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Murphy Dourieu E, Lisiecka D, Evans W, Sheahan P. Xerostomia: a silent burden for people receiving palliative care - a qualitative descriptive study. BMC Palliat Care 2025; 24:1. [PMID: 39757147 DOI: 10.1186/s12904-024-01617-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 12/05/2024] [Indexed: 01/07/2025] Open
Abstract
BACKGROUND The prevalence of dry mouth in the palliative care population is well documented and increases due to polypharmacy, radiotherapy and systemic conditions. Saliva as a lubricant for the mouth and throat has implications for swallowing, chewing, and speech. The literature about the experience of xerostomia (perceived feeling of dry mouth) in palliative care is scarce. Clinical evidence suggests that xerostomia has a negative impact on people's comfort, however, no recent studies explored this impact in detail. This new knowledge is paramount to adhere to the principles of palliative care. AIMS To evaluate the impact of xerostomia on the lives of people receiving palliative care with particular reference to eating and speaking. DESIGN: A qualitative descriptive study (interview design). Thematic analysis was used for data analysis. SETTING A single specialist palliative care centre in Ireland. RESULTS The majority of participants (35/40) had cancer. Xerostomia was reported to have multiple physical, psychological, and daily life consequences. Participants provided insights into the impact of xerostomia on sleeping, eating, talking, denture wearing, and they described in detail their intra-oral sensations associated with xerostomia. The negative effect of xerostomia on speech was reported as the most significant to participants. CONCLUSION Xerostomia has a profound impact on the daily lives of people receiving palliative care, including physical and psychological consequences. Speaking is often affected, which can impede the person's ability to communicate. There needs to be increased awareness of the impact of xerostomia and more research is required to understand how best to manage xerostomia in a palliative care setting.
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Affiliation(s)
- Emir Murphy Dourieu
- Kerry Specialist Palliative Care Service, University Hospital Kerry, Tralee, Co. Kerry, Ireland
- Department of Nursing and Health Sciences, Munster Technological University, Tralee, Co. Kerry, Ireland
| | - Dominika Lisiecka
- Department of Nursing and Health Sciences, Munster Technological University, Tralee, Co. Kerry, Ireland.
| | - William Evans
- Department of Nursing and Health Sciences, Munster Technological University, Tralee, Co. Kerry, Ireland
| | - Patricia Sheahan
- Kerry Specialist Palliative Care Service, University Hospital Kerry, Tralee, Co. Kerry, Ireland
- Department of Medicine, University College Cork, Cork, Co. Cork, Ireland
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Lee YJ, Hwang IC, Choi YS, Ahn HY, Lee EJ, Kim DE. Association Between Oral Health Status and Survival Time in Terminally Ill Cancer Patients. Am J Hosp Palliat Care 2024; 41:1138-1144. [PMID: 38063372 DOI: 10.1177/10499091231221204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2024] Open
Abstract
INTRODUCTION Patients with terminal cancer often experience various oral problems. Whether oral health status is associated with the survival of terminally ill cancer patients receiving palliative care remains unclear. METHODS We analyzed the data of 59 Korean patients with terminal cancer receiving palliative care, including their oral health status, using a modified Korean version of the Oral Health Assessment Tool (OHAT). Patients were categorized into "Good," "Moderate," or "Poor" groups based on OHAT scores. The Kaplan-Meier method was used to compare the median survival time, and the prognosis between groups was estimated using Cox proportional hazard models. RESULTS The most common oral symptoms observed were xerostomia (69.5%) and mucositis (17.0%). Significantly shorter survival times were observed in patients with hyperbilirubinemia, elevated creatinine levels, and no use of dentures. The "Poor" group had a shorter survival than the "Good" oral group (P = .010). A multivariate Cox proportional hazards analysis revealed that the "Poor" group was significantly associated with poor survival compared to the "Good" group (hazard ratio, 2.05; P = .047). CONCLUSION Terminally ill cancer patients with poor oral health may have a higher risk of shorter survival. Palliative care professionals should pay attention to oral health. Further research is needed to determine the effects of oral care on survival.
