Assessing and improving quality of life in patients with head and neck cancer

Health-related quality of life (QoL) indicates the patients' perception of their health. It depends not only on disease- and treatment-related factors but also on complex inter-relationships of expectations, values and norms, psychologic distress, and comparison with other patients. This article introduces methods and challenges of QoL assessment in patients with head and neck cancer, as well as ways to overcome measurement problems and ways to improve their QoL. </p

Oral White Lesions Associated with Chewing Khat

<p>Abstract</p> <p>Introduction</p> <p>Khat is a cultivated plant whose leaves when chewed elevate mood. Unlike the chewing of betel nut, no association between the white oral mucosal lesions in khat users and oral malignancies has been reported. Chewing of khat has been documented in many countries and has increased with worldwide migration. The impact of chewing khat upon the oral mucosa is essentially unknown.</p> <p>Purpose</p> <p>The purpose of this study was to assess the occurrence of oral white changes in chronic khat chewers. Oral mucosal changes in a group of 47 Yemenite Israeli men over 30 years of age, who had chewed khat more than 3 years, were compared to those of 55 Yemenite men who did not chew.</p> <p>Results</p> <p>White lesions were significantly more prevalent in the khat chewers (83%) compared to the non chewing individuals (16%) (P < 0.001). White oral lesions were identified primarily on the lower buccal attached gingival mucosa, the alveolar mucosa and the lower mucobuccal fold on the chewing side (p < 0.001). There was no significant association between the occurrence of the white lesions and smoking. Even though the majority of the white lesions (85.4%) were homogenous, 71.4% of the non homogenous lesions were identified in khat chewers. Vital staining with toluidine blue and exfoliative cytology was conducted on a subset of patients with homogenous and non-homogenous oral lesions, and there were no findings suspicious for pre-malignant or malignant changes.</p> <p>Discussion</p> <p>This study demonstrated a relationship between khat chewing and oral white lesions, which we attribute to chronic local mechanical and chemical irritation of the mucosa. Our findings also suggest that mucosal changes associated with khat are benign, however, this initial study requires further studies including follow-up of khat users to confirm the current findings, including the likely benign changes associated with chronic use and histologic findings of clinical lesions.</p

Clinical use of photobiomodulation for the prevention and treatment of oral mucositis: the real-life experience of MASCC/ISOO members

AimTo assess clinical use and patient outcome of photobiomodulation (PBM) for oral mucositis (OM) prevention and treatment among specialized practitioners.MethodsA poll was emailed to the members of the Mucositis Study Group of MASCC/ISOO. The PBM parameters used by the respondents were analyzed using exploratory statistical methods to identify combinations of PBM parameters (patterns) that characterize the variance in the protocols (principal component analysis).ResultsResponses were received from 101 MSG members, with 78 providing analyzable data. Most of the responders were dental practitioners or oral medicine specialists. PBM was used by 59% of the responders for OM or targeted therapy stomatitis. Technical parameters varied widely. Most responders used wavelengths & SIM;650 nm intra-orally. The spot-size and distance from the tissue were the main factors driving the variation. All PBM users noted that PBM relieved pain, either immediately or a delayed effect. High likelihood of pain relief (measured as responder's report of pain relief in 67-100% of patients) was reported by 22% and 19% of PBM users for immediate pain relief and delayed pain relief, respectively. The most common reported barriers to using PBM were financial considerations, time constraints, lack of training or experience and concern about the potential for malignant transformation or increased risk of cancer recurrence.ConclusionsThe use of PBM for OM prevention or treatment is in early phases of adoption in practices, facing some obstacles to implement it. A wide variation in technical parameters was found. Nonetheless, responses indicate that PBM provided pain relief

