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Kakei Y, Shimosato M, Soutome S, Funahara M, Shikama Y, Sakamoto Y, Ikegami Y, Otsuru M, Natsume N, Umeda M. Interventional Prospective Studies on Xerostomia in Patients Undergoing Palliative and End-of-Life Care: A Scoping Review. Cureus 2024; 16:e63002. [PMID: 38915834 PMCID: PMC11194537 DOI: 10.7759/cureus.63002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2024] [Indexed: 06/26/2024] Open
Abstract
Patients undergoing palliative care often develop debilitating oral conditions, including xerostomia. These conditions may significantly impact patients' quality of life. Despite the high prevalence and adverse impact of xerostomia, effective management strategies remain unclear. This scoping review was performed to elucidate effective interventions for xerostomia in patients undergoing palliative and end-of-life care. A comprehensive search strategy was employed to identify relevant studies up to August 2023. Full-text primary articles focusing on xerostomia in patients receiving palliative care were included in the review. Eleven articles were selected for analysis, and data were extracted by six reviewers. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Among the 11 studies, interventions ranged from oral care to saliva substitutes and methods to stimulate saliva secretion. The primary method of assessing xerostomia was the performance of subjective evaluations using visual analog scale scores or numerical rating scale scores. Various interventions including oral care regimens, topical treatments, and mixed efficacy outcomes were reported. Notably, only one study directly measured the saliva volume, highlighting a reliance on subjective endpoints in most studies. Although no definitive conclusions can be drawn regarding the most effective intervention, oral care was a preferred option for managing xerostomia in patients undergoing palliative care. Additionally, adjunctive treatments such as ice cubes, saline, and moisturizers showed promise but require further investigation. Objective measures should be incorporated into future intervention trials to complement subjective assessments and provide a comprehensive evaluation of xerostomia management strategies in this patient population.
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Affiliation(s)
- Yasumasa Kakei
- Department of Oral and Maxillofacial Surgery, Kobe University Hospital, Kobe, JPN
| | - Maiko Shimosato
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, JPN
| | - Sakiko Soutome
- Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | - Madoka Funahara
- School of Oral Health Sciences, Kyushu Dental University, Kitakyusyu, JPN
| | - Yuko Shikama
- Department of Oral and Maxillofacial Surgery, Nagoya City University Hospital, Nagoya, JPN
| | - Yuki Sakamoto
- Department of Oral Surgery, Kansai Medical University Medical Center, Moriguchi, JPN
| | - Yumiko Ikegami
- Department of Nursing, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, JPN
| | - Mitsunobu Otsuru
- Department of Oral and Maxillofacial Surgery, Kanagawa Dental University, Yokosuka, JPN
| | - Nagato Natsume
- Division of Research and Treatment for Oral and Maxillofacial Congenital Anomalies, School of Dentistry, Aichi Gakuin University, Nagoya, JPN
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
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Serra R, de Oliveira CS, Roque S, Herrera F, Arco H. Oral hygiene care and the management of oral symptoms in patients with cancer in palliative care: a mixed methods systematic review protocol. JBI Evid Synth 2024; 22:673-680. [PMID: 37791797 PMCID: PMC10986783 DOI: 10.11124/jbies-23-00096] [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: 10/05/2023]
Abstract
OBJECTIVE The objective of this review is to examine the effectiveness of oral hygiene care in the management of oral symptoms in patients with cancer under specialist palliative care and the patients' experience of such symptoms and care. INTRODUCTION Oral symptoms, such as xerostomia, mouth pain, or dysgeusia, are highly prevalent in patients with cancer under specialist palliative care. These symptoms have a negative effect on patients' quality of life. Oral hygiene care can manage oral symptoms and could be improved with a more systematized approach, adequate guidelines, and training to properly integrate oral hygiene into the care provided in specialist palliative care. INCLUSION CRITERIA This review will consider quantitative, qualitative, and mixed methods studies on the effectiveness and experience of oral hygiene care intended to manage oral symptoms in patients with cancer aged 18 years or older, diagnosed with any type of cancer, under specialist palliative care. METHODS The search will be conducted in MEDLINE (PubMed), CINAHL (EBSCOhost), Cochrane Central Register of Controlled Trials, Dentistry and Oral Sciences Source (EBSCOhost), and MedicLatina (EBSCOhost). Sources of unpublished studies and gray literature to be searched will include Networked Digital Library of Theses and Dissertations and Repositórios Científicos de Acesso Aberto de Portugal. Studies in English, Portuguese, and Spanish published from 2000 to the present will be considered. Methodological quality of included studies will be assessed and data will be extracted. Synthesis and integration will follow the JBI segregated approach for mixed methods reviews. REVIEW REGISTRATION PROSPERO CRD42023400554.