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Affiliation(s)
- Yoo Jeong Lee
- Palliative Care Center and Department of Family Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - In Cheol Hwang
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Youn Seon Choi
- Palliative Care Center and Department of Family Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - Hong Yup Ahn
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Eun Jeong Lee
- Palliative Care Center, Korea University Guro Hospital, Seoul, South Korea
| | - Da Eun Kim
- Department of Medicine, Korea University College of Medicine, Seoul, South Korea
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Shimosato M, Kada S, Yase E, Sakane N. Oral candida lesions and Candida tropicalis: Potential prognostic markers in end-of-life cancer patients. SPECIAL CARE IN DENTISTRY 2024; 44:1097-1106. [PMID: 38168741 DOI: 10.1111/scd.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
AIMS Oral candidosis is common in patients with end-of-life cancer; however, its prognosis is unclear. We aimed to assess oral candidosis and Candida species as prognostic indicators in palliative care for these patients. METHODS We consecutively included palliative care patients, assessed for candidosis via microbiological techniques, and classified into three groups by the extent of oral lesions. The association between oral candidosis and overall survival was assessed using a Cox proportional hazards model adjusted by performance status (PS). RESULTS We studied 142 patients (median age 77; 52.8% women) with a 76.1% oral candidosis prevalence. Candida albicans (80.6%) was the most common species. Oral lesions were classified as none, grade 1 (28.7%), or ≥ grade 2 (14.8%). During follow-up, Cox models identified ≥grade 2 lesions (aHR = 2.04; 95% CI: 1.18-3.54; p = .011) and Candida tropicalis (aHR = 2.38; 95% CI: 1.03-5.55; p = .044) as predictors. CONCLUSION The extent of oral candidosis lesions or the presence of C. tropicalis may serve as prognostic indicator in patients with end-of-life cancer. Therefore, solely concentrating on the prevalence and frequency of fungal species may be insufficient for predicting life prognosis; it is advisable to assess these parameters through both visual examination and culture.
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Affiliation(s)
- Maiko Shimosato
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shinpei Kada
- Department of Otolaryngology-Head and Neck Surgery, Otsu Red Cross Hospital, Otsu, Shiga, Japan
- Division of Clinical Research Planning and Management, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Eriko Yase
- Department of Pharmacy, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Phelan C, Hammond L, Thorpe C, Allcroft P, O'Loughlin M. A Novel Approach to Managing Thirst and Dry Mouth in Palliative Care: A Prospective Randomized Cross-Over Trial. J Pain Symptom Manage 2023; 66:587-594.e2. [PMID: 37562697 DOI: 10.1016/j.jpainsymman.2023.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
CONTEXT Thirst and xerostomia are significant and highly distressing symptoms experienced by patients receiving palliative and end-of-life care. OBJECTIVES Determine a reduction of thirst intensity and perceptions of dry mouth on a numerical scale following both the experimental intervention (mini mint ice cubes) and control (plain ice chips). METHODS Cross-over Randomized Controlled Trial (RCT) to assess the effectiveness of novel intervention in the treatment of dry mouth and the sensation of thirst in palliative care patients. RESULTS Patients rated the severity of their symptoms of dry mouth and thirst using a numeric rating scale (NRS). On commencing the study and preintervention, all patients suffered severe dry mouth and thirst (≥5/10). Mint and plain ice cubes produced improvement of symptoms immediately after interventions. Results from dry mouth ratings show, a decrease of 1.6 points for plain ice cubes (P < 0.0001), on average, ratings for mint ice cubes decreased 3.7 (P < 0.0001). For the sensation of thirst, the plain ice cube intervention group rating decreased 1.7 points (P < 0.006), ratings for mint ice cubes decreased 3.4 points (P < 0.0001). The average decrease in dry mouth and thirst intensity scores from preintervention to postintervention were significantly greater for mint ice cubes (P < 0.05) and 86.6% of patients preferred mint ice cubes. CONCLUSION This trial found that while usual mouth care and the intervention were both able to reduce the intensity of dry mouth and the sensation of thirst, the mint intervention had a greater response.
