Oral complications of cancer and cancer therapy

Abstract

Answer questions and earn CME/CNEOral complications resulting from cancer and cancer therapies cause acute and late toxicities that may be underreported, underrecognized, and undertreated. Recent advances in cancer treatment have led to changes in the incidence, nature, and severity of oral complications. As the number of survivors increases, it is becoming increasingly recognized that the aggressive management of oral toxicities is needed to ensure optimal long‐term oral health and general well‐being. Advances in care have had an impact on previously recognized oral complications and are leading to newly recognized adverse effects. Here, the authors briefly review advances in cancer therapy, including recent advances in surgery, oral care, radiation therapy, hematopoietic cell transplantation, and medical oncology; describe how these advances affect oral health; and discuss the frequent and/or severe oral health complications associated with cancer and cancer treatment and their effect upon long‐term health. Although some of the acute oral toxicities of cancer therapies may be reduced, they remain essentially unavoidable. The significant impact of long‐term complications requires increased awareness and recognition to promote prevention and appropriate intervention. It is therefore important for the primary oncologist to be aware of these complications so that appropriate measures can be implemented in a timely manner. Prevention and management is best provided via multidisciplinary health care teams, which must be integrated and communicate effectively in order to provide the best patient care in a coordinated manner at the appropriate time. CA Cancer J Clin 2012. © 2012 American Cancer Society.

Oral mucosal injury caused by mammalian target of rapamycin inhibitors: emerging perspectives on pathobiology and impact on clinical practice

“…Oral pain can profoundly impact the patient's oral function and overall quality of life (QOL) 39. In addition, the oral pain can limit administration of chemotherapy and mTOR inhibitors, resulting in delivery of suboptimal cancer treatment dosing 3. Unfortunately, treatments with nonopioid analgesics may not adequately control oral pain in some patients 39.…”

“…The pathogenesis and clinical phenotype of oral mucositis caused by high‐dose chemotherapy or radiotherapy are well described in the literature 1, 2, 3, 4, 5, 6, 7, 8. In contrast, a unique manifestation of oral mucosal injury has been documented within the past 5 years in association with mammalian target of rapamycin (mTOR) inhibitors 8, 9, 10.…”

Limitation of mouth opening after radiotherapy for head and neck

“…Epstein et al 15 stress that active/passive exercises should be commenced after surgery and radiotherapy in the region of the head and neck, when the muscles responsible for the movement of the lower jaw lie within the radiation field, as once a limitation on mouth opening is established, mobility is impaired. According to Ren et al 16 , the TheraBite ® , a tool used for mouth opening exercises, may be employed, or even other simple devices such as tongue depressors and corkscrews that are used in clinical practice to help with mouth opening.…”

Appropriate and necessary oral care for people with cancer: guidance to obtain the right oral and dental care at the right time

“…Patients with head and neck cancers may be treated with surgical resection, external beam radiotherapy and/or brachytherapy, and systemic drugs (chemotherapy and/or targeted agents), depending on the location, stage, and histology of the tumor and the clinical condition of each patient [2,4]. Treatments may be provided as single modality for early stage, localized disease, or more commonly, due to late stage diagnosis, using combined modalities of care [2,[5][6][7].…”

“…Advances in cancer treatment include intensitymodulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), ARC therapy, proton therapy, surgical technique (e.g., laser, robotic surgery, implants, vascularized tissue transfer), dose-dense chemotherapy regimens, targeted agents, immunotherapy, and maintenance therapy. These advances have led to improved cure rates, increased survivorship, and a growing number of people living with cancer [1][2][3].…”