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Affiliation(s)
- Ricardo Serra
- Department of Health Sciences and Technologies, Polytechnic Institute of Portalegre, Portalegre, Portugal
- Lisbon School of Nursing, Lisbon, Portugal
- University of Lisbon, Lisbon, Portugal
- Research Center for the Valorization of Endogenous Resources – VALORIZA, Polytechnic Institute of Portalegre, Portalegre, Portugal
| | | | - Sofia Roque
- Department of Health Sciences and Technologies, Polytechnic Institute of Portalegre, Portalegre, Portugal
- Research Center for the Valorization of Endogenous Resources – VALORIZA, Polytechnic Institute of Portalegre, Portalegre, Portugal
| | | | - Helena Arco
- Department of Health Sciences and Technologies, Polytechnic Institute of Portalegre, Portalegre, Portugal
- Research Center for the Valorization of Endogenous Resources – VALORIZA, Polytechnic Institute of Portalegre, Portalegre, Portugal
- Comprehensive Health Research Center (CHRC), University of Évora, Évora, Portugal
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Sandvik RKNM, Husebo BS, Selbaek G, Strand G, Patrascu M, Mustafa M, Bergh S. Oral symptoms in dying nursing home patients. Results from the prospective REDIC study. BMC Oral Health 2024; 24:129. [PMID: 38273300 PMCID: PMC10811859 DOI: 10.1186/s12903-024-03901-x] [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: 02/15/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The mouth is a central organ for communication and fluid intake, also for dying nursing home patients. This study describes the prevalence and severity of oral symptoms from nursing home admission until the day of perceived dying and the day of death. METHODS A prospective, longitudinal cohort study including 696 patients who were admitted to 47 Norwegian nursing homes in 35 municipalities. During the first year of their stay, 189 died (27%), of whom 82 participants were assessed on the day they were perceived as dying and 134 on the day of death. Mouth care, nutrition, and bedsores were assessed with the Residents' Assessment Instrument for nursing homes (RAI-NH) and palliative care (RAI-PC). Pain intensity was assessed with the Mobilization-Observation-Behaviour-Intensity-Dementia-2 Pain Scale (MOBID-2). RESULTS The proportion of patients with ≥ 6 oral symptoms increased from 16% when perceived as dying to 20% on the day of death (P = 0.001). On the day of death, xerostomia (66%), dysphagia (59%), and mastication problems (50%) were the most frequently observed oral symptoms. Only 16% received mouth care every hour and 12% were in pain during this procedure. Compared to people without dementia, those with a diagnosis of dementia at admission (N = 112, 86%) had xerostomia and mastication problems more frequently (50% vs. 73%; 32% vs. 56% (P = 0.038), respectively) on the day of death. CONCLUSIONS The high extent of oral symptoms such as xerostomia, dysphagia, and mastication problems underline the need for systematic assessment and improved oral palliative care for dying nursing home patients with dementia. TRIAL REGISTRATION Clinicaltrials.gov NCT01920100 08/08/2013. First submission to BMC oral 15/03/2023.
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Affiliation(s)
- Reidun K N M Sandvik
- Department of Health and Caring sciences, Faculty of Health and Social Sciences, Western University of Applied Sciences, Haukelandsbakken 15, Bergen, N-5009, Norway.
