A survey of mouth pain and dryness in patients with advanced cancer

Abstract

An 11-item face-to-face survey was conducted in 99 consecutive patients with advanced cancer to determine the prevalence, intensity, reporting and treatment, presumed cause(s), and importance of mouth pain and dryness. Sixteen of the 99 patients (16%) reported experiencing mouth pain at a mean intensity corresponding to 5.5 +/- SD 2.21 on a 0 (no pain) to 10 (worst possible pain) numerical scale, and 88 (88%) patients reported dry mouth at a mean intensity corresponding to 6.2 +/- SD 2.21. Nine (56%) of the 16 patients with mouth pain and 39 (44%) of the 88 patients with mouth dryness reported these symptoms to their attending physician(s). Sixty-nine percent (27/39) of patients who reported having a dry mouth were advised by their physician(s) to pursue one or more treatments. The most common treatments recommended (and frequencies) were drinking water/taking sips of fluid (13), gargling with bicarbonate mouthwash (4), using an artificial saliva spray (4), and using an oral fungal suspension for thrush (4). The most common findings on oral examination included: possible thrush (53 patients), upper and lower dentures (33 patients), and multiple dental restorations (23 patients). The causes most frequently assumed to be responsible were ill-fitting dentures for mouth pain, and medications and possible oral fungal infections for mouth dryness. The mean values given for the importance of the symptoms of mouth pain and dryness relative to other symptoms or problems experienced by the patients were 4.4 +/- SD 1.84 and 3.6 +/- SD 1.67, respectively, on a Likert scale ranging from 1 (not important) to 7 (great importance). Mouth dryness was more frequently reported than mouth pain. The mean rating for the intensity of mouth pain was higher than that for mouth dryness, although both were of moderate importance to patients relative to other symptoms or problems experienced at the time. Patients tended to underreport mouth pain and dryness, and physicians tended to address such complaints inadequately.

Prevalence of oral mucositis, dry mouth, and dysphagia in advanced cancer patients

“…In patients attending a palliative care outpatient clinic, the prevalence of dry mouth was even higher to that reported in this survey [16]. Data were even more relevant in another study in which 88 % of palliative care patients reported dry mouth, with an intensity similar to that found in this study [13]. Dry mouth was one of the symptoms that presented a tendency to persist or to worse after admission to a palliative care unit [17].…”

“…Pain may be of concern, possibly limiting the ingestion of food and fluids. Sixteen percent of patients reported mouth pain at a mean intensity of 5.5 on a numerical scale from 0 to 10 [13]. As a consequence, oral cavity should be carefully assessed to treat the local condition, while eliminating eventual reversible factors, and pain management should be optimized.…”

“…Unfortunately, treatments are limited, and evidence on the effectiveness of measures in the treatment of dry mouth is poor [2]. The most common treatments recommended were drinking water/taking sips of fluid, gargling with bicarbonate mouthwash, using an artificial saliva spray, and using an oral fungal suspension for thrush [13]. In this study, chlorexidine, antifungal drugs, benzydamine, and natural agents have been prevalently prescribed by oncologist, in most cases unsuccessfully, and generally to treat also mucositis.…”

Oral status during radiotherapy and chemotherapy: a descriptive study of patient experiences and the occurrence of oral complications

“…This emphasises that hospital and dental staff should gather data on patient experiences of oral symptoms in addition to performing clinical examinations. This has also been emphasised by Dodd et al [5], who demonstrated that the medical record severely underdocumented the prevalence of mucositis compared with an interview, and by Oneschuk et al [28], who found that mouth pain and mouth dryness were underreported by patients with advanced cancer. However, clinical examinations and tests provide important indicators of the extent of oral complications and should be used as a complement to data on patient experiences.…”

Quantifying Radioxerostomia: Salivary Flow Rate, Examiner’s Score, and Quality of Life Questionnaire

“…This is of major importance as patients tend to underreport mouth pain and dryness, with the result that these complaints are inadequately represented in outcomes and interpretation of clinical studies [44]. These problems have led to several attempts to define "more valid" xerostomia outcome ratings covering the broad range of salivary properties [14,37].…”