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Affiliation(s)
- Caroline Phelan
- Research Centre for Palliative Care (C.P., L.H., C.T., P.A., M.O.), Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.
| | - Lauren Hammond
- Research Centre for Palliative Care (C.P., L.H., C.T., P.A., M.O.), Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Courtney Thorpe
- Research Centre for Palliative Care (C.P., L.H., C.T., P.A., M.O.), Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Peter Allcroft
- Research Centre for Palliative Care (C.P., L.H., C.T., P.A., M.O.), Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia; Southern Adelaide Local Health Network (P.A., M.O.), Southern Adelaide Palliative Services, Bedford Park, Australia
| | - Muireann O'Loughlin
- Research Centre for Palliative Care (C.P., L.H., C.T., P.A., M.O.), Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia; Southern Adelaide Local Health Network (P.A., M.O.), Southern Adelaide Palliative Services, Bedford Park, Australia
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Hammond L, Chakraborty A, Thorpe C, O'Loughlin M, Allcroft P, Phelan C. Relieving Perception of Thirst and Xerostomia in Patients with Palliative and End-of-life Care Needs: A Rapid Review. J Pain Symptom Manage 2023; 66:e45-e68. [PMID: 36828290 DOI: 10.1016/j.jpainsymman.2023.02.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
CONTEXT Thirst and dry mouth are interlinked symptoms that frequently cause significant distress for patients with life-limiting conditions. OBJECTIVES The objective of this rapid review was to identify and synthesize effective interventions that relieve perceptions of thirst and dry mouth of patients with palliative care and end-of-life care needs. METHODS Eligible studies were undertaken in clinical settings, with patients experiencing thirst-related distress and/or dry mouth. This review of peer-reviewed literature was conducted following aspects of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. The main outcomes of interest were: 1) efficacy of thirst and dry mouth interventions for patient, and 2) patient, caregiver, and staff acceptability and satisfaction of the interventions. Scientific journal articles were retrieved through searches in electronic databases of MEDLINE (Ovid), CINAHL (EBSCO), and AgeLine (EBSCO). RESULTS Eleven studies were included for analysis and synthesis of the results. Most studies either focused on a dry mouth intervention or reported dry mouth outcomes within a broader thirst intervention (n = 9/11 studies). Standard oral care was the common intervention type (n = 5/11). All but one dry mouth intervention reported statistical improvement in outcomes of interest. All studies that reported on thirst were conducted in an Intensive Care Unit (ICU) setting (n = 4/4). No studies specifically addressed thirst in patients in specialist palliative care settings. CONCLUSION Evidence from this review suggests that thirst interventions established within the ICU setting may prove effective for treatment of terminally ill patients receiving specialist palliative care.
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Affiliation(s)
- Lauren Hammond
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University (L.H., A.C., C.T., M.O., P.A., C.P.), Bedford Park, South Australia
| | - Amal Chakraborty
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University (L.H., A.C., C.T., M.O., P.A., C.P.), Bedford Park, South Australia
| | - Courtney Thorpe
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University (L.H., A.C., C.T., M.O., P.A., C.P.), Bedford Park, South Australia
| | - Muireann O'Loughlin
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University (L.H., A.C., C.T., M.O., P.A., C.P.), Bedford Park, South Australia; Southern Adelaide Local Health Network, Southern Adelaide Palliative Services (M.O., P.A.), Bedford Park, South Australia
| | - Peter Allcroft
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University (L.H., A.C., C.T., M.O., P.A., C.P.), Bedford Park, South Australia; Southern Adelaide Local Health Network, Southern Adelaide Palliative Services (M.O., P.A.), Bedford Park, South Australia
| | - Caroline Phelan
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University (L.H., A.C., C.T., M.O., P.A., C.P.), Bedford Park, South Australia.