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
- Department of Global Public Health and Primary Care, Neuro-SysMed Center, University of Bergen, Bergen, Norway
| | - Geir Selbaek
- The Norwegian National Centre for Ageing and Health (Ageing and Health), P.O. box 2136, Tønsberg, 3103, Norway
- Faculty of medicine, University of Oslo, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Gunhild Strand
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Monica Patrascu
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
- Department of Global Public Health and Primary Care, Neuro-SysMed Center, University of Bergen, Bergen, Norway
- Department of Automatic Control and System Engineering, Complex Systems Laboratory, University Politehnica of Bucharest, Bucharest, Romania
| | - Manal Mustafa
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway
| | - Sverre Bergh
- The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, P.O. box 68, Ottestad, 2313, Norway
- The Norwegian National Centre for Ageing and Health (Ageing and Health), P.O. box 2136, Tønsberg, 3103, Norway
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Martins MDLDC, Barros CGDD. (No) Oral Health in Palliative Care Patients: Predisposing Factors and Treatment. J Palliat Care 2023:8258597231212305. [PMID: 37981831 DOI: 10.1177/08258597231212305] [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: 11/21/2023]
Abstract
OBJECTIVE To describe mouth disorders in patients undergoing palliative care (PC); to identify predisposing factors for oral disorders and pharmacological and nonpharmacological strategies. METHODS Observational, exploratory, correlational, and descriptive study about mouth disorders of patients admitted to a hospital specializing in PC in Portugal, between November 6, 2019, and July 31, 2020. The data collection instrument was a questionnaire and the consultation of the patient's clinical file. It was obtained the previous authorization of the ethics committee and the patient's informed consent. Data were analyzed using the SPSS® software (V.26). RESULTS The sample was 46, 56.52% were over 71 years old, and the male sex ratio of 63.04%. Most of the patients had an advanced oncological disease, were polymedicated, had missing teeth, and no regular hygiene habits. Xerostomia and oral candidiasis were the most identified problems. Patients with oncological diseases have more probability to suffer from mouth disorders (P = .047), compared to noncancer patients. Patients with frequent oral hygiene have fewer mouth disorders (rp = -0.304; P = .040). There is a considerable improvement in the tongue coating with an increase in oral hygiene (P = .005). Mouth care plays is important in patient comfort (n = 45; 97.83%) and nonpharmacological strategies are effective for the relief of xerostomia (n = 35; 94.59%). CONCLUSIONS Nonpharmacological strategies are effective in the treatment of xerostomia and tongue coating. More information to determine the effectiveness of the strategies in the treatment of mouth disorders is necessary.
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Affiliation(s)
- Maria de Lurdes da Costa Martins
- Palliative Medicine Department, Clinical Academic Center of Trás-os-Montes e Alto Douro-Professor Doutor Nuno Grande - CACTMAD
- Palliative Medicine Department, Hospital Center of Trás-os-Montes and Alto Douro Hospital, Vila Real, Portugal
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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: 0] [Impact Index Per Article: 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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6
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Malik Z, Wright F. Dental and nursing collaboration in oral healthcare research in palliative care inpatient settings. Int J Palliat Nurs 2023; 29:318-320. [PMID: 37478068 DOI: 10.12968/ijpn.2023.29.7.318] [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: 07/23/2023]
Abstract
Collaboration between palliative care nurses and oral health professionals has been frequently recommended to ensure optimal oral healthcare. However, the importance of this collaboration to the success of evidence-based protocols, involving oral healthcare interventions in the inpatient palliative care setting, is less discussed. Feasibility requires consideration during the planning, intervention and implementation phases of any clinical trial; all of which typically rely on good collaboration with nursing staff. Therefore, it is imperative that nursing staff appreciate the need for oral healthcare at the end of a person's life. Nursing and dental collaboration is critical to the feasibility of running research trials in this group and can help overcome some of the logistical and ethical challenges in this vulnerable population.
