Care For Oral Cancer Patients Research Articles

Performance and trend of core measures among oral cancer patients: A population-based cohort study

Abstract Objectives This study explores the performance and trend of core measures, which were established as evidence-based indicators to assess and improve the quality of care for oral cancer patients. Methods This retrospective cohort study uses the National Health Insurance Research Database (NHIRD), Taiwan Cancer Registry, and Cause of Death Statistics, provided by the Health and Welfare Data Science Center (HWDC), Ministry of Health and Welfare (MOHW). The study population was adult patients hospitalized for oral cancer surgery with stage I-IV between 2014 and 2021. The trend tests and the generalized linear mixed model (GLMM) were applied. Results A total of 23392 oral cancer patients were enrolled. The core measure set used in this study included five indicators (two process-related and three outcome-related indicators). Process indicators’ mean achievement rates significantly increased from 82.6% to 85.7% (p = 0.018, trend test). On the other hand, most patients demonstrated good achievement rates to the outcome indicators (98.9% to 99.3%) (p = 0.218, trend test). Overall indicators’ 100% achievement rate increased over time from 62.9% in 2014 to 66.2% in 2021 (p < 0.001, trend test). Subgroup analyses were performed by age, stage, and comorbidity score. The analysis of the GLMM revealed that the 100% achievement to overall indicators was positively associated with age<45, not-low socioeconomic status, body mass index ≥ 24, squamous cell carcinoma, recent treatment year, treated with surgery only, negative surgical margins, and receiving care in a high-volume hospital (all p < 0.01). Conclusions The results highlight a significant measurable improvement in the quality of oral cancer care. However, there is still room for enhancement in process indicator performance. Key messages • The results highlight a significant measurable improvement in the quality of oral cancer care. • There is still room for enhancement in process indicator performance.

Tube feeding in patients with head and neck cancer undergoing chemoradio-/radio therapy: A systematic review and meta-analysis based on the GRADE approach

ScopeThe scope of this systematic review (SR) was to determine whether a nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG) is a more useful supportive therapy in patients with oral cancer undergoing chemoradio-/radio therapy. MethodsFor the review, two authors searched MEDLINE, Cochrane CENTRAL and Ichushi-Web to identify clinical practice guidelines, SRs and randomised controlled trials (RCTs) according to pre-determined criteria. RevMan Web was used to combine trials and analyse the data. We evaluated the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation system approach. ResultsIt was not possible to perform a meta-analysis of only treatment completion based on the included RCTs; therefore, we performed a meta-analysis of treatment breaks as a surrogate outcome. A meta-analysis of potential treatment breaks, including treatment discontinuation, revealed no superiority between PEG and NGT (risk ratio=0.64 [0.23, 1.79]). A meta-analysis was conducted on two RCTs regarding the harms of infection. There does not appear to be a significant increase in the risk of infection with either PEG or NGT (risk ratio=1.18 [0.45, 3.08]). The certainty of the evidence for two outcomes was judged to be very low. Further, meta-analyses of quality of life and nutritional status were not possible because of differences in assessment methods. ConclusionWe could not determine the superiority of NGT or PEG in the supportive care of oral cancer patients who received chemoradio-/radio therapy. The effect of PEG feeding is uncertain, and it is necessary to consider indications for each case.

Oral Complications and Management Strategies for Cancer Patients: Principles of Supportive Oncology in Dentistry.

It is recognized that patients undergoing cancer treatment experience different adverse effects depending on the type of therapy they received. The objective of this work is to provide a scientific evidence-based protocol for oral care in cancer patients. Cancer resection surgery, chemotherapy, and radiotherapy can cause important complications that impact patients' quality of life. Cancer patients, from the moment of diagnosis to the end of treatment and subsequent follow-up, have diverse care needs, both from a systemic and local point of view. The implementation of oral care protocols before, during, and after cancer therapy is essential because it helps to identify risk factors for the development of predictable oral complications. It is essential to establish that all cancer patients, before starting treatment, undergo a systematic dental check-up to avoid limitations during treatment and also alter their quality of life. Regular professional oral care maintenance and follow-up programs are essential to maintaining a patient's long-term oral health.

