Moslemi et al, 2016; Sroussi et al, 2018) This may lead to large variations in the amount and/or quality of the odontological care given because it is up to the individual dental clinic to plan for the care of each patient, which may lead to inequalities in the care provided
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