Oral Oncology Research Articles

5th World Congress of the International Academy of Oral Oncology (IAOO).

5th World Congress of the International Academy of Oral Oncology (IAOO).

Theoretical Foundations of Adherence Behaviors: Synthesis and Application in Adherence to Oral Oncology Agents

The use of theory can provide structure for understanding the dynamics of adherence to oral agents for cancer (OACs) and facilitate the development of strategies for patient assessment and care planning related to oral adherence. The focus of this article is to identify common theories pertinent to medication-taking behavior, as well as their applications toward assessment and care planning regarding adherence to OACs. Approaches to apply these theories and their concepts in clinical practice are identified. Theories applied to adherence behaviors were reviewed, and their concepts were compared and synthesized. These concepts were then applied to medication adherence behavior. Various theories can help healthcare providers to better understand the influences and determinants of patients' adherence decisions and behaviors. They can then be used to structure assessment and plan related aspects of care.

Outcomes analysis for patients taking oral chemotherapy through specialty and retail pharmacy.

e17772 Background: Specialty pharmacy programs are increasingly used to better manage healthcare outcomes of patient therapy with targeted oral oncology medications. A large US health plan provides...

Anterior gradient protein 2 expression in high grade head and neck squamous cell carcinoma correlated with cancer stem cell and epithelial mesenchymal transition.

Anterior gradient protein 2 (AGR2) is a novel biomarker with potential oncogenic role. We sought to investigate the diagnostic and prognostic role of AGR2 on head and neck squamous cell carcinoma (HNSCC) with an emphasis on its correlation of cancer stemloid cells (CSC) and epithelial mesenchymal transition (EMT). We found that AGR2 protein levels were higher in HNSCC than in normal oral mucosa. High levels of AGR2 were associated with the T category, pathological grade and lymph node metastasis of HNSCC. Expression of AGR2 increased in recurring HNSCC after radiotherapy and in post cisplatin-based chemotherapeutic tissues. In HNSCC cell lines, knock-down of AGR2 induced apoptosis, reduced sphere formation, and down-regulated Survivin, Cyclin D1, Bcl2, Bcl2l1, Slug, Snail, Nanog and Oct4. In addition, over-expressed AGR2 in transgenic mice with spontaneous HNSCC was associated with lost function of Tgfbr1 and/ or lost function of Pten. In vitro knockdown TGFBR1 in HNSCC cell lines increased AGR2 expression. These results suggest that AGR2 is involved in EMT and self-renewal of CSC and may present a potential therapeutic target (oncotarget) for HNSCC.

Editorial introductions

Editorial introductions

Quality Check in Oral Cell Lines: The Need for Molecular Characterization

Oral cell lines have provided valuable insights into the various molecular pathways in oral carcinogenesis. Several landmark studies in oral oncology have utilized commercially available normal, dysplastic and cancer cell lines to decode the genetic alterations leading to the development of oral cancer. Most of these studies have shown a significant degree of variation in their mutation landscapes. These variations were thought to represent the heterogeneity of oral cancer.(1) But in a recent study, Dickman et al have shown that normal and dysplastic cell lines carry specific genetic alterations within the parent cell line, thus questioning the authenticity of several published mutation profiles. These genetic alterations in the commercial cell lines have been attributed to several factors, the most common being immortalization. Normal and dysplastic cell lines unlike cancer cell lines attain senescence following limited number of replication. Immortalization of the normal and dysplastic cell lines would aid the researcher in maintaining a viable population of cells for further studies. Ideally, the immortalized cell line must possess potential for indefinite replication and must retain the genetic makeup of its parent cell line.(2).

Utility of laser as an ablative modality for intra-oral pathologic lesions: A case series

Some medical specialties have been using lasers for over 30 years; their use did not become relatively common in oral and maxillofacial surgery but recently. However, over the past 10 years, gradually lasers have become an important part of oral surgical tools. Literature in oral and maxillofacial oncology continues to support the use of lasers in surgery of premalignant and malignant lesions. Various wavelengths that can be used by oral and maxillofacial surgeons are carbon-dioxide (CO 2 ), Nd: YAG, pulsed dye, erbium: YAG, holmium: YAG, and copper vapor. The most useful has proved to be the CO 2 laser. Several authorities have explored the indications, techniques, results, benefits, and risk issues of lasers used in oral and maxillofacial surgery. The advantages of laser application are that it provides relatively bloodless surgical and postsurgical courses with minimal swelling and scarring. In this article, we have discussed about the application of lasers in oral and maxillofacial surgery.

Can Challenges of Oral Cancer Diagnosis be Resolved?

Can Challenges of Oral Cancer Diagnosis be Resolved? Early oral cancer detection and accurate diagnosis remain the most challenging aspects of oral oncology. Heterogeneity in oral cancer (mostly squamous cell carcinoma) renders accurate classification problematic, which in turn impacts on treatment decision and patient outcome. Early oral cancer detection coupled with appropriate treatment can significantly improve patient outcome, reduce mortality and alleviate public healthcare costs. Clinical diagnosis of early potentially malignant oral lesion is one of the first challenges of dental practitioners when encountering an oral lesion. Whilst most oral lesions are clinically well characterized and easy to identify, the main problem is to be able to identify which lesions are potentially malignant.

No evidence of association of xenotropic murine leukemia virus-related virus with oral cancers: Experience from a tertiary care center in South India

Development of oral cancer, a widely prevalent cancer in India, is multifactorial with increased risk in those habituated to smoking, consuming alcohol and chewing paan and tobacco. This does not preclude other etiological factors in the causation of this cancer. Exploratory studies on several oncogenic viruses have found varied associations with oral cancers. The aim of this study was to explore the association of xenotropic murine leukemia virus-related virus, (XMRV) a retrovirus recently implicated in oncogenesis in humans, with oral cancers. The presence of XMRV proviral deoxyribonucleic acid (DNA) was evaluated by standard nucleic acid amplification from DNA extracted from representative bits of tumor tissues and adjacent normal tissues from surgically resected specimens sent post-operatively for routine histopathological testing. This prospective study comprised 109 patients with a provisional diagnosis of oral cancer who were operated at the Oral Oncology Department of Kidwai Memorial Institute of Oncology, over a period of 10 months. XMRV was not found in any of the tumor tissues (squamous cell carcinomas - 98; verrucous carcinomas - 4) nor in any of the normal tissues. It is thus important that the absence of this oncogenic virus in all the cases makes the association of XMRV with oral cancers very unlikely. There is a need to investigate potentially oncogenic viruses in other solid tumors and in larger sample sizes. Any such association could have implications in detecting, preventing and treating these cancers.

Limited dissection and early primary closure of the tracheostomy stoma in head and neck oncology operations: a retrospective study of 158 cases

Tracheostomy is an efficient and widely used method to secure a patent airway in patients undergoing major oral and maxillofacial oncology operations. The inferiorly based Björk flap technique, through a limited incision, followed by early primary skin closure, has been the preferred method in our unit. Patients who underwent tracheostomy for major oral and maxillofacial oncology operations during the period June 2005 to December 2012 were reviewed. Age, gender, preoperative diagnosis, duration the tracheostomy tube was in situ, tracheostomy-associated complications, and long-term sequelae were evaluated. A total 158 tracheostomies were performed using the same surgical approach in patients aged 18–84 years (median 59, mean 58.2, standard deviation 14.24 years). The time the tracheostomy tube was in situ ranged from 3 to 40 days (median 7, mean 9.0, standard deviation 6.52 days). The complication rate was 5.06% (8/158 patients). A major concern highlighted in previous publications is the risk of surgical emphysema with early closure. In this study, no patients developed surgical emphysema, tracheal fistula, clinical tracheal stenosis, or cosmetically unacceptable scarring of the neck. No patient died of a tracheostomy-related cause. In summary, the Björk flap with early primary closure of the skin by simple sutures provides a safe and easily managed approach, causing minimal postoperative morbidity.