End-of-life care for oral cancer patients: A single-center retrospective study

End-of-life care for oral cancer patients: A single-center retrospective study

Prevalence of Anxiety, Depression, and Perceived Stress Among Family Caregivers of Patients Diagnosed With Oral Cancer in a Tertiary Care Hospital in Central India: A Cross-Sectional Study.

Background and objectives Oral cancer is a significant health issue in India, with one of the highest incidence rates globally. Family caregivers play a crucial role in the care of oral cancer patients, but their mental health often faces challenges. This study aimed to assess the prevalence of anxiety, depression, and perceived stress among family caregivers of oral cancer patients in a tertiary care hospital in central India and explore the associated psychosocial factors. Population and method The study was carried out between March 2023 and August 2023 in a tertiary care hospital in Wardha, Maharashtra. Family caregivers (N=82, mean age = 36.1 (SD 10.5) years) of patients with clinically diagnosed oral cancer were subjected first tostructured psychiatric clinical interviews to screen for psychiatric diagnoses and then were given self-reporting questionnaires for socio-demographic data, Beck Depression Inventory (BDI-II) for measuring the emotional, cognitive, and motivational symptoms of depression, Manifest Anxiety Scale (MAS) to assess the degree of anxiety and Perceived Stress Scale-10 (PSS-10) to assess stress level. Data was analysed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Chi-square test and logistic regression analyses were conducted wherever appropriate in order to explore predictive factors of depressive, anxious, or stress symptoms. Result In the studied population, the majority experienced symptoms of depression (65.1%), anxiety (69.5%), and perceived stress (74.7%). Caregivers of patients with advanced oral cancer were found to have a higher likelihood of experiencing depression (χ2 (1) = 16.76, p < .001) and anxiety related to unemployment (χ2 (1) = 10.12, p = .001) or insufficient earnings (χ2 (1) = 28.63, p < .001). Additionally, participants with no or little formal education (χ2 (1) = 4.63, p = 0.031) and lower income (χ2 (1) = 28.63, p < .0001) were significantly more likely to experience distress compared to those with higher levels of education. Conclusion This study highlights the need for comprehensive support systems for family caregivers of oral cancer patients. Educational programs, financial assistance, and mental health services should be tailored to caregivers' specific needs. Early identification and intervention strategies can help mitigate the psychological impact of caregiving. Further research is essential to develop targeted interventions that enhance the well-being of caregivers and improve the quality of life for both patients and caregivers.

Can Nurses' Training and Documentation Audit Improve the Oral Care Practice among Patients Receiving Cancer Treatment? Results from the Pretest-Post-Pest Study.

Oral complications arising out of radiation therapy and chemotherapy significantly affect the oral health status of patients leading to severe distress. Poor oral health can impair nutritional intake and patient recovery. Trained nurses lack knowledge of oral care of patients receiving cancer treatment. The study is aimed at training the nurses and conducting a documentation audit to assess the effect of the training on their clinical practice. Methods: A quantitative research approach was adopted using one group pretest-post-test design to train 72 nurses on oral care of cancer patients working in radiation oncology wards of a tertiary care setting in the southern part of India. After the training program, 80 head and neck cancer patient records were audited to monitor the implementation of oral care. After completing the training program, the knowledge score increased to 13.54 with a mean difference of 4.15 at a p-value <0.001, which indicates that the training was effective, resulting in a gain in knowledge scores. Nurses reported usage of evidence-based intervention, and patient education materials helped them in the clinical practice and a few barriers to oral care practice were identified while implementing the oral care i.e increased frequency of oral care, increased documentation, and time issues. There was poor adherence to the implementation of oral care for cancer patients after the training program, as monitored by a documentation audit. Capacity building of the nurses in providing effective oral care of cancer patients will help in improving the standards of cancer nursing practice. An implementation audit of the records would help check adherence to the new oral care practice. A hospital-instituted protocol can result in the effective implementation of the practice change rather than a researcher-introduced protocol.

