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Karimi Afshar M, Behniafar M, Abbaszadeh E, Parizi MT, Karimi Afshar M. Knowledge about dental care in patients with head and neck cancer among senior dental school students: a cross-sectional descriptive study. BMC MEDICAL EDUCATION 2024; 24:776. [PMID: 39030591 PMCID: PMC11264978 DOI: 10.1186/s12909-024-05728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/01/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND The dentist's central role in treating head and neck cancer patients is to care for the patient's oral cavity before, during, and after radio/chemotherapy. This research aimed to determine dental students' knowledge about head and neck cancer patients' dental care. METHODS One hundred and four fifth and sixth-year dental students participated in this cross-sectional descriptive study. The data collection tool was a questionnaire that collected demographic information (gender, year of study) and four questions consisting of attendance to courses or workshops, passing a dedicated course at the university, willing to participate in a course or workshop on the treatment of head and neck cancer patients and self-evaluating information about the treatment of head and neck cancer patients. Final part 36 questions about oral and dental care for head and neck cancer patients before, after, and during treatment. The data were analyzed with SPSS 26 statistical software and using t-tests, ANOVA, and linear regression at the 0.05 significance level. RESULTS Most of the participants were in their sixth year (48.9%). A total of 48.1% of the people reported that their information about dental treatments in patients with head and neck cancer was bad. 85% of participants agreed with the necessity of evaluating the patient's mouth and teeth before starting the treatment. The lowest percentage of correct answers was related to the ideal duration of tooth extraction and a poor prognosis before the start of cancer treatment. The regression analysis revealed a significant relationship between years of education, willingness to participate in courses, and students' knowledge evaluation and knowledge. CONCLUSION The findings showed that students' awareness of oral and dental treatment and care for patients with head and neck cancer is insufficient. It is recommended that teaching staff pay more attention to the lack of knowledge and effort to educate students by holding special courses and workshops.
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Affiliation(s)
- Marzieh Karimi Afshar
- Orthodontics, Medical Education, Orthodontics Department, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Milad Behniafar
- Kerman University of Medical Sciences, Private Practice, Kerman, Iran
| | - Elham Abbaszadeh
- Oral Medicine, Oral Disease Department, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Molook Torabi Parizi
- Oral and Maxillofacial Pathology, Medical Education, Oral and Maxillofacial Department, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehrnaz Karimi Afshar
- Prosthodontics, Medical Education, Prosthodontics Department, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
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Nakandi K, Benebo FO, Hopstock LA, Stub T, Kristoffersen AE. Adherence to lifestyle recommendations among Norwegian cancer survivors and the impact of traditional and complementary medicine use: the Tromsø Study 2015-2016. BMC Complement Med Ther 2023; 23:292. [PMID: 37598174 PMCID: PMC10439550 DOI: 10.1186/s12906-023-04123-4] [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: 03/27/2023] [Accepted: 08/11/2023] [Indexed: 08/21/2023] Open
Abstract
INTRODUCTION Adherence to healthy lifestyle recommendations has positive effects on cancer outcomes yet adherence is low among cancer survivors. Differences in adherence between women and men, phase of survivorship, and other factors that might increase adherence, like the use of traditional and complementary medicine (T&CM), need to be explored. We aimed to study the adherence to national recommendations for a healthy diet (daily intake of ≥ 5 portions of fruit/vegetables), physical activity (150 min of moderate-intensity or 75 min of high-intensity/week), normal body mass index (BMI) (18.5-24.9 kg/m2), non-smoking, and low-risk alcohol consumption (women ≤ 10 g/day, men ≤ 20 g/day) among Norwegian cancer survivors and their associations with sex, the use of T&CM, and survivorship phase. METHODS We used logistic regression, independent sample t-test, and chi-square test to study self-reported (diet, physical activity, smoking, alcohol consumption) and measured (BMI) adherence in 1530 cancer survivors (40 