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Affiliation(s)
- Zanab Malik
- Specialist Special Needs Dentistry, School of Health Sciences, Faculty of Health and Medicine, Campbelltown Hospital Dental Centre Specialist Clinic, Sydney, Australia
| | - Fac Wright
- Clinical Professor, Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Sydney, Australia
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7
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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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Choi YS, Lee YJ, Hwang IC, Ahn HY. Oral care and survival time in terminally ill patients with cancer: nested case-control pilot study. BMJ Support Palliat Care 2023:spcare-2023-004200. [PMID: 36918258 DOI: 10.1136/spcare-2023-004200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023]
Affiliation(s)
- Youn Seon Choi
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea (the Republic of)
| | - Yoo Jeong Lee
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea (the Republic of)
| | - In Cheol Hwang
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea (the Republic of)
| | - Hong Yup Ahn
- Department of Statistics, Dongguk University, Seoul, Korea (the Republic of)
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9
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Cleary N, Mulkerrin OM, Davies A. Oral symptom assessment tools in patients with advanced cancer: a scoping review. Support Care Cancer 2022; 30:7481-7490. [PMID: 35657401 PMCID: PMC9385820 DOI: 10.1007/s00520-022-07169-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/19/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Oral symptoms are common in patients with advanced cancer. The aim of this scoping review was to identify oral symptom assessment tools that have been specifically utilised in patients with "advanced cancer". METHODS The review was conducted/reported according to international guidelines for undertaking scoping reviews. PubMed, Embase, and CINAHL were searched for articles involving adult patients with advanced cancer, which involved assessment of ≥ 2 oral symptoms, and which involved patients with > 1 type of cancer. RESULTS The review identified four validated symptom assessment scales, including one cancer-specific quality of life scale (EORTC QLQ OH-15), one generic tool for assessing the "social impact" of specific oral problems (OHIP), one cancer-specific generic symptom assessment scale (MSAS), and one cancer-specific oral symptom assessment scale (OSAS). CONCLUSION Symptom assessment tools can facilitate good symptom control in clinical practice, and are an integral component of clinical research. The review identified four validated symptom assessment scales that could be utilised to assess oral symptoms in patients with advanced cancer.
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Affiliation(s)
- Niamh Cleary
- Trinity College Dublin, Dublin, Ireland.
- Our Lady of Lourdes Hospital, Drogheda, Drogheda, Ireland.
- Our Lady's Hospice Dublin, Dublin, Ireland.
| | | | - Andrew Davies
- Trinity College Dublin, Dublin, Ireland
- Our Lady's Hospice Dublin, Dublin, Ireland
- University College Dublin, Dublin, Ireland
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10
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Maruoka Y, Michiwaki Y, Sekiya H, Kurasawa Y, Natsume N. What does oral care mean to society? Biosci Trends 2022; 16:7-19. [DOI: 10.5582/bst.2022.01046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yutaka Maruoka
- Oral and Maxillofacial Surgery, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukihiro Michiwaki
- Division of Special Dentistry and Oral Surgery, Japanese Red Cross Musashino Hospital, Musashino, Japan
| | - Hideki Sekiya
- Department of Oral Surgery, School of Medicine, Toho University, Tokyo, Japan
| | - Yasuhiro Kurasawa
- Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nagato Natsume
- Division of Research and Treatment for Oral and Maxillofacial Congenital Anomalies, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
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11
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Pei Y, Qi X, Chen X, Wu B. Orofacial pain among Chinese older adults in the last year of life. Gerodontology 2021; 39:384-390. [PMID: 34841577 DOI: 10.1111/ger.12608] [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: 05/02/2021] [Revised: 10/18/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the prevalence of orofacial pain and associated factors in Chinese older adults at the end of life. METHODS This cross-sectional study included 1646 participants (65 years or older) in their last year of life from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used the 6-month prevalence questions to measure two specific orofacial pain symptoms: toothache, and jaw or facial pain. Logistic regression analyses were used to examine factors, such as socioeconomic status, health behaviours and chronic diseases, that were associated with these two orofacial pain symptoms in the last year of life. RESULTS The 6-month prevalence estimates for toothache and jaw pain or facial pain for older adults in the last year of life were 14.1% and 4.5% respectively. Higher socioeconomic status was associated with lower odds of toothache and jaw pain or facial pain. Smoking was associated with high odds of toothache. Participants who brushed their teeth at least once a day were more likely to have toothache and jaw or facial pain than those who did not. Having any chronic conditions was associated with higher odds of toothache and jaw or facial pain. Older adults who had at least one tooth were more likely to have jaw or facial pain than those without any teeth. CONCLUSION A considerable proportion of Chinese older adults in their last year of life reported toothache and/or jaw pain or facial pain. These findings suggest that appropriate measures need to be taken to address the oral health needs in these vulnerable individuals, especially those of low socioeconomic status and chronic conditions.