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Silva ARP, Bodanezi AV, Chrun ES, Lisboa ML, de Camargo AR, Munhoz EA. Palliative oral care in terminal cancer patients: Integrated review. World J Clin Cases 2023; 11:2966-2980. [PMID: 37215429 PMCID: PMC10198072 DOI: 10.12998/wjcc.v11.i13.2966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/07/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Palliative care (PC) aims to improve quality of life in patients and its families against life threatening diseases, through suffering's prevention and relief. It is the duty of the dental surgeon to possess the knowledge needed to treat a patient with little life span, in order to establish an adequate treatment plan for each situation. AIM To synthesize the published evidence on oral conditions, impact, management and challenges in managing oral conditions among palliative patients. METHODS Articles were selected from PubMed and Scopus electronic platforms, using a research strategy with diverse descriptors related to "palliative care", "cancer" and "oral health". The article's selection was done in two phases. The first one was performed by the main researcher through the reading of the abstracts. In the second phase two researchers selected eligible articles after reading in full those previous selected. Data was tabulated and analyzed, obtaining information about what is found in literature related to this subject and what is necessary to be approached in future researches about PC. RESULTS As results, the total of 15 articles were eligible, being one a qualitative analysis, 13 (92.8%) clinical trials and one observational study. Of the 15 articles, 8 (53.4%) involved questionnaires, while the rest involved: one systematic review about oral care in a hospital environment, 2 oral exams and oral sample collection, one investigation of terminal patient's (TP) oral assessment records, 2 collection of oral samples and their respective analysis and one treatment of the observed oral complications. CONCLUSION It can be concluded that the oral manifestations in oncologic patients in terminal stage are, oral candidiasis, dry mouth, dysphagia, dysgeusia, oral mucositis and orofacial pain. Determining a protocol for the care of these and other complications of cancer - or cancer therapy - based on scientific evidence with the latest cutting-edge research results is of fundamental importance for the multidisciplinary team that works in the care of patients in PC. To prevent complications and its needed to initial the dentist as early as possible as a multidisciplinary member. It has been suggested palliative care protocol based on the up to date literature available for some frequent oral complications in TP with cancer. Other complications in terminal patients and their treatments still need to have further studying.
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Affiliation(s)
- Ana Rute Preis Silva
- Department of Dentistry, Federal University of Santa Catarina, Florianopolis 88040-379, Brazil
| | - Augusto Vanni Bodanezi
- Department of Dentistry, Federal University of Santa Catarina, Florianopolis 88040-379, Brazil
| | - Emanuely Silva Chrun
- Department of Pathology, Federal University of Santa Catarina, Florianopolis 88040900, Brazil
| | - Mariah Luz Lisboa
- Professor Polydoro São Thiago Ernani Hospital, Federal University of Santa Catarina, Florianopolis 88040900, Brazil
| | - Alessandra R de Camargo
- Department of Dentistry, Federal University of Santa Catarina, Florianopolis 88040-379, Brazil
| | - Etiene Andrade Munhoz
- Department of Dentistry, Health Science Centre, Federal University of Santa Catarina, Florianopolis 88040-379, Brazil
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Delgado MB, Plessas A, Burns L, Neilens H, Griffiths S, Latour J. Oral care experiences of palliative care patients, their relatives/carers and healthcare professionals. Int J Palliat Nurs 2021; 27:504-514. [PMID: 34919418 DOI: 10.12968/ijpn.2021.27.10.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To explore the oral care experiences of palliative care patients and of those who support or deliver oral care to these patients: nurses, doctors, dentists, their relatives and carers. DATA SOURCES An electronic search of the databases included: Embase, MEDLINE, DOSS, AMED and PsycINFO was performed. DATA SELECTION Six articles were included in the final synthesis. DATA EXTRACTION Thematic analysis was applied by two researchers. DATA SYNTHESIS Three themes were identified: 'performing oral care', 'effects on oral health' and 'challenges in palliative care'. CONCLUSIONS Despite similarities of oral care experiences, this review identified some differences, crucially in terms of the wider impact of oral symptoms, namely social interactions with others and challenges to oral care. This confirms the need to investigate these topics further in relation to different stakeholders, such as nurses; and to have consistent guidance to facilitate the provision of effective oral care to palliative care patients.