years and above, participating in the population-based Tromsø Study conducted in 2015-2016 (65% attendance). We dichotomized all assessed lifestyle recommendations (adherence = 1 point, non-adherence = 0 points), and created a score for every recommendation (0-5 points). Adherence to individual lifestyle recommendations and the use of T&CM as well as the phase of survivorship was adjusted for sex, age, income, and living with a partner. RESULTS Adherence to recommendations was 7.5% for diet, 85.3% for physical activity, 30.5% for BMI, 89.3% for non-smoking, and 87.6% for alcohol consumption. In total 2.3% adhered to all five recommendations concurrently (mean score 2.96 [SD = 0.86]). Women adhered to more recommendations concurrently compared to men (3.03 [SD = 0.90] vs. 2.89 [SD = 0.80] points respectively, [p = .012]). In total, 31% reported the use of T&CM and there were no differences in adherence to individual lifestyle recommendations or concurrent adherence in overall T&CM use compared to non-use. Users of self-help techniques were more likely to adhere to the recommendations of diet (aOR 2.69, 95% CI 1.45-4.98) and physical activity (aOR 6.26, 95% CI 1.51-25.92). Users of traditional healers and users of more than one T&CM modality were less likely to adhere to the low-risk alcohol consumption recommendation, (aOR 0.32, 95% CI 0.13-0.77, and aOR 0.53, 95% CI 1.08-2.17, respectively) compared to T&CM non-users. Survivors with cancer previously (1162) had higher odds of adhering to the recommendation of diet (aOR 2.66, 95% CI 1.36-5.19) than survivors with cancer presently (n = 368), but not to other recommendations. CONCLUSION The health of cancer survivors can be improved through adherence to lifestyle recommendations, yet our study found partial adherence among survivors in Norway, in accordance with findings from other countries. Although overall T&CM use was not associated with higher adherence to lifestyle recommendations, differences in adherence were seen among individual modalities like the use of self-help techniques and traditional healers. Our results suggest the need for intensified follow-up of lifestyle with attention to male survivors and diet among all survivors throughout the cancer survivorship continuum.
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Affiliation(s)
- Kiwumulo Nakandi
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Science, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, N-9037, Norway.
| | - Faith O Benebo
- Systems Epidemiology, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Laila A Hopstock
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Trine Stub
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Science, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, N-9037, Norway
| | - Agnete E Kristoffersen
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Science, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, N-9037, Norway
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Abed H. Dental considerations for head and neck cancer: A clinical review. Saudi Dent J 2023; 35:476-486. [PMID: 37520601 PMCID: PMC10373080 DOI: 10.1016/j.sdentj.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Radiotherapy is one of the treatment modalities for the treatment of head and neck cancer (HNC). However, it leads to the development of chronic and acute side effects. These side effects impact negatively on the patient's quality of life and oral functioning. This clinical review aims to provide basic information about HNC, understand the impact of radiotherapy on oral health, and explain the role of dental care providers for HNC patients during the pre-and post-radiotherapy time. Materials and Methods Electronic databases (i.e., PubMed, Scopus, and Google Scholar) were searched using defined keywords. The main inclusion criteria were any studies describing "dental management of patients with head and neck cancer" and "dental management of patients treated with radiotherapy." Results Thematic analysis was used to summaries the findings of the included studies (n = 102) into main headings and subheadings. All studies were published between 1970 and 2023. Conclusion The number of HNC patients is increasing. This necessitates the need for raising the awareness of dental care providers to the side-effects of HNC therapy which includes treatment with radiotherapy, chemotherapy, and/or surgery. Dental care providers should understand the common side-effects and their treatments besides their role in the pre- (i.e., dental extraction of teeth with poor prognosis and maintaining good oral hygiene) and post- (i.e., oral rehabilitation and post-HNC dental care) radiotherapy dental care.
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Ntoukas SM, McNeely ML, Seikaly H, O'Connell D, Courneya KS. Feasibility and safety of Heavy Lifting Strength Training in Head and Neck Cancer survivors post-surgical neck dissection (the LIFTING trial). Support Care Cancer 2023; 31:348. [PMID: 37212970 DOI: 10.1007/s00520-023-07815-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Light-to-moderate intensity strength training (LMST) improves muscular strength, physical functioning, and some side effects in head and neck cancer survivors (HNCS). Heavy lifting strength training (HLST) may further improve these outcomes; however, it has not been studied in HNCS. The primary aim of the LIFTING trial was to examine the feasibility and safety of a HLST program in HNCS ≥1-year post-surgical neck dissection. METHODS In this single-arm feasibility study, HNCS were asked to complete a twice weekly, 12-week, supervised HLST program, gradually progressing to lifting heavy loads of 80-90% of 1 repetition maximum (1RM) for barbell squat, bench press, and deadlift. The feasibility outcomes included recruitment rate, 1RM completion rate, program adherence, barriers, and motivation. The preliminary efficacy outcomes included changes in upper and lower body strength. RESULTS Nine HNCS were recruited over an 8-month period during the COVID-19 pandemic. All 9 (100%) completed the 1RM tests and successfully progressed to heavy loads at approximately 5 weeks. The median attendance was 95.8% (range 71-100%), and few barriers were reported. Weight lifted increased for squat/leg press (median change: +34kg; 95% CI +25 to +47), bench press (median change: +6kg; 95% CI +2 to +10), and deadlift (median change: +12kg; 95% CI +7 to +24). No adverse events were reported and participants were motivated to continue HLST after the study. CONCLUSIONS HLST appears feasible and safe for HNCS and may result in meaningful improvements in muscular strength. Future research should consider additional recruitment strategies and compare HLST to LMST in this understudied survivor population. TRIAL REGISTRATION NCT04554667.
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Affiliation(s)
- Stephanie M Ntoukas
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, Alberta, T6G 2H9, Canada
| | - Margaret L McNeely
- Faculty of Rehabilitation Medicine, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Hadi Seikaly
- Division of Otolaryngology and Head and Neck Surgery, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel O'Connell
- Division of Otolaryngology and Head and Neck Surgery, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, Alberta, T6G 2H9, Canada.
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Malnutrition, nutrition support and dietary intervention: the role of the dietitian supporting patients with head and neck cancer. Br Dent J 2022; 233:757-764. [DOI: 10.1038/s41415-022-5107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022]
Abstract
AbstractMalnutrition is prevalent in patients with head and neck cancer (HNC) at diagnosis but can occur at any stage of the treatment pathway. The impact of disease burden and treatment side effects can lead to altered anatomy, compromised quality and quantity of saliva and impaired swallowing function, which can result in deleterious effects on nutritional status. Optimising nutrition status is critical, as malnutrition is adversely associated with treatment tolerance and outcomes, wound healing, morbidity, mortality, quality of life and survival. Dietitians are integral members of the HNC multidisciplinary team and are uniquely qualified in the assessment, management and optimisation of nutritional status across the care pathway. This includes providing informational counselling to patients and carers on the short- and long-term nutritional impact of planned treatments alongside multidisciplinary members. Dietitians lead on the recommendation, provision and monitoring of nutrition support, which can be via the oral, enteral or parenteral route. Oral nutrition support includes dietary counselling, nourishing dietary, food fortification advice and high energy/protein oral nutritional supplements. Enteral nutrition support, or tube feeding, can be required on a short- and/or long-term basis and dietitians support appropriate decision-making for the type of tube and timing of placement across the care pathway.
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Bertl K, Savvidis P, Kukla EB, Schneider S, Zauza K, Bruckmann C, Stavropoulos A. Including dental professionals in the multidisciplinary treatment team of head and neck cancer patients improves long-term oral health status. Clin Oral Investig 2021; 26:2937-2948. [PMID: 34792667 PMCID: PMC8600104 DOI: 10.1007/s00784-021-04276-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/02/2021] [Indexed: 12/24/2022]
Abstract
Objective To assess in a cross-sectional study the impact of including dental professionals in the multidisciplinary treatment team of head and neck squamous cell carcinoma (HNSCC) patients on the long-term oral health status. Materials and methods Oral health status, dental care behaviours, and oral health–related quality of life were assessed based on a clinical and radiographic examination, interview, and medical records in patients treated for HNSCC ≥ 6 months ago. This patient group (‘cohort 2’) was treated in a multidisciplinary treatment team including dental professionals and compared to a group of HNSCC patients previously treated at the same university, but without dental professionals included in the multidisciplinary treatment team (‘cohort 1’). Results Cohort 2 consisted of 34 patients, who had received a dental check-up and if necessary, treatment by dental professionals prior to the initiation of cancer treatment. This cohort showed significantly improved oral hygiene habits and a better periodontal health status compared to cohort 1. However, cohort 2 still presented high demand for treatment due to active carious lesions; only a few, statistically insignificant improvements were detected compared to cohort 1. Conclusion Including dental professionals in the multidisciplinary treatment team of HNSCC patients has a positive impact on patient oral health status—primarily in terms of periodontal disease—6 months and longer after finishing cancer therapy. Clinical relevance A team-based approach including dental professionals specialised in head and neck cancer improves oral health status. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04276-x.