Adverse Reactions to Anticancer Drugs in the Oral Cavity

The development, testing, and adoption into clinical practice of anticancer medications have revolutionized cancer care over the past decades. A better understanding of the biology of cancer has translated into development of novel systemic agents, as well a more effective use of older chemotherapy agents. As a consequence, cancer mortality continues to decrease. However, greater cure and disease control rates come at a price of an increased risk of adverse effects, which often affects the mouth and related structures including the oral mucosa, salivary glands, jawbones, and cranial nerves. Oral mucositis, hyposalivation, dysgeusia, and osteonecrosis of the jaw (ONJ) are some examples of the potential adverse effects of anticancer therapies to the oral cavity, which affect an increasing number of individuals living with cancer and cancer survivors and can lead to persistent discomfort, pain, dysfunction, and a notable reduction in the quality of life. Management of these oral adverse effects can be challenging, as it typically requires a multidisciplinary approach and a close collaboration between the cancer team and oral health care providers, both in primary care and in the specialist setting. This special issue provides a useful update of some of the most significant adverse reactions to anticancer drugs in the oral cavity, with a view to inform clinical practice and inspire further research. Multitargeted tyrosine kinase inhibitors including sunitinib, sorafenib, axitinib, and cabozantinib are increasingly used in the cancer setting, and C. Arena et al. provide in this special issue a useful systematic review on oral mucositis associated with these agents. Similarly, K. Pimolbutr et al. report on the development of ONJ associated with antiangiogenic agents in the subset of antiresorptive-na\uefve patients. Prevention of toxicity is crucial in individuals due to commence and in those who have been using antiresorptive medications, and O. Di Fede et al. discuss the main strategies to reduce the risk ONJ in this patient population. The surgical treatment of medication-related ONJ is a relatively new field of research, as this condition has been historically managed conservatively with a focus on pain management and resolution of infection. In this special issue, R. Mauceri et al. report on the use of Er,Cr:YSGG laser and platelet-rich plasma in the surgical treatment of ONJ, whereas R. Sacco et al. provide a systematic review of the efficacy of microsurgical reconstruction of the jaws using vascularized free flap in patients with medication-related ONJ. We hope that the readers of BioMed Research International will find this special issue interesting and informative

Patterns of Cone-Beam Computed Tomography (CBCT) Utilization by Various Dental Specialties: A 4-Year Retrospective Analysis from a Dental and Maxillofacial Specialty Center

The study aimed to analyze the uses of cone-beam computed tomography (CBCT) in the diagnosis and treatment in various dental specialties. This 4-year cross-sectional study analyzed the records of 1409 individuals who underwent a CBCT at the Oral and Maxillofacial Center at Sheba Medical Center, Israel. The average age of the patients was 27.9 ± 11.5 (range: 9–86 years). Patients were referred for CBCT by the following departments: Oral and Maxillofacial Surgery (1063; 75.5%), Endodontics (182; 12.9%), Periodontology (122; 8.6%) and Orthodontics (42; 3.0%). Most CBCT radiographs evaluated the maxilla (774; 55.0%), followed by the mandible (481; 34.1%) and both (154; 10.9%). The target anatomical structures included: bone (694; 49.3%), teeth (307; 21.7%), and both jaws (408; 29.0%). The main indications for CBCT use were: assessment of anatomical structures and implant sites (787; 55.9%), determine root canals morphology (182; 12.9%), visualization of impacted teeth, tooth alignment, and localization (177; 12.6%), suspected cysts or tumors (148; 10.5%), evaluation of Temporomandibular joint disorders (106; 7.5%) and other reasons (9; 0.6%). In 279 (19.8%) of cases, the diagnosis changed following CBCT, mainly in Orthodontics tooth analysis (28 (66.7%); p &lt; 0.001). Practitioners and health authorities should be aware of this baseline information regarding CBCT use in the diagnosis and assessment of various oral and maxillofacial pathologies, anomalies and tooth position relative to anatomic structures. Continuing research and publications of CBCT utilization and guidelines are recommended

A life put on pause: an exploration of the health-related quality of life issues relevant to adolescents and young adults with cancer

Purpose: in recent years, the assessment of health-related quality of life (HRQoL) has been recognized as particularly informative to health care providers. For adolescents and young adults (AYAs), the impact of a cancer diagnosis and subsequent treatment is likely to be distinct from other age groups given the unique and complex physical and psychosocial challenges of this developmental phase. The objective of this study was to capture the HRQoL issues described by AYAs with cancer using thematic analysis.Methods: semi-structured interviews were carried out with 45 AYAs aged 14-25 years from 6 countries. Results: the most prevalent cancers presented were leukemia (n=12) and lymphoma (n=8). AYAs’ descriptive accounts were analysed and 12 categories identified: Symptoms (i.e., pain, nausea, vomiting) (84% AYAs); activity limitations (education, leisure time activities) (87%); disrupted life plans (29%); social (loss of friends, family life) (91%); emotional (depression, anxiety) (64%); body image (conscious of changed appearance) (36%); self-appraisals (greater maturity, braver) (47%); outlook on life (altered priorities, increased motivation to achieve) (33%); lifestyle (restricted diet, avoidance of infections) (18%), treatment-related (absence of age-appropriate information, treatment burden) (31%); fertility (24%); and financial concerns (13%). Conclusions: a wide spectrum of both negative and positive issues were described. Several of these issues, such as disrupted life plans and difficulty establishing romantic relationships, are likely to be more common to AYAs with cancer and might not be captured by existing HRQoL measures. Recognition of these issues and finding ways of addressing them should be seen as an essential component of AYA-tailored cancer care.<br/