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Affiliation(s)
| | - Anastasios Plessas
- Academic Fellow, Peninsula Dental School, Faculty of Health, University of Plymouth, UK
| | - Lorna Burns
- Information Specialist, Peninsula Dental School, Faculty of Health, University of Plymouth, UK
| | - Helen Neilens
- Senior Research Advisor/Trust Innovation Lead, Research and Development Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Sarah Griffiths
- Research Fellow, Peninsula Medical School, Faculty of Health, University of Plymouth, UK
| | - Jos Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, UK
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Wu TY, Liu HY, Wu CY, Chen HC, Huang ST, Chen PH. Professional oral care in end-of-life patients with advanced cancers in a hospice ward: improvement of oral conditions. BMC Palliat Care 2020; 19:181. [PMID: 33246449 PMCID: PMC7697385 DOI: 10.1186/s12904-020-00684-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/10/2020] [Indexed: 11/21/2022] Open
Abstract
Background In end-of-life patients with advanced cancers, oral examination, oral care, and oral re-examination are crucial. Although oral symptoms are among the major complaints of end-of-life patients, few studies have focused on oral care in these patients. In this study, the association between oral symptoms and oral dryness among end-of-life patients was examined, and improvement of oral conditions after oral care interventions by a professional dentist was quantified. Methods This prospective intervention study included 27 terminally ill patients with advanced cancers in a hospice ward. Professional oral care was administered every morning, and the improvement of oral conditions was assessed by comparing oral conditions before and after the intervention. Oral assessment was performed using the Oral Health Assessment Tool (OHAT) and Oral Assessment Guide. Oral dryness was evaluated through Clinical Diagnosis Classification of oral dryness and an oral moisture device. Oral cleanliness was evaluated using a bacterial counter, and tongue smears were collected for Candida examination; furthermore, oral function was recorded. Results The presence of oral mucositis was closely associated with severe oral dryness (odds ratio [OR] = 14.93; 95% confidence interval [CI]: 1.95–114.38). The level of oral debris retention was significantly related to the degree of oral dryness (OR = 15.97; 95% CI: 2.06–123.72). The group with higher scores (OHAT > 8), which represent poor oral conditions, showed severe oral dryness (OR = 17.97; 95% CI: 1.45–223.46). Total OHAT scores (median: 7 vs 2) and those of other subgroups (lip, tongue, gums and tissues, saliva, and oral cleanliness showed a significant decrease after the intervention. Furthermore, the occurrence of mucositis (47.1% vs 0%), candidiasis rate (68.8% vs 43.8%), oral dryness self-sensation (63.6% vs 9.1%), and severe oral debris (52.9% vs 11.8%) decreased significantly. Conclusions Proper oral care can improve oral health and hygiene, reduce the rate of mucositis, reduce the sensation of oral dryness, increase oral moisture, and reduce the chances of oral infections among end-of-life patients. Daily oral care is necessary and can alleviate oral discomfort, increase food intake, and increase the chances of communication between end-of-life patients and their families. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12904-020-00684-0.
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Affiliation(s)
- Ting-Ying Wu
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
| | - Hsiu-Yueh Liu
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
| | - Chien-Yi Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
| | - Hung-Cheng Chen
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
| | - Shun-Te Huang
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan. .,Division of Special Care Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan.
| | - Ping-Ho Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan. .,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan. .,Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan. .,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, 80424, Taiwan.