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Affiliation(s)
- Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Philippe Savvidis
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Edmund Benjamin Kukla
- Comprehensive Center Unit, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Steffen Schneider
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria
| | - Konstantin Zauza
- Comprehensive Center Unit, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Corinna Bruckmann
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden. .,Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria. .,Division of Regenerative Dentistry and Periodontology, University Clinics of Dental Medicine (CUMD), University of Geneva, Geneva, Switzerland.
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Kovarik JP, Voborna I, Barclay S, Iqbal MS, Cunnell M, Kelly C, Willis N, Kennedy M, Kovarik J. Osteoradionecrosis after treatment of head and neck cancer: a comprehensive analysis of risk factors with a particular focus on role of dental extractions. Br J Oral Maxillofac Surg 2021; 60:168-173. [PMID: 34857411 DOI: 10.1016/j.bjoms.2021.03.009] [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] [Received: 12/22/2020] [Accepted: 03/09/2021] [Indexed: 11/16/2022]
Abstract
In head and cancer (HNC), osteoradionecrosis (ORN) is one of the most significant complications of radiotherapy (RT). With an absence of effective non-surgical treatment, prevention of the development of ORN is the best approach. The purpose of this study was to identify the risk factors for the development of ORN in HNC. Records of 1,118 patients with HNC treated with radical RT (≥55Gy) from January 2010 to December 2019 were reviewed. After applying the exclusion criteria, 935 patients were included in the final analysis. In patients with confirmed ORN, exact RT doses were mapped. In total, 91 patients were found (9.7%) with a median (range) time of eight (3-89) months to the development of ORN. Smoking, having a primary site in the oropharynx, bone surgery before adjuvant RT, the addition of concurrent chemotherapy, the presence of xerostomia, dental extraction pre-RT, the time ≤20 days between dental extraction and start of RT, and receiving >55Gy RT dose were significant factors for its development. This comprehensive analysis including the precise RT dose mapping has shown the risk factors for the development of ORN. In practice, every effort should be made to avoid these risk factors without compromising the oncology treatment. The findings of this analysis may provide a basis for future prospective research on this topic.
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Affiliation(s)
- J P Kovarik
- Institute of Dentistry and Oral Sciences, Palacky University Olomouc, Czech Republic.
| | - I Voborna
- Institute of Dentistry and Oral Sciences, Palacky University Olomouc, Czech Republic
| | - S Barclay
- Dental Hospital, Newcastle upon Tyne, United Kingdom
| | - M S Iqbal
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - M Cunnell
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - C Kelly
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - N Willis
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - M Kennedy
- Department of Oral and Maxillofacial Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - J Kovarik
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
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Dhaliwal JS, Murang ZR, Haji Husaini HA, Idris DR, Venkatasalu MR. The need for oral assessment and referral practices tool for palliative patients in Brunei Darussalam: A cross-sectional study. Nurs Open 2021; 8:39-47. [PMID: 33318810 PMCID: PMC7729708 DOI: 10.1002/nop2.591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/29/2020] [Accepted: 07/13/2020] [Indexed: 11/07/2022] Open
Abstract
Aim This study aimed to investigate knowledge, experiences, perceptions and barriers of healthcare professionals regarding palliative oral care. Methods The study involved 169 palliative care professionals in Brunei. Data collection tool was pretested, validated and self-administered with sections on demographics; knowledge, attitude and practices; referral of patients; perspectives; and barriers to oral palliative care. Results 97.3% of participants believed that palliative patients need oral care, and 11.6% of participants were trained in this area. 43.8% were unsure about referral process, and 66.1% of participants had never used a tool to assess oral conditions of palliative patients. Most common oral condition encountered was mucositis (54.5%). 74.1% of participants expected family members to be responsible, and the absence of proper guidelines for assessment (66.1%) was the top challenge in providing oral care for palliative patients. Conclusion This study highlights perceptions and experiences of healthcare professionals and need for improved care through development of oral assessment and referral practices tool for palliative patients.
