Self-reported oral health status: Perspectives of patients undergoing therapy for cancer of the head and neck region, in the eThekwini District, KZN
Keywords:Trismus, predominance, . Xerostomia
There is a dearth of published evidence related to understanding oral health needs for patients undergoing therapy for cancer of the head and neck region in South Africa. This study aimed to assess perceived oral health status of patients undergoing therapy for cancer of the head and neck region, in eTthekwini district, KwaZulu-Natal. This was a cross-sectional case study using quantitative
data to determine patients’ perspectives of oral health status and need. The study population comprised 235 voluntary patients (aged between 20-70 years old), undergoing treatment or follow up for cancer therapy of the head and neck region, in a public tertiary referral hospital in the eThekwini district, KwaZulu-Natal. Purposive sampling technique was used for participant selection. The research instrument comprised a combination of two previously validated questionnaires: a core questionnaire (EORTC QLQ-C30, Version 3.0) and the head and neck cancer specific module (EORTC H&N-35). Data was analysed using the statistical package for software sciences (SPSS), version 24. More than half of the study population were male (60%;n= 141). The mean age was 54.38 (SD= 12.30). The results indicate that 14.5% (n=34) were employed, 46.4% (n=109) were unemployed because of cancer and 39.1% (n=92) were unemployed due to other reasons (old age, housewife). Oral cavity cancer was the most common (n=91; 38.7%), followed by laryngeal cancer (n= 53; 22.6%) among all the other head and neck cancers. Males(n=50; 21.3%) were more affected by oral cavity cancer as compared to females (n=41; 17.4%). With reference to treatment, 20.4% (n=48) were on radiotherapy, 28.5% (n=67) were on chemotherapy and 9.8% (n=23) were on CCRT, 17.4% (n=41) had surgery, 8.5% (n=20) were recently diagnosed with cancer of the head and neck and 23.4% (n=55) were on follow up. Oral health-related symptoms were experienced to varying degree by the
participants. The majority of participants (n=125; 53.2%) did not report any pain and discomfort. More female participants (n=7;
7.4%) in the age group of 41-60 reported of severedifficulty in swallowing liquids than males of the same age group. Most participants (n=148; 63.0%) had difficulty in swallowing solid foods. Similarly, the majority of participants experienced problems with their teeth (n=162; 69.0%), reported xerostomia (n=159; 67.7%). With reference to trismus, a higher proportion of females (n=27; 28.7%)
reported severe trismus compared to male participants (n=33; 23.4%). With reference to increased viscosity of saliva, 34.0% (n=32) of females reported extremely sticky saliva as compared to 29.8% males (n=42).
Sammut L, Ward M, Patel N. Physical Activity and Quality of Life in Head and Neck Cancer Survivors : RESEARCH < 605A Literature Review. International Journal of Sports Medicine. 2014;35(9):794–9.
Romesser PB, Riaz N, Ho AL, Wong RJ, Lee NY. Cancer of the Head and Neck. 2012. p. 1037–70.
World Health Organization. Pathology and Genetics of Head and Neck Tumours. WHO Classification of Tumours. 2005. 1-435 p. Available from: https://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb9/BB9.pdf.
Shinde KJ, Hashmi SIH. Retrospective Study Of Malignant Lesions Of Head & Neck In Rural Area Of Ahmednagar District. IOSR Journal of Dental and Medical Sciences. 2013;4(2):12–9.
Tulunay-Ugur OE, McClinton C, Young Z, Penagaricano JA, Maddox A-M, Vural E. Functional Outcomes of Chemoradiation in Patients with Head and Neck Cancer. Otolaryngology-Head and Neck Surgery. 2013;148(1):64–8. Available from: http://journals.sagepub.com/doi/10. 1177/0194599812459325.
Lieshout HFJ, Bots CP. The effect of radiotherapy on dental hard tissue-a systematic review. Clinical Oral Investigations. 2014;18(1):17–24.
Mawardi H., Al-Mohaya M., Treister N. Oral health considerations in cancer survivors. Saudi Medical Journal. 2013;34(5):461–9. Available from: https://www.scopus.com/inward/record.url?eid=2-s2.0-84878361172&partnerID=40&md5=69cc3777ed9f5
Jawad H, Hodson NA, Nixon PJ. A review of dental treatment of head and neck cancer patients, before, during and after radiotherapy: part 1. British Dental Journal. 2015;218(2):65–8. Available from: http://dx.doi.org/10.1038/sj.bdj.2015.28.
Shavi GR, Thakur B, Bhambal A, Jain S, Singh V, Shukla A. Oral Health Related Quality of Life in Patients of Head and Neck Cancer Attending Cancer Hospital of Bhopal City, India. Journal of International Oral Health: JIOH. 2015;7(8):21–7. Available from: http://www.pubmedcentral.nih. gov/articlerender.fcgi?artid=4588784&tool=pmcentrez&rendertype=abstract.
Jablonski RA. Oral Health and Hygiene Content in Nursing Fundamentals Textbooks. Nursing Research and Practice, vol. 2012, Article ID 372617, 7 pages. 2012; Available from: https://www.researchgate.net/publication/224919846_Oral_Health_and_Hygiene_
Bhayat A, Chikte U. The changing demographic profile of dentists and dental specialists in South Africa: 2002-2015. International Dental Journal. 2017;1–6. Available from: http://doi.wiley.com/10.1111/idj.12332.
Ramphoma KJ. Oral Health in South Africa: Exploring the role of dental public health specialists . South African Dental Journal, 71(9), pp. 402–403. Available at: http://www.scielo.org.za/pdf/sadj/v71n9/05.pdf.
Singh S, Myburgh NG, Lalloo R. Policy analysