Financial and socio-economic factors influencing pre- and post-cancer therapy oral care

A systematic review of dentists' knowledge, perception, practice and confidence in managing patients with cancers

PURPOSE

Little is known about dentists' preparedness in managing oral side effects in patients undergoing cancer therapy (CTx). The purpose of this systematic review is to identify barriers and facilitators of dentists in managing oral health of cancer patients (CPs).

METHODS

The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was Prospero registered (CRD42022333055). CINAHL, Embase, Medline, PsycInfo and Scopus databases were searched using keywords and MeSH terms: dentists, oral health, cancer. The outcomes were analysed descriptively and thematically.

RESULTS

Of the 2303 articles screened 53 met eligibility criteria. Most of articles (n = 50) reported on head and neck cancer (HNC) management. Dentists' oral cancer (OC) knowledge varied across studies (27% to 81%, n = 35). Regardless of their knowledge level, the majority of dentists expressed interest in further cancer education. Across studies, dentists perceived that their role included providing dental treatment for OC patients. However, of the few studies (n = 3) that explored dentists' confidence in managing CPs, less than half of dentists felt confident providing advice to patients with HNC. More barriers than facilitators are identified in providing dental care provision to CPs.

CONCLUSION

This review demonstrates gap in dental care for patients with non-HNCs and highlights a need for methods to involve dentists in managing dental health of CPs.

Association of Medical Appointment Cancellation Rates on Survival After Esophagectomy for Esophageal Cancer

BACKGROUND

Cancelled healthcare appointments, especially in patients with complex cancers, such as esophageal cancer, risk delayed treatment and adverse outcomes. We hypothesized that patients with greater rates of healthcare appointment cancellations would have decreased survival after esophagectomy for esophageal cancer.

METHODS

A retrospective analysis of patients from a single institution who underwent esophagectomy for esophageal cancer between 2004 and 2020 was performed. Appointment cancellations were queried 2 years pre-/post-esophagectomy and categorized as medical or ancillary. Continuous and categorical variables were compared by Mann-Whitney and chi-squared analyses, respectively. Survival associations post-esophagectomy were made by Kaplan-Meier analysis.

RESULT

Seventy-six patients were identified. Total medical and ancillary appointments post-esophagectomy increased by 188% and 136%, respectively. Per patient, there was a median increase of 57.5 medical appointments in the post-esophagectomy period. Of medical appointments, 23.7% were cancelled pre-esophagectomy but 33.4% post-esophagectomy (p < 0.001). This trend held true for ancillary appointments. Patients with increased medical cancellation rates post-esophagectomy had shortened recurrence-free (p = 0.09) and overall survival (p < 0.01) versus patients with low cancellation rates.

CONCLUSION

A significant increase in healthcare appointments is seen after esophagectomy. Patients with increased healthcare appointment cancellations have decreased post-esophagectomy survival which presents an opportunity to intervene in patients who historically have a high cancellation rate.

Addressing oral health barriers to care in head and neck cancer patients using a novel collaborative care approach

With appropriate interprofessional collaboration, dental schools have the capacity to facilitate the dental management of patients with head and neck cancer who are facing multiple barriers to care.

Inequalities in utilization and provision of dental services: a scoping review

BACKGROUND

There are many determinants that can affect inequality in oral and dental health. This study is aimed to explore the main determinants of inequality in both utilization and provision of dental services in Organization for Economic Co-operation and Development (OECD) countries.

METHODS

Four databases including PubMed, ISI WOS, Scopus, and ProQuest were searched up to 8 Aug 2020, applying the relevant keywords. Thematic analysis was used for synthesizing and extracting data. Trend analysis was applied to determine the trends of the inequality determinants.

RESULTS

Thematic analysis led to 6 main themes, 13 sub-themes, and 53 sub-sub-themes. The main themes represent the main inequality determinants for both utilization and provision of dental services. The streamgraph illustrated that fewer studies have been conducted on social and cultural determinants, and for almost all determinants the trend of published articles has been increasing since 2007, with the exception of health policies.

CONCLUSIONS

Inequality in the utilization and provision of dental services is addressed by various factors including individual, social, cultural and economic determinants, health policies, and availability of services. The first four determinants are related to utilization and the last two are related to the provision of services. All these aspects must be considered to reduce inequality in dental services.