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Affiliation(s)
- Jagjit S. Dhaliwal
- Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health SciencesUniversiti Brunei DarussalamBandar Seri BegawanBrunei Darussalam
- All India Institute of Medical SciencesRishikeshIndia
| | - Zaidah R. Murang
- Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health SciencesUniversiti Brunei DarussalamBandar Seri BegawanBrunei Darussalam
| | - Hajah A. Haji Husaini
- Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health SciencesUniversiti Brunei DarussalamBandar Seri BegawanBrunei Darussalam
| | - Deeni R. Idris
- Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health SciencesUniversiti Brunei DarussalamBandar Seri BegawanBrunei Darussalam
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Evaluation of Diet Quality Among American Adult Cancer Survivors: Results From 2005-2016 National Health and Nutrition Examination Survey. J Acad Nutr Diet 2020; 121:217-232. [PMID: 33158797 DOI: 10.1016/j.jand.2020.08.086] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diet quality among adult cancer survivors is low, and there is minimal information on the Healthy Eating Index (HEI)-2015 score, a measure of diet quality and adherence to the 2015-2020 Dietary Guidelines for Americans, in this population. OBJECTIVE This study aimed to examine HEI-2015 total and component scores and associated factors among adult cancer survivors. Also, this study examined which dietary components needed the most change to improve diet quality in this population. DESIGN The National Health and Nutrition Examination Survey (NHANES) is an ongoing nationally representative population-based cross-sectional study that is conducted annually. PARTICIPANTS/SETTING In all, 1971 adults with a self-reported cancer diagnosis in their lifetime (both individuals with cancer currently and those that are cancer-free) from NHANES 2005-2016 were included in this study. MAIN OUTCOME MEASURES HEI-2015 total and 13 component scores were calculated using the simple scoring algorithm method from the average of 2 24-hour recalls. STATISTICAL ANALYSES The associations of the HEI-2015 total score with sociodemographic, lifestyle, and health-related factors were analyzed using the least square means comparisons. A multivariable survey regression model was used to identify associations with the HEI-2015 total score after adjustment for potential confounders. The 13 component scores were also compared by participant characteristics to identify target food groups for subgroup-specific nutrition intervention. RESULTS The average HEI-2015 total score was 55.6 (95% confidence interval = 54.8-56.4). Factors associated with the HEI-2015 total score included age, race/ethnicity, education, smoking status, body mass index, and oral health status. Overall, poor adherence to the 2015-2020 Dietary Guidelines for Americans was found for most HEI-2015 components, with Whole Grains, Greens and Beans, Sodium, and Fatty Acids components having less than 50% of the maximum possible scores. CONCLUSIONS Results indicate poor diet quality among American adult cancer survivors, with significant disparities observed across sociodemographic and lifestyle factors, particularly education levels, body mass index, and smoking status. Nutrition interventions for cancer survivors should consider focusing on improving diet quality by increasing intakes of whole grains and greens and beans, lowering sodium consumption, and achieving a healthy balance of fatty acids (ie, a favorable ratio of unsaturated fats to saturated fats).