Importance of Oral Care in Cancer Patients Receiving Chemotherapy and Radiotherapy

Importance of Oral Care in Cancer Patients Receiving Chemotherapy and Radiotherapy

Interprofessional Collaboration Among Dental Hygiene and Nursing Students on the Oral Health of Cancer Patients.

One third of patients diagnosed with cancer develop oral complications during cancer treatment. Health care professionals play an important role in the management of patients undergoing cancer therapies; however, optimal oral care for cancer patients is often missing from nursing and dental hygiene curricula. A quasi-experimental mixed-methods study was conducted with accelerated bachelor of nursing and dental hygiene students following a presentation and small-group case review. Pre/post surveys and findings from a debriefing session showed increased confidence to screen, counsel, and refer patients between disciplines compared to a control group.

Specimen-driven intraoperative assessment of resection margins should be standard of care for oral cancer patients.

With an incidence of 350.000 new cases per year, cancer of the oral cavity ranks among the 10 most common solid organ cancers. Most of these cancers are squamous cell carcinomas. Five‐year survival is about 50%. It has been shown that clear resection margins (>5 mm healthy tissue surrounding the resected tumor) have a significant positive effect on locoregional control and survival. It is not uncommon that the resection margins of oral tumors are inadequate. However, when providing the surgeon with intraoperative feedback on the resection margin status, it is expected that obtaining adequate resection margins is improved. In this respect, it has been shown that specimen‐driven intraoperative assessment of resection margins is superior to defect‐driven intraoperative assessment of resection margins. In this concise report, it is described how a specimen‐driven approach can increase the rate of adequate resections of oral cavity squamous cell carcinoma as well as that it is discussed how intraoperative assessment can be further improved with regard to the surgical treatment of oral cavity squamous cell carcinoma.

Evaluating the Effects of a Mobile Health App on Reducing Patient Care Needs and Improving Quality of Life After Oral Cancer Surgery: Quasiexperimental Study.

BackgroundIntervention with a mobile Health (mHealth) app can improve the efficacy of early detection of oral cancer and the outcomes for patients taking oral anticancer medications. The quality of life of oral cancer patients is significantly reduced within three months after surgery; also, their needs for nursing care and health information increase, mainly due to side effects and associated psychological problems.ObjectiveThis study aimed to evaluate changes in the care needs and quality of life of patients with oral cancer after receiving the intervention of a newly developed mHealth app.MethodsAfter surgery, oral cancer patients were divided into an experimental group (n=50) who received the mHealth app intervention and a control group (n=50) who received routine health care and instruction. After 3 months of intervention, survey questionnaires were used to assess the patients’ quality of life, nursing care needs, and acceptance of the mHealth app.ResultsThe physiological care needs were significantly decreased in the experimental group compared with the control group (P<.05). Although the differences were not statistically significant, the psychological needs, communication needs, and care support needs all improved after the mHealth app intervention. The overall improvement in quality of life was higher in the experimental group than in the control group (–7.24 vs –4.36). In terms of intention to use, perceived usefulness, and perceived ease of use, the acceptability scores of the mHealth app were significantly increased after 3 months of intervention (P<.05).ConclusionsCompared with routine health care and instruction, for patients after surgery, the education/information intervention using the mHealth app significantly reduced their nursing care needs, improved their quality of life, and increased their acceptance of using an mHealth app on a mobile device. These findings can provide a theoretical basis for future health care app design and improvement. This study suggests that an mHealth app should be incorporated into the routine care of oral cancer patients to provide medical information quickly and improve their self-management abilities, thereby reducing the patients’ need for physiological care and improving their quality of life.Trial RegistrationClinicalTrials.gov NCT04049968; https://www.clinicaltrials.gov/ct2/show/NCT04049968