Clinical approach in the management of oral chronic graft-versus-host disease (cGVHD) in a series of specialized medical centers.

The oral cavity is frequently affected in chronic graft-versus-host disease (cGVHD), with variable clinical presentations. The literature on the effective management of patients suffering from oral cGVHD is limited. The objective of this study was to assess the clinical approaches used in the diagnosis and treatment of cGVHD in a group of health-care providers specialized in the oral care of oncology patients. The secondary objective was to assess the level of implementation of the National Institutes of Health (NIH) guidelines for cGVHD patients. One hundred twenty questionnaires were sent to the members of the Oral Care Study Group (OCSG) of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). The questionnaire included 50 questions about the responder's demographics, level of exposure to cGVHD patients, diagnostic and evaluation methods in their practice, preferred treatment strategies for mucosal and salivary gland involvement, and preventive measures. Twelve responders, representing 12 sites, stated that they treat oral cGVHD patients on a regular basis. This fraction of responders was confirmed by another online survey. Eleven out of the 12 providers were dentists. Seventy-five percent of the providers did not use biopsy in order to diagnose oral cGVHD. The NIH scale for the clinical assessment was used sporadically. The first-line topical treatment for oral mucosal cGVHD was predominantly steroids (91.7 %), and the second preferred treatment was tacrolimus (41.7 %). The preferred treatment for hyposalivation was pilocarpine (41.7 %). The recommended frequency of oral cancer screening varied; half of the providers suggest a follow-up every 6 months. The responses described the common practices for oral cGVHD in several specialized centers across the world. The choice of topical treatments was influenced by the availability of medications in the provider's country.

Making an IMPAQTT on the quality of life of cancer patients.

Christine Boers-Doets* speaks to Francesca Lake, Managing Commissioning Editor: Christine underwent nursing training in The Netherlands. Currently, she is a PhD candidate, researcher and oncology clinical nurse specialist at the Department of Clinical Oncology at the Leiden University Medical Center (Leiden, The Netherlands). She is a member of the Board of Directors at the International Society of Oral Oncology; Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology alliance, and has acted as a consultant for companies including Amgen, Astra Zeneca, Bayer Pharmaceuticals, Boehringer Ingelheim, Eusa Pharma, GlaxoSmithKline, Merck Serono, Merck Sharp and Dohme, Nordic Pharma, Novartis, Pfizer, Roche, and Takeda. She is also the founder for the newly founded IMPAQTT FOUNDATION, and has her own company (IMPAQTT).

Utilization patterns for oral oncology medications in a specialty pharmacy cycle management program.

The cycle management program (CMP) was implemented in 2008 at a national specialty pharmacy with a focus on providing specialized counseling and monitoring for patients on select oral oncology medications. The program now includes nine medications: bexarotene, dasatinib, erlotinib, everolimus, nilotinib, pazopanib, sorafenib, sunitinib, and vorinostat. Patients receive frequent assessments to encourage adherence, identify adverse events, and track discontinuations through a pharmacist outreach at the initiation of therapy, day 10 and 20 of the first month, then monthly thereafter. The use of oral agents is increasing in cancer patients, shifting away from regimens exclusively involving intravenous chemotherapy. This offers advantages for patients in terms of convenience, but introduces risk as patients become more responsible for the administration and monitoring of the medications. To evaluate utilization patterns of the oral oncology medications in the CMP including adverse event occurrence, medication discontinuations, and adherence markers. This study is a retrospective review of patient-reported data from the CMP assessments completed in 2013. Data collected include adverse events and grades, adherence markers, and discontinuation rates. A total of 1163 assessments were reviewed from 557 patients. The assessments included in the analysis were the initial assessment, 10-day assessment, 20-day assessment, and the first monthly follow-up assessment, which encompasses the first two months of therapy. A total of 1453 adverse events were reported. Adverse events were cited as the reason for 39% of discontinuations and 28% of missed/held doses. A total of 101 discontinuations were reported across the nine CMP medications based on the first two months of data. Missed or held doses were reported in 130 assessments. Patient engagement and pharmacist interventions, through programs such as the CMP, are important to help patients manage these complex, high-risk medications.

Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT).

PurposeHematology–oncology patients undergoing chemotherapy and hematopoietic stem cell transplantation (HSCT) recipients are at risk for oral complications which may cause significant morbidity and a potential risk of mortality. This emphasizes the importance of basic oral care prior to, during and following chemotherapy/HSCT. While scientific evidence is available to support some of the clinical practices used to manage the oral complications, expert opinion is needed to shape the current optimal protocols.MethodsThis position paper was developed by members of the Oral Care Study Group, Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT) in attempt to provide guidance to the health care providers managing these patient populations.ResultsThe protocol on basic oral care outlined in this position paper is presented based on the following principles: prevention of infections, pain control, maintaining oral function, the interplay with managing oral complications of cancer treatment and improving quality of life.ConclusionUsing these fundamental elements, we developed a protocol to assist the health care provider and present a practical approach for basic oral care. Research is warranted to provide robust scientific evidence and to enhance this clinical protocol.

A to Z and HIV: Free and her team take patient care to the streets

L–R: Kendra Frassetto, PharmD; Tirena Schue, CPhT; Heather Free, PharmD; Naitia Nwatu, PharmD candidate; Bryan Staromana, CPhT Not shown: Joanne Barnett, CPhT; Solomon Abera, PharmD candidateHow can you practice for the nation's largest chain and still work in a small pharmacy where you are very engaged with your patients and community? At an inconspicuous pharmacy in a gentrifying Washington, DC, neighborhood once known as the city's red light district, Heather Free, PharmD, has found a way.

Outcome and prognostic factors of salivary gland carcinoma arising in minor, submandibular, or sublingual glands: A retrospective multicenter study of the Japan Oral Oncology Group.

e17038 Background: Carcinomas of the salivary glands may arise either from major or minor glands. Surgery represents the mainstay of treatment of salivary gland carcinomas. The complete excision of...

Prognostic impact of oral squamous cell carcinoma on 513 patients with pathologically positive lymph node metastasis: A retrospective multicenter study of the Japan Oral Oncology Group.

e17005 Background: Extracapsular spread (ECS) of pathologically positive regional lymph node metastasis (pN+) and the presence of positive margins are recognized as major adverse prognostic factors...

PCN175 - A Retrospective Study of Patients Out-of-Pocket Costs for Oral Oncology Medications for Multiple Myeloma

PCN175 - A Retrospective Study of Patients Out-of-Pocket Costs for Oral Oncology Medications for Multiple Myeloma

HPV and head and neck cancers: State-of-the-science

Oral human papillomavirus (HPV) infection causes a significant and growing proportion of head and neck squamous cell cancers. These malignancies arise from the oropharynx and tend to be located in the base of tongue and tonsil [1,2]. Studies in the past decade have demonstrated that HPV-positive head and neck cancers have distinct epidemiologic, clinical, and molecular features [3], which have significant implications for prevention, diagnosis, and treatment of this disease entity. This special issue of Oral Oncology provides an in-depth update on recent advances in the epidemiology, clinical and therapeutic implications, and molecular features of HPV-positive head and neck cancers.

Restricted mouth opening and trismus in oral oncology.

Restricted mouth opening (RMO) and trismus are terms commonly used in oral oncology in instances where there is difficulty in mouth opening. The term trismus in oral oncology is mainly used to indicate the radiation-induced fibrosis of the muscles of mastication. The treatment given for RMO as reported in the literature is given for muscular dysfunction trismus, whereas RMO in oral oncology can occur owing to various reasons other than muscular dysfunction. RMO occurs in various conditions of the oral cavity; in posterior pharyngeal infection, where it is termed reflectory trismus; in oral submucous fibrosis; in oral mucosal disorders; in the use of certain drugs; and in minor dental procedures of the posterior oral cavity. The usage of the term trismus in all RMO cases would complicate the treatment; thus, the word should not be used in all RMO cases.