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Watson E, Eason B, Kreher M, Glogauer M. The DMFS160: A new index for measuring post-radiation caries. Oral Oncol 2020; 108:104823. [PMID: 32521312 DOI: 10.1016/j.oraloncology.2020.104823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/17/2020] [Accepted: 05/24/2020] [Indexed: 12/14/2022]
Abstract
The current systems used to measure post-radiation caries underestimate the severity of the disease by failing to account for the unique spread of post-radiation caries, including incisal-edge and cusp tip decay, enamel delamination and crown amputation. A novel and clinically applicable index to measure post-radiation caries is proposed. The DMFS160 index counts 5 surfaces per tooth, accounting for incisal-edge caries, and is broken down into missing surfaces and decayed/filled surfaces. A staging and grading system is used to capture enamel delamination and crown amputation. The staging and grading provides a clinically-relevant measure at the whole-mouth level and is paired with evidence-based treatment strategies. In this paper the DMFS160 index is applied to three cases and compared to the DMFS index, demonstrating the improved accuracy of the DMFS160 index in measuring the extent of post-radiation caries.
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Affiliation(s)
- Erin Watson
- Princess Margaret Cancer Centre, 610 University Avenue, Room 2-933, Toronto, Ontario M5G2M9, Canada.
| | - Brady Eason
- Princess Margaret Cancer Centre, 610 University Avenue, Room 2-933, Toronto, Ontario M5G2M9, Canada.
| | - Matthew Kreher
- Princess Margaret Cancer Centre, 610 University Avenue, Room 2-933, Toronto, Ontario M5G2M9, Canada.
| | - Michael Glogauer
- Princess Margaret Cancer Centre, 610 University Avenue, Room 2-933, Toronto, Ontario M5G2M9, Canada; University of Toronto, Faculty of Dentistry, 101 Elm Street, Toronto, Ontario M5G2L3, Canada.
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Kubrak C, Farhangfar A, Woynorowski M, Jha N, Preshing W, Baracos V. Dentition, nutritional status and adequacy of dietary intake in treatment naïve head and neck cancer patients. Heliyon 2020; 6:e03617. [PMID: 32258472 PMCID: PMC7114741 DOI: 10.1016/j.heliyon.2020.e03617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/28/2019] [Accepted: 03/13/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To examine the relationship of reduced numbers of occluding teeth and dietary intake (DI), nutrition impact symptoms (NIS), and weight loss (WL) in head and neck cancer (HNC) patients. METHODS As a part of the standard of care, treatment-naïve HNC patients (n = 104) completed dental evaluation (number of teeth, total anterior/posterior occlusal teeth, Eichner Index (EI) classification), WL, DI questionnaire and HNC Symptom Checklist©. Descriptive statistics (Kruskal-Wallis, Fisher-exact, χ2 tests) and (uni-) multi-variable logistic regression. RESULTS Overall, 42, 45 and 13% of patients were in EI-class A, B and C with a median of 8, 3, and 0 total posterior occlusal teeth. EI-class B/C patients were older, more likely to have impaired DI (OR = 3.88; 95%CI:1.63-9.26; P = 0.002) and reported interference with DI by 11 NIS (p < 0.05). DI was, however, reported as unimpaired in 77, 49 and 39% of patients in EI-class A, B and C, respectively. The subset of EI-class B/C patients with impaired DI, had more NIS interference with DI (P < 0.05; difficulty chewing, pain, early satiety, lack of energy); EI-class C patients additionally had dry mouth, thick saliva and dysphagia (P < 0.05). In logistic regression, EI-classes B/C patients with reduced (vs unimpaired) DI were more likely to have ≥5% WL (OR = 10.1; 95%CI:2.0-50.0), higher NIS interference (range OR 4.3-10.7). CONCLUSIONS More than half of these HNC patients had reduced numbers of occlusal teeth or were edentulous. EI-class B/C patients did not necessarily have impaired DI, however the combination of EI-class B/C and a constellation of NIS, associated with reduced DI. CLINICAL SIGNIFICANCE Treatment naïve head and neck cancer (HNC) patients with reduced occlusal and masticatory performance (Eichner Index B/C) and reduced dietary intake are at high risk for weight loss. Identifying HNC patients at risk may improve their oral health, dietary intake and reduce their risk of weight loss.