A Prospective Study to Assess the Effectiveness of an Educational Package on Home-Based Post-operative Care of Oral Cancer Patients by Primary Caregivers

This prospective study was conducted in collaboration with the Department of Surgical Oncology and Nursing. A total of 60 patients (30 patients in each group selected in consecutive fashion) were included based on assumption of α error and power of 5% and 90% respectively. A structured questionnaire for knowledge assessment of primary caregivers before and after intervention was used in the intervention group. The control group received routine care. The demographic profile, tumor location, and surgical intervention were comparable in both groups. At the initial assessment, 76.3% of patient’s caregivers did not have prior knowledge of post-operative care. With the specific educational intervention, 68% of the caregivers in the interventional group obtained poor (0–11) knowledge score which was improved to good score (19–25) in 73% of caregivers after the administration of the educational package but this improvement was not seen in the control group which received routine care. This study suggested that there is a need for specific educational package for the primary caregivers to improve their knowledge regarding home-based post-operative care of oral cancer patients that helps in the early recovery of the surgical patients.

Atención odontológica de pacientes oncológicos desde la perspectiva de actores institucionales en Cali, Colombia, 2019.

Objetivo: caracterizar la atención odontológica de los pacientes oncológicos desde la perspectiva de diferentes actores institucionales en Cali – Colombia, durante el año 2019. Métodos: estudio cualitativo, descriptivo. Se empleó la entrevista semiestructurada como técnica de investigación, dirigida a quince actores institucionales relacionados con la atención del paciente con cáncer en Cali y la revisión documental en las Instituciones Prestadoras de Servicios de Salud. Las preguntas incluyeron las siguientes categorías: atención, acceso, integralidad, limitaciones, fortalezas y recomendaciones. Para la codificación y categorización de los datos se utilizó el software ATLAS.ti. versión 8.4.0. Resultados: no hay guías de atención odontológica para los pacientes con cáncer. El acceso al servicio tiene barreras personales, económicas, organizacionales, sociales y culturales. Las rutas de atención de cáncer del Ministerio de Salud y Protección Social no incluyen al odontólogo. Fueron limitaciones el fraccionamiento del servicio y la priorización de la patología de base. La fortaleza fue la capacidad instalada. Las recomendaciones principales fueron establecer Guías de atención, mayor articulación entre entidades y visibilización de la problemática. Conclusión: Aunque la ciudad tiene suficiente capacidad instalada, los entrevistados manifestaron que no cuentan con una directriz desde el ente rector, por lo tanto, se evidencian barreras en la atención odontológica a los pacientes con cáncer. Hay falta de articulación entre las diferentes instituciones que impide el cumplimiento de la atención integral y equitativa. Los entrevistados hicieron recomendaciones a los diferentes sectores para mejorar la atención.

Oral Care Protocol for Chemotherapy- and Radiation Therapy-Induced Oral Complications in Cancer Patients: Study Protocol

Objective:The purpose of this study is to describe a randomized control trial protocol that assesses the effectiveness of an oral care protocol on chemotherapy- and radiation therapy-induced oral complications in cancer patients.Methods:This study is a randomized, outcome assessor blinded study. For Phase I training phase, one group pretest-posttest design will be implemented for training the staff nurses on oral care in cancer patients and for Phase II Intervention Phase, randomized clinical trial will be used to determine the effectiveness of oral care protocol. Twenty-five staff nurses working in radiation oncology areas hospital will be trained about oral care in cancer patients. Seventy newly diagnosed patients with head and neck cancer admitted to the oncology wards of a tertiary care hospital in South India will be enrolled. Patients will be randomly allotted to a control and intervention group. The primary outcome variables are oral complications and oral health assessment.Results:The results of the preliminary survey conducted among 158 staff nurses showed that 81 (51.3%) of the staff nurses had poor knowledge regarding oral care of cancer patients and majority 128 (81.0%) of them suggested for training in the specific area of oral care of cancer patients. A pilot study conducted by the principal investigator to determine the feasibility of the study among 9 participants (4 experimental and 5 control) revealed that there was slight difference found in the incidence of oral complications among the group in relation to weeks of assessment.Conclusions:The present study may give data regarding the occurrence of oral complications in head and neck cancer patients, and even, it can enlighten on the effectiveness of oral care protocol on oral complications. If this protocol is found effective, then this protocol can be made part of daily nursing care to improve the patient outcome.