Lower levels of education and household income mediate lower dental care utilization among survivors of early life cancers

This study was an examination of dental care utilization among survivors of early life cancers (cancer diagnosis at 20 years of age or younger) and the extent to which socio-economic factors may present a barrier to care. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016 (n = 28,640). Survey-weighted regression models were used to evaluate associations between early life cancers and subsequent frequency of dental care as adults. A mediation analysis was conducted to test education and household income as potential mediators of this association using a non-parametric bootstrap approach. Early life cancers were associated with a significant decrease in dental care utilization as adults (OR:0.459, 95%CI:(0.226, 0.935)). This diminished utilization was particularly pronounced with survivors in their 20s and 30s. Over time dental care utilization began a slow recovery. The association between early cancer and level of education was estimated to be negative but did not reach statistical significance (OR:0.739, 95%CI:(0.503, 1.086), p = 0.123). Survivors of early life cancers were less likely to be in a higher income bracket (OR:0.663, 95%CI:(0.452, 0.973), p = 0.036)). Decreases in education and household income (p < 0.001) mediated the association between early cancers and lower dental utilization. This pathway accounted for 41.7% (95%CI:(14.1%, 50.6%)) of the association. Survivors of early life cancers did not utilize professional oral health care at a rate commensurate with their risk of dental disease. Providers involved in the long-term care should promote routine dental maintenance. Further study into non-economic barriers in this population is warranted.

Associated factors with health-compromising behaviors among patients treated for oral cancer

BACKGROUND

To improve eradication strategies of health-compromising behaviors between oral cancer survivors, this study aimed to explore the extent of clustering of risk behaviors and to assess possible factors associated.

MATERIAL AND METHODS

A cross-sectional study was carried out among oral cancer patients at least 6 months after treatment. They completed a questionnaire about smoking, alcohol consumption, oral hygiene habits and dental visits. Presence of clusters was evaluated through pairwise Pearson correlations and principal component analysis. Factors associated with each identified cluster were analyzed with multivariate models.

RESULTS

Among 142 patients, 14.8% smoked, 51.7% consumed alcohol, 52.1% performed oral hygiene less than twice a day, and 74.6% visited to dentist when there was a problem or never. There were two distinct clusters: smoking-alcohol consumption (general risk behaviors cluster) and oral hygiene-dental attendance (oral risk behaviors cluster). Multivariate analysis showed significant associations between males and both clustering patterns of health compromising behaviors, patients with clinical stage I or with longer follow-up and the presence of general risk behaviors cluster and worse social class and the presence of oral risk behaviors cluster.

CONCLUSIONS

A high proportion of patients treated for oral cancer presented health-compromising behaviors occurring in clusters which reinforce the need for health promotion strategies to target multiple behaviors. Factors analyzed suggest that chances of having detrimental behavioral clustering are higher in male, patients with clinical stage I, with lower social class and those with longer follow-up after treatment.

Oral health and dental morbidity in long-term allogeneic blood and marrow transplant survivors in Australia

BACKGROUND

Oral and dental disease is a major cause of long-term morbidity following allogeneic blood and marrow transplantation (Allo-BMT). This study aimed to describe the extent and range of oral and dental complications in BMT recipients and to identify gaps in service provision provided to this high-risk group.

METHODS

Participants were Allo-BMT recipients, aged >18 years, and received transplants between 2000 and 2012 in NSW. They completed seven surveys, the purpose-designed Sydney Post-BMT Study survey and six other validated instruments.

RESULTS

Of 441 respondents, many reported dry mouth (45.1%), dental caries (36.7%), mouth ulcers (35.3%), oral GVHD (35.1%), gingivitis (16.2%), tooth abscess (6.1%) and oral cancer (1.5%). Regular dental visits were reported by 66.2% of survivors. Middle-high income, older age and geographic location showed a positive association with regular dental visits. Of those who did not visit the dentist regularly, 37% stated they did not feel it necessary, 36% reported cost and 20% stated it was not advised by the treating team.

CONCLUSION

Despite oral complications commonly occurring after Allo-BMT, many survivors receive inadequate dental care. These results emphasize the need for improved oral health education, the importance of regular dental checks and improvement in the delivery of dental health services for BMT survivors.