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Affiliation(s)
- Catherine Kubrak
- Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada
| | - Arazam Farhangfar
- Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada
| | - Matthew Woynorowski
- Faculty of Dentistry, Division of Oral Medicine, University of Alberta, Edmonton Clinic, 11400 University Avenue, Edmonton, Alberta, T6G 1Z1, Canada
| | - Naresh Jha
- Department of Oncology, Division of Radiation Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada
| | - William Preshing
- Faculty of Dentistry, Division of Oral Medicine, University of Alberta, Edmonton Clinic, 11400 University Avenue, Edmonton, Alberta, T6G 1Z1, Canada
| | - Vickie Baracos
- Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada
- Corresponding author.
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Epstein JB, Villines D, Epstein GL, Smutzer G. Oral examination findings, taste and smell testing during and following head and neck cancer therapy. Support Care Cancer 2020; 28:4305-4311. [PMID: 31912362 DOI: 10.1007/s00520-019-05232-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/05/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE Diet and nutrition are critical in health and disease and are highly impacted by the presence and treatment for head and neck cancer (HNC). The purpose of this paper is to present oral examination findings and taste and smell test results in patients during and following HNC. METHODS Patients with HNC were evaluated during and following radiation therapy with/without chemotherapy. Oral examination findings including mucositis, saliva, oral hygiene (plaque levels, gingivitis), and taste and smell testing was completed on all subjects. NCI Common Terminology Criteria for Adverse Events (CTCAE) 4.0, and the Scale of Subjective Total Taste Acuity (STTA) were used to provide patient report of symptoms. RESULTS Mucositis and pain affected oral diet during therapy and improved in follow-up. Weight loss of 5% during and 12% following treatment was identified. Tobacco use was associated with increased severity of mucositis and increased weight loss. The subjects maintained excellent oral hygiene as reflected in plaque levels and gingivitis. Spicy/pungent perception was the most strongly disliked of testing stimuli. Umami and fat taste perception were reported of highest intensity during HNC treatment and rated as moderate in intensity after treatment. These results suggest improvement in these taste functions over time following treatment. Salt taste was of high intensity and associated with strong dislike in follow-up. CONCLUSIONS In HNC patients, oral status and taste change occurs throughout the cancer trajectory and represent potential concerns in cancer survivorship. Taste change (as evaluated by taste testing) occurred in all HNC patients, whereas olfactory changes occurred in 30% of cases. Management of oral changes and symptoms should be considered in all HNC patients in addition to dietary and nutritional guidance in patient care to promote oral intake. Continuing study of taste changes may further define this problem and support dietary and nutritional guidance and product development.
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Affiliation(s)
- Joel B Epstein
- , Beverly Hills, CA, USA. .,Cedars-Sinai Medical Center, Los Angeles, CA, USA. .,City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
| | - Dana Villines
- Department of Research, Advocate Health Care, Chicago, IL, USA
| | | | - Gregory Smutzer
- Department of Biology, Temple University, Philadelphia, PA, 19122, USA
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Kamal M, Barrow MP, Lewin JS, Estrella A, Gunn GB, Shi Q, Hofstede TM, Rosenthal DI, Fuller CD, Hutcheson KA. Modeling symptom drivers of oral intake in long-term head and neck cancer survivors. Support Care Cancer 2019; 27:1405-1415. [PMID: 30218187 PMCID: PMC6408256 DOI: 10.1007/s00520-018-4434-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/20/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE This study examined the relationship between self-reported symptom severity and oral intake in long-term head and neck cancer (HNC) survivors. METHODS An observational survey study with retrospective chart abstraction was conducted. HNC patients who had completed an MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) questionnaire and also had clinician graded oral intake ratings (Functional Oral Intake Scale [FOIS]) were included. Correlation coefficients were computed. FOIS scores were regressed on MDASI-HN symptom items using stepwise backwards elimination for multivariate models. RESULTS One hundred and fifty-two survey pairings were included in the analysis (median 44 months follow-up, range 7-198). Per FOIS, 28% of survivors maintained a total oral diet with no restrictions, 67% reported a restricted oral diet (without tube), 3% were partially tube-dependent with some oral intake, and 2% were NPO. Of the 22 symptom items, the most severe items in decreasing order were dry mouth, difficulty swallowing\chewing, problems with mucus, tasting food, and choking/coughing. Significant bivariate correlations, after Bonferroni correction for multiple comparisons, were present for 8 of 22 symptoms with FOIS. On multivariate analysis, symptom severity for difficulty swallowing and problems with teeth/gums remained significantly associated with FOIS. CONCLUSIONS Oral intake in HNC survivorship is a multidimensional issue and functional outcome that is impacted not only by dysphagia but also by dental status. Symptom drivers of oral intake likely differ in acute survivorship. Nonetheless, these findings highlight the lack of specificity in this end point and also the need for multidisciplinary supportive care to optimize oral intake in survivors.