Association between perioperative oral care and postoperative pneumonia after cancer resection: conventional versus high-dimensional propensity score matching analysis.

Perioperative oral care was reported to decrease postoperative pneumonia after cancer resections. However, the effect remains controversial because previous studies were limited due to their small sample sizes and lack of strict control for patient backgrounds. The present study evaluated the association between perioperative oral care and postoperative pneumonia using high-dimensional propensity score (hd-PS) matching to adjust for confounding factors. Using a Japanese health insurance claims database, we identified patients who underwent surgical treatment of cancer from April 2014 to March 2015. To compare outcomes (postoperative pneumonia and procedure-related complications) between patients with and without perioperative oral care, we performed hd-PS matching and conventional PS matching and chi-square test. We identified 621 patients with oral care and 4374 patients without oral care. The occurrences of postoperative pneumonia were not significantly different between patients with and without oral care in the unmatched (2.9% vs. 3.2%), conventional PS-matched (2.9% vs. 2.9%), or hd-PS-matched (2.9% vs. 3.3%) groups. The occurrences of procedure-related complication were not significantly different between patients with and without oral care in the unmatched (23.8% vs. 24.5%), conventional PS-matched (23.8% vs. 26.4%), or hd-PS-matched (24.4% vs. 27.7%) groups. There was no significant difference in postoperative pneumonia or procedure-related complications between patients with and without perioperative oral care. While maintaining optimal oral care in cancer patients is an important goal, the present study revealed no significant difference in postoperative outcomes. Further investigations would be needed to determine the effect of perioperative oral care.

Oral care in cancer nursing: Practice and barriers.

Oral health awareness and oral care are crucial aspects of oncology nursing practice. However, very few studies concentrate on the oral care of cancer patients undergoing cancer treatment and nursing practice in the Indian subcontinent scenario/situation. Most of the published studies have been conducted in the Western and European countries. This study aimed to determine the nurses' practice and barriers regarding oral care in cancer patients undergoing chemotherapy and radiation therapy. A cross-sectional descriptive survey was conducted among 158 staff nurses working in oncology-related areas from four different hospitals of Dakshina Kannada district and Udupi district of Karnataka state, India. Descriptive and inferential statistics was used by using SPSS 16 version. More than half of respondents [54 (34.2%)] did not perform oral care as a part of routine duties. Maintenance of various records, lack of manpower, and lack of standard operating procedures were major barriers in providing oral care. Documentation audit revealed that nurses recorded oral care in the chart only when order was present in the care sheet, but oral problem assessment was not recorded at all. In all four hospitals surveyed, there was no protocol specifically designed for oral care of cancer patients. Nurses expressed that oral care in cancer patients was one of the most ignored aspect in oncology nursing. Our result highlights the need to develop evidence-based oral care intervention protocol and motivate staff nurses to attend continuing nursing educations regularly to keep themselves abreast of the latest trends in order to render comprehensive care to the patients.