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Affiliation(s)
- Yaolin Pei
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Xiang Qi
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Xi Chen
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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Gustafsson A, Skogsberg J, Rejnö Å. Oral health plays second fiddle in palliative care: an interview study with registered nurses in home healthcare. BMC Palliat Care 2021; 20:173. [PMID: 34753462 PMCID: PMC8579523 DOI: 10.1186/s12904-021-00859-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background Oral health is crucial to the experience of well-being, and symptoms from the mouth are common at the end of life. Palliative care aims to identify and treat symptoms early to avoid unnecessary suffering and is thus an important part of nursing in home healthcare. The aim of this study was to illustrate the professional reflections of registered nurses about oral health amongst patients in palliative care, who are being cared for in a home healthcare setting. Results The results showed oral health in end-of-life care, to be an area marked by responsibility and ethical considerations. This was seen in all four partly overlapping themes that emerged through the analysis: Oral health is easily overlooked in palliative care, Oral health is everybody’s but in reality nobody’s responsibility, Patient integrity can be an obstacle for oral health, and Focus on oral health is urgently needed. The mouth is often not included as part of the daily basic care routine, by the registered nurses and the home healthcare staff, until the patient is near end of life. Moreover, neither does the patient tell about symptoms from the mouth. The interpreted whole indicates that the registered nurses had a bad conscience about not doing what they are actually responsible for and ought to do. Conclusion The oral health of patients at the end of life risks being forgotten or falling between the cracks, due to the nurses’ scattered tasks and unclear delimitations between their, and other professionals’ responsibilities. The responsibilities of registered nurses are also ethically demanding, since their intent to respect the patient’s integrity could mean that in some cases the patients does not allow them to help with oral health. To reduce the risk that oral health is overlooked, clearer demarcation and guidelines on the division of responsibilities are required. Routines that clearly implement early and recurring oral health assessments in home healthcare as well as continuing education updates on oral health and oral care are also needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00859-3.
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Affiliation(s)
| | - Johanna Skogsberg
- MedPro Clinic Stavre Primary Health Care Centre, Trollhättan, Sweden
| | - Åsa Rejnö
- Department of Health Sciences, University West, Trollhättan, Sweden. .,Skaraborg institute of Research and Development, Skövde, Sweden. .,Department of Medicine, Skaraborg Hospital Skövde, Skövde, Sweden.
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Jesus M, Morgado M, Duarte AP. PARP inhibitors: clinical relevance and the role of multidisciplinary cancer teams on drug safety. Expert Opin Drug Saf 2021; 21:541-551. [PMID: 34668821 DOI: 10.1080/14740338.2022.1996561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Cancer is considered one of the most devastating causes of death for humanity. Innovative and targeted therapies have become urgent in the treatment of this large subset of diseases. Over the last decade, the development of PARP (poly (ADP-Ribose) polymerase) inhibitors has emerged as a new target in cancer therapy. AREAS COVERED The authors conducted a review focusing on the clinic relevance and adverse effects of the four drugs already approved by drug regulatory agencies, namely: olaparib, rucaparib, niraparib and talazoparib. Despite the targeted action of this drug class, the adverse effects should be carefully monitored for the adequate safety of cancer patients taking them. The role of multidisciplinary cancer teams is crucial to help more and more patients to benefit from these revolutionary agents. EXPERT OPINION PARP (poly (ADP-Ribose) polymerase) inhibitors are drugs with great potential in the treatment of several types of cancer. However, their toxicity profiles often lead to treatment interruption or early discontinuation. The daily monitoring of these cancer patients by multidisciplinary cancer teams is essential for the success of therapy and for the promotion of a better quality of life.