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Kong AC, George A, Villarosa AR, Agar M, Harlum J, Wiltshire J, Srinivas R, Parker D. Perceptions of nurses towards oral health in palliative care: A qualitative study. Collegian 2020. [DOI: 10.1016/j.colegn.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Shimosato M, Asai K, Yokomichi N, Nagano K, Sakane N. Diagnostic accuracy of patient-reported dry mouth as a predictor for oral dryness in terminally ill cancer patients. Support Care Cancer 2020; 29:2743-2748. [PMID: 32989524 DOI: 10.1007/s00520-020-05798-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 09/22/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of the study was to determine the diagnostic accuracy of patient-reported dry mouth using an oral moisture-checking device in terminally ill cancer patients. METHODS The study was conducted following the STARD guidelines, and the participants were recruited prospectively from the Palliative Care Unit, Kyoto Medical Center, Japan, between 1 January 2017 and 30 November 2018. Patients reporting dry mouth were asked to rate oral dryness on a 5-point rating scale. The outcome was oral dryness at the lingual mucosa, measured using an oral moisture-checking device. Receiver operating characteristic (ROC) curves were plotted, and the sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR), and overall diagnostic accuracy were calculated. RESULTS Of 103 participants, the prevalence of oral dryness was 65.0%. ROC analysis indicated that patient-reported dry mouth was a poor predictor of oral dryness, with an area under the curve of 0.616 (95% confidence interval: 0.508-0.723), a sensitivity of 46.3%, a specificity of 75.8%, a PPV of 55.9%, an NPV of 68.1, a positive LR of 1.9, a negative LR of 0.7, and an overall diagnostic accuracy of 64.1%, with a cut-off value of 3 points. CONCLUSION In conclusion, patient-reported dry mouth is not a useful parameter for the assessment of oral dryness in terminally ill cancer patients.
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Affiliation(s)
- Maiko Shimosato
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Kyoto Medical Center, 1-1, Fukakusa-Mukaihata, Fushimi-Ku, Kyoto, 612-8555, Japan.
| | - Keita Asai
- Department of Oral and Maxillofacial Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naosuke Yokomichi
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Keiji Nagano
- Division of Oral Biology, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Naoki Sakane
- Division of Preventive Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Nakajima N. Challenges of Dental Hygienists in a Multidisciplinary Team Approach During Palliative Care for Patients With Advanced Cancer: A Nationwide Study. Am J Hosp Palliat Care 2020; 38:794-799. [PMID: 32969232 DOI: 10.1177/1049909120960708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Palliative care is constructed by various kinds of professionals. This study aimed to identify the challenges that dental hygienists (DHs) encountered when working with other professionals in a multidisciplinary team approach in palliative care for advanced cancer patients. METHODS We conducted the following two studies: (1) a questionnaire-based survey for DHs who belong to Japanese Society for Oral Care (JSOC) on oral care in palliative care settings (n = 1,290), and (2) surveys on education for DHs in universities. Items in this study included the following: 1) a cross-sectional analysis of the curriculum on palliative care at 10 universities and 2) a questionnaire-based survey on palliative care education at 1 of the 10 universities (n = 75). RESULTS (1) Seventy-three percent had experience in oral care in palliative care settings. The number of DHs with ≥20 years' experience was significantly higher than those with <10 years' experience (76% vs 66%, p = 0.042). Further, 92% received no formal palliative care education, and 94% perceived a lack of knowledge on palliative care. These data did not differ based on the years of experience. (2) (a) There was no specific curriculum on the subject of palliative care in 10 universities. Lectures on palliative care were provided at 3 universities. (b) Fifty-five percent of students attended lectures on palliative care. However, 88% of them experienced anxiety, and 78% perceived few classes on palliative care. CONCLUSIONS For DHs, to positively contribute to multidisciplinary palliative care team approach, it is important to establish pregraduate and postgraduate education systems.