A survey on the current status and the opinion of professional oral health care for oral cancer patients

A survey on the current status and the opinion of professional oral health care for oral cancer patients

361P - Aloe Vera: A multifaceted ayurvedic herb used in palliative care of oral cancer patients

361P - Aloe Vera: A multifaceted ayurvedic herb used in palliative care of oral cancer patients

Multi-Disciplinary Team (MDT) Approach in Oral Cancer Management: An Exploratory Study

Background: Treatment of oral cancer has evolved throughout the past decades which has led to the introduction of the multi-disciplinary team approach (MDT). The MDT concept has been endorsed as the main approach to ensure holistic care for oral cancer patients worldwide. In Malaysia, the MDT concept has been introduced in few hospitals throughout the country. According to the available literature, the MDT approach has improved coordination of care for oral cancer patients, communication between the different disciplines, decision making to obtain the best treatment plan, provided educational opportunities for development of the members, and improved staff and patient well-being. However, little evidence is available to support the fact that the MDT approach has improved patient survival and outcome. Aim: The aim of this study was to explore the MDT approach in the management of oral cancer patients. To our knowledge this is the first study on head and neck MDTs in Malaysia. Methods: The study was conducted at University of Malaya. A mixed-method study was commenced including both quantitative and qualitative designs. The quantitative part assessed the MDT members' attitude toward the role and use of the MDT approach in oral cancer patient management, while the qualitative part assessed the perception of the MDT members regarding the MDT approach in terms of: team structure, team process, decision making, barriers and suggestions for improvement of the MDT approach. The quantitative study was conducted through a structured self-administered questionnaire which were both content and face validated, and distributed to the members of the head and neck MDT. The qualitative study was commenced through two focus group discussions (FGDs) conducted separately. Results: The study was conducted among the head and neck MDT members at University Malaya which received a 100% response rate. The majority of the MDT members showed positive attitudes toward the MDT approach, with the seniors being more positive than the juniors. The MDT approach has improved team dynamics in terms of communication, care coordination and decision making. However, there were a few issues of miscommunication as well as long waiting lists for oncological radiotherapy machines and radiologic scanning. Conclusion: The MDT approach is certainly the preferable mode of care for oral cancer patients in University of Malaya. However, there is a need for further improvement with regards to communication between the team members, expansion of the current team composition, training of the MDT members with regards to clinical and nonclinical skills, guidelines, protocols and certain facilities. Teamwork is a fundamental perspective which is crucial for an effective MDT. As such, a better understanding of each other's roles and responsibilities within the team is essential to ensure optimum patient care and management.

Survey of Oral Care for Cancer Patients on Chemotherapy, and Measures to Improve Nurses’ Assessment and Nursing Care Abilities

Survey of Oral Care for Cancer Patients on Chemotherapy, and Measures to Improve Nurses’ Assessment and Nursing Care Abilities

Nurses' Knowledge and Education about Oral Care of Cancer Patients Undergoing Chemotherapy and Radiation Therapy.

Context:Oral health awareness and oral care are crucial aspects of oncology nursing practice. However very few studies concentrate on the oral care of cancer patients undergoing cancer treatment and nursing practice in the Indian subcontinent. Most of the published studies have been conducted in the Western and European countries.Aim:This study aimed to determine the nurses’ knowledge and education about oral care in cancer patient undergoing chemotherapy and radiation therapy.Setting and design:A cross sectional descriptive survey was conducted among 158 staff nurses working in oncology related areas from 4 different hospitals of Dakshina Kannada district and Udupi district of Karnataka state, India.Statistical Analysis:descriptive and inferential statistics was used by using SPSS 16 version.Results:Majority 81 (51.3%) of the staff nurses had poor knowledge of oral care in cancer patients whereas 87 (55.1%) reported that knowledge acquired through basic education in oral care is not sufficient. Most of the staff nurses 115 (72.8%) did not receive basic education in oral care of cancer patients. There was significant association between knowledge and variables such as designation (.005), years of work experience (.040) and years of experience in cancer wards (.000) at 0.05 levels.Conclusion:Lack of knowledge suggest the need to develop and implement continuing nursing education programs on oral care specifically for patients receiving cancer treatments, for improving knowledge of staff nurses’ in order to render comprehensive care to the patients. This study also recommends the importance of inclusion of cancer patient specific oral care in the curriculum which can enhance competency of the qualified nurses in cancer wards.