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Affiliation(s)
- Mafalda Jesus
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,CICS-UBI - Health Sciences Research Center, University of Beira Interior, Covilhã, Portugal
| | - Manuel Morgado
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,CICS-UBI - Health Sciences Research Center, University of Beira Interior, Covilhã, Portugal.,Pharmaceutical Services, University Hospital Center of Cova da Beira, Covilhã, Portugal
| | - Ana Paula Duarte
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,CICS-UBI - Health Sciences Research Center, University of Beira Interior, Covilhã, Portugal.,UFBI - Pharmacovigilance Unit of Beira Interior, University of Beira Interior, Covilhã, Portugal
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Binda F, Clari M, Nicolò G, Gambazza S, Sappa B, Bosco P, Laquintana D. Quality of dying in hospital general wards: a cross-sectional study about the end-of-life care. BMC Palliat Care 2021; 20:153. [PMID: 34641824 PMCID: PMC8507336 DOI: 10.1186/s12904-021-00862-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/30/2021] [Indexed: 12/02/2022] Open
Abstract
Background In the last decade, access to national palliative care programs have improved, however a large proportion of patients continued to die in hospital, particularly within internal medicine wards. Objectives To describe treatments, symptoms and clinical management of adult patients at the end of their life and explore whether these differ according to expectation of death. Methods Single-centre cross-sectional study performed in the medical and surgical wards of a large tertiary-level university teaching hospital in the north of Italy. Data on nursing interventions and diagnostic procedure in proximity of death were collected after interviewing the nurse and the physician responsible for the patient. Relationship between nursing treatments delivered and patients’ characteristics, quality of dying and nurses’ expectation about death was summarized by means of multiple correspondence analysis (MCA). Results Few treatments were found statistically associated with expectation of death in the 187 patients included. In the last 48 h, routine (70.6%) and biomarkers (41.7%) blood tests were performed, at higher extent on patients whose death was not expected. Many symptoms classified as severe were reported when death was highly expected, except for agitation and respiratory fatigue which were reported when death was moderately expected. A high Norton score and absence of anti-bedsore mattress were associated with unexpected death and poor quality of dying, as summarized by MCA. Quality of dying was perceived as good by nurses when death was moderately and highly expected. Physicians rated more frequently than nurses the quality of dying as good or very good, respectively 78.6 and 57.8%, denoting a fair agreement between the two professionals (k = 0.24, P < 0.001). The palliative care consultant was requested for only two patients. Conclusion Staff in medical and surgical wards still deal inadequately with the needs of dying people. Presence of hospital-based specialist palliative care could lead to improvements in the patients’ quality of life.
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Affiliation(s)
- Filippo Binda
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy.
| | - Marco Clari
- Department of Public Health and Paediatrics - University of Torino, Via Santena, 5, 10126, Torino, Italy
| | - Gabriella Nicolò
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Simone Gambazza
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Barbara Sappa
- Department of Healthcare Professions (General Internal Medicine Unit), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Paola Bosco
- Department of Healthcare Professions (High-dependency Unit), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Dario Laquintana
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
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15
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Tan LLC, Lim Y, Ho P, Lim LY, Lim YY, Low JA. Understanding Quality of Life for Palliative Patients With Dysphagia Using the Swallowing Quality of Life (SWAL-QOL) Questionnaire. Am J Hosp Palliat Care 2021; 38:1172-1176. [PMID: 33530694 DOI: 10.1177/1049909121992532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE There are few studies concerning the differences in quality-of-life (QOL) between palliative care patients with and without dysphagia to date. We aimed to compare the QOL and symptoms in palliative patients with and without dysphagia using Swallowing Quality of Life (SWAL-QOL). METHODS Eighty-one palliative patients with and without dysphagia underwent the SWAL-QOL questionnaire. A series of Mann Whitney U tests were performed between non-dysphagic and dysphagic groups for the total SWAL-QOL score and the 11 SWAL-QOL domains. RESULTS Dysphagia significantly impacted patients' QOL in the dysphagic group (mean, 69.5; SD 21.9) than non-dysphagic group (mean, 83.2; SD 14.8) (P = 0.006). Significant differences were observed between both groups for the domains of burden, eating desire, eating duration, symptoms, food selection, communication and mental health. The results also showed that the dysphagic group had lower symptom score across all symptoms, suggesting higher symptom burdens. CONCLUSIONS This study is the first to examine QOL and swallow symptoms in palliative care patients with and without dysphagia. Dysphagia causes significantly worse QOL in palliative care patients. Screening for dysphagia and managing its impact on symptoms and QOL domains is important in palliative care.