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Affiliation(s)
- Nobuhisa Nakajima
- Division of Community-Based Medicine and Primary Care, 118113University of the Ryukyus Hospital, Nishihara, Nakagami, Okinawa, Japan
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Venkatasalu MR, Murang ZR, Ramasamy DTR, Dhaliwal JS. Oral health problems among palliative and terminally ill patients: an integrated systematic review. BMC Oral Health 2020; 20:79. [PMID: 32188452 PMCID: PMC7079519 DOI: 10.1186/s12903-020-01075-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High incidence of treatable oral conditions has been reported among palliative patients. However, a large proportion of palliative patients lose their ability to communicate their sufferings. Therefore, it may lead to under-reporting of oral conditions among these patients. This review systematically synthesized the published evidence on the presence of oral conditions among palliative patients, the impact, management, and challenges in treating these conditions. METHODS An integrative review was undertaken with defined search strategy from five databases and manual search through key journals and reference list. Studies which focused on oral conditions of palliative patients and published between years 2000 to 2017 were included. RESULTS Xerostomia, oral candidiasis and dysphagia were the three most common oral conditions among palliative patients, followed by mucositis, orofacial pain, taste change and ulceration. We also found social and functional impact of having certain oral conditions among these patients. In terms of management, complementary therapies such as acupuncture has been used but not well explored. The lack of knowledge among healthcare providers also posed as a challenge in treating oral conditions among palliative patients. CONCLUSIONS This review is first in its kind to systematically synthesize the published evidence regarding the impact, management and challenges in managing oral conditions among palliative patients. Although there is still lack of study investigating palliative oral care among specific group of patients such as patients with dementia, geriatric or pediatric advanced cancer patients, this review has however provided baseline knowledge that may guide health care professionals in palliative settings.
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Affiliation(s)
- Munikumar Ramasamy Venkatasalu
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Zaidah Rizidah Murang
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Divya Thirumalai Rajam Ramasamy
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Jagjit Singh Dhaliwal
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam.
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Fitzgerald R, Gallagher J. Oral health in end-of-life patients: A rapid review. SPECIAL CARE IN DENTISTRY 2018; 38:291-298. [DOI: 10.1111/scd.12316] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/18/2018] [Accepted: 07/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Richard Fitzgerald
- King's College London Dental Institute; Denmark Hill Campus; Bessemer Road London SE5 9RS UK
| | - Jennifer Gallagher
- King's College London Dental Institute; Denmark Hill Campus; Bessemer Road London SE5 9RS UK
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14
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Berger K, Schopohl D, Bollig A, Strobach D, Rieger C, Rublee D, Ostermann H. Burden of Oral Mucositis: A Systematic Review and Implications for Future Research. Oncol Res Treat 2018; 41:399-405. [PMID: 29734184 DOI: 10.1159/000487085] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/22/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Surprisingly little is known about the burden of oral mucositis (OM). We provide a systematic review of studies on the burden of OM (incidence, economic impact, health-related quality of life (HRQoL)). METHODS Systematic literature searches were made in BIOSIS, EMBASE, and MEDLINE. Inclusion criteria were studies on OM in hematology/oncology patients of ≥ 18 years, journal articles, English language, and published between 2000 and 2016; OM treatment studies were excluded. Quality assessment was performed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS We screened 4,996 hits, and identified 68 studies of which 13 were without transparency on OM grading. The evidence level of 65 studies was rated 'low' or 'very low' in 58.5%, 'moderate' in 20% and 'high' in 21.5%. Mean value of incidence (7 studies) was 83.5% for all grades of OM with hematopoietic stem cell transplantation. OM incidence for all grades in head and neck cancer patients was 59.4-100%. Considering the economic impact, 16 studies showed highly variable numbers. HRQoL was measured in 16 studies using 13 different instruments. Statistically significant changes in HRQoL scores were demonstrated. CONCLUSION OM is common, burdensome, costly and imposes major reductions in HRQoL. However, from a quality standpoint, the level of current evidence in OM is disappointing. The field needs continued attention to address methodological challenges.
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