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Affiliation(s)
- Mona Kamal
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Martha P Barrow
- Departments of Head and Neck Surgery Unit 1445, The University of Texas MD Anderson Cancer Center, P. O. Box 301402, Houston, TX, 77030, USA
| | - Jan S Lewin
- Departments of Head and Neck Surgery Unit 1445, The University of Texas MD Anderson Cancer Center, P. O. Box 301402, Houston, TX, 77030, USA
| | - Alicia Estrella
- Departments of Head and Neck Surgery Unit 1445, The University of Texas MD Anderson Cancer Center, P. O. Box 301402, Houston, TX, 77030, USA
| | - G Brandon Gunn
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Quiling Shi
- Departments of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Theresa M Hofstede
- Departments of Head and Neck Surgery Unit 1445, The University of Texas MD Anderson Cancer Center, P. O. Box 301402, Houston, TX, 77030, USA
| | - David I Rosenthal
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton David Fuller
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- MD Anderson Cancer Center/UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Katherine A Hutcheson
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Departments of Head and Neck Surgery Unit 1445, The University of Texas MD Anderson Cancer Center, P. O. Box 301402, Houston, TX, 77030, USA.
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Alvarez PB, Perez-Sayáns M, Alves MGO, Torreira MG, Iruegas MEP, Carrión AB, García-García A. Dental management prior to radiation therapy in patients with head and neck cancer. Indian J Cancer 2019; 55:251-256. [PMID: 30693889 DOI: 10.4103/ijc.ijc_20_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Patients diagnosed with head and neck tumors, are treated by surgery, radiation therapy (RT), chemotherapy (CT) or a combination thereof. The goal is to describe the management protocol for patients subjected to radiation therapy (RT) and to study their long-term oral health status. MATERIALS AND METHODS A retrospective study was performed in a sample of 50 patients. We analyzed the oral health status and all the variables included applying the adapted protocol of pre-RT. RESULTS Prior to RT, 84% of patients required scaling and 32% conservative treatment. Around 74% of patients required at least one exodontia. The mean of exodontias for patients presenting Grade 3 of oral hygiene was 6.50 per person (p<0.0001). The pre-RT study of possible candida infection showed that 78% of patients were negative for this infection. The mean resting saliva production was 39.10 (SD: 23.30; range: 13-145), with a stimulated value of 64.78 (SD: 33.92; range: 16-200). CONCLUSIONS All patients should be protocoled to ensure that they present optimal oral conditions prior to initiating RT treatment.
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Affiliation(s)
- Paula Bonar Alvarez
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Dentistry, Santiago de Compostela, Spain
| | - Mario Perez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Dentistry, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | | | - Mercedes Gallas Torreira
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Dentistry, Santiago de Compostela, Spain
| | - María Elena Padín Iruegas
- Human Anatomy and Embryology Area, Faculty of Physiotherapy, Department of Functional Biology and Health Sciences, Pontevedra, Spain
| | - Andrés Blanco Carrión
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Dentistry, Santiago de Compostela, Spain
| | - Abel García-García
- Maxillofacial Surgery, Oral Medicine, Oral Surgery and Implantology Unit, Department of Maxillofacial Surgery, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
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Cardoso RC, Qazali A, Zaveri J, Chambers MS, Gunn GB, Fuller CD, Lai SY, Mott FE, Hutcheson KA. Self-reported oral morbidities in long-term oropharyngeal cancer survivors: A cross-sectional survey of 906 survivors. Oral Oncol 2018; 84:88-94. [DOI: 10.1016/j.oraloncology.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/26/2018] [Accepted: 07/10/2018] [Indexed: 01/30/2023]
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