Oral Hygiene Care in Patients With Advanced Disease: An Essential Measure to Improve Oral Cavity Conditions and Symptom Management

Magnani, Caterina; Mastroianni, Chiara; Giannarelli, Diana; Stefanelli, Maria Consiglia; Cienzo, Valeria Di; Valerioti, Teresa; Casale, Giuseppe

doi:10.1177/1049909119829411

Cited by 32 publications

(39 citation statements)

References 17 publications

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“…Despite the multitude of di culties, administering oral care to terminally ill patients is necessary. In a previous study, oral care was shown to increase oral moisture levels, provide relief from oral symptoms, provide a sensation of oral comfort, reduce the degree of dysgeusia, reduce the chances of odontogenic infections, increase the amount of food intake, and improve quality of life [4,5,8,[24][25][26]. Some conclusions were also provided by this present study.…”

Section: Discussionsupporting

confidence: 65%

“…Because of the general weakness and pain experienced by patients, side effects of cancer treatment or surgery, or depression, most patients ignore their oral health. Consequently, most patients have been reported to show poor oral health at admission into hospice wards [2,3,5,6,10,[23][24][25]. Among our patients, only 2 patients accepted a routine dental follow-up during the past 1-2 years.…”

Section: Discussionmentioning

confidence: 97%

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Professional oral care in end-of-life patients with advanced cancers in a hospice ward: Improvement of oral conditions

Liu

et al. 2020

Preprint

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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.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 97%

Professional oral care in end-of-life patients with advanced cancers in a hospice ward: Improvement of oral conditions

Liu

et al. 2020

Preprint

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“…Ensuring that patients maintain adequate oral hygiene care may also be helpful for dysgeusia management. 55 Diarrhea and/or constipation have frequently occurred in approximately one-third of patients treated with PARPi maintenance, and are generally grade 1-2 ( Table 3). Other frequent gastrointestinal disorders include abdominal pain and decrease in appetite; however, rates of abdominal pain seem to be similar in the placebo arm, and may also be related to underlying disease (Table 3).…”

Section: Gastrointestinal Disordersmentioning

confidence: 99%

Manage wisely: poly (ADP-ribose) polymerase inhibitor (PARPi) treatment and adverse events

Madariaga

Bowering

Ahrari

et al. 2020

Int J Gynecol Cancer

100

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Poly (ADP-ribose) polymerase (PARP) inhibitors (PARPi) have transformed the treatment landscape in front-line and recurrent high-grade serous ovarian cancer. Maintenance strategies with PARPi have been assessed in randomized phase III trials in ovarian cancer; switch maintenance in the case of olaparib, niraparib, and rucaparib; and concurrent followed by continuation maintenance with veliparib. These studies have shown progression-free survival advantage with PARPi maintenance, with no major adverse changes in the quality of life; however, overall survival data remain immature to date. PARPi have also been incorporated in clinical practice as a single-agent treatment strategy in high-grade serous ovarian cancer, mainly in women who harbor alterations in the BRCA1/2 genes or have alterations in the homologous recombination deficiency (HRD) pathway. Contemporary studies are looking into potentially synergistic combination strategies with anti-angiogenics and immune checkpoint inhibitors, among others. The expansion of PARPi treatment has not been limited to ovarian cancer; talazoparib is licensed in patients with HER2-negative breast cancer with germline BRCA mutations (BRCAm), and front-line olaparib maintenance in patients with pancreatic cancer with germline BRCAm. Numerous studies assessing PARPi either in monotherapy or in combination with other agents are ongoing in multiple tumors, including prostate, endometrial, brain, and gastric cancers. Many patients are being treated with PARPi, some for prolonged periods of time. As a result, a thorough knowledge of the potential short- and long-term adverse events and their management is warranted to improve patient safety, treatment efficacy, and towards maintaining an appropriate dose intensity.

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“…The median total OHAT score was 8 on Day 1, and it signi cantly decreased to 3. In conscious patients, during the care process, we used the assessment of care comfort for conscious patients, per a previous study [25]. Of the 17 conscious patients, 15 felt comfortable or slightly comfortable.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Professional oral care in end-of-life patients with advanced cancers in a hospice ward: Improvement of oral conditions

Liu

et al. 2020

Preprint

View full text Add to dashboard Cite

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.

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Oral Hygiene Care in Patients With Advanced Disease: An Essential Measure to Improve Oral Cavity Conditions and Symptom Management

Cited by 32 publications

References 17 publications

Professional oral care in end-of-life patients with advanced cancers in a hospice ward: Improvement of oral conditions

Professional oral care in end-of-life patients with advanced cancers in a hospice ward: Improvement of oral conditions

Manage wisely: poly (ADP-ribose) polymerase inhibitor (PARPi) treatment and adverse events

Professional oral care in end-of-life patients with advanced cancers in a hospice ward: Improvement of oral conditions

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