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Affiliation(s)
- Laurence Lean Chin Tan
- Department of Geriatric Medicine and Palliative Care, 150819Khoo Teck Puat Hospital, Singapore, Singapore.,GeriCare, 150819Khoo Teck Puat Hospital, Singapore, Singapore.,Geriatric Education and Research Institute (GERI), Singapore, Singapore
| | - Yujun Lim
- GeriCare, 150819Khoo Teck Puat Hospital, Singapore, Singapore
| | - Peiyan Ho
- Department of Geriatric Medicine, 150819Khoo Teck Puat Hospital, Singapore, Singapore
| | - Lee Yen Lim
- Supportive Care and Palliative Medicine, 242949Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Ying Yin Lim
- Department of Geriatric Medicine, 150819Khoo Teck Puat Hospital, Singapore, Singapore
| | - James Alvin Low
- Department of Geriatric Medicine and Palliative Care, 150819Khoo Teck Puat Hospital, Singapore, Singapore.,GeriCare, 150819Khoo Teck Puat Hospital, Singapore, Singapore.,Geriatric Education and Research Institute (GERI), Singapore, Singapore
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16
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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: 1.0] [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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17
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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: 1.0] [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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Venkatasalu MR, Murang ZR, Husaini HABH, Idris DR, Dhaliwal JS. Why oral palliative care takes a backseat? A national focus group study on experiences of palliative doctors, nurses and dentists. Nurs Open 2020; 7:1330-1337. [PMID: 32802353 PMCID: PMC7424450 DOI: 10.1002/nop2.480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/21/2020] [Accepted: 03/02/2020] [Indexed: 12/03/2022] Open
Abstract
Aim Poor oral care among frail older people at the end of life endangers quality of life. However, only few dying people have access to oral palliative care services. Therefore, this study aimed to investigate oral palliative care practices and referral patterns for palliative patients in the Brunei healthcare settings. Design An exploratory qualitative study. Methods Five focus groups were conducted among palliative care nurses (N = 7), palliative medicine doctors (N = 4), dentists (N = 6), oncologists (N = 4) and oncology nurses (N = 4). Verbatim was analysed using qualitative thematic analysis. Results Analyses revealed four distinct themes emerging as current oral palliative care assessment and referral practice in the Brunei healthcare settings: "taking a back seat," "opportunistic oral care," "they refused and refused" and "challenging healthcare resources and oral palliative care."
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Affiliation(s)
| | - Zaidah Rizidah Murang
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health SciencesUniversiti Brunei DarussalamBruneiBrunei Darussalam
| | - Hajah Asmah binti Haji Husaini
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health SciencesUniversiti Brunei DarussalamBruneiBrunei Darussalam
| | - Deeni Rudita Idris
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health SciencesUniversiti Brunei DarussalamBruneiBrunei Darussalam
| | - Jagjit Singh Dhaliwal
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health SciencesUniversiti Brunei DarussalamBruneiBrunei Darussalam
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Madariaga A, Bowering V, Ahrari S, Oza AM, Lheureux S. Manage wisely: poly (ADP-ribose) polymerase inhibitor (PARPi) treatment and adverse events. Int J Gynecol Cancer 2020; 30:903-915. [PMID: 32276934 PMCID: PMC7398227 DOI: 10.1136/ijgc-2020-001288] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 12/17/2022] Open
Abstract
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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Affiliation(s)
- Ainhoa Madariaga
- Medical Oncology & Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Valerie Bowering
- Medical Oncology & Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Soha Ahrari
- Pharmacy, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Amit M Oza
- Medical Oncology & Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Stephanie Lheureux
- Medical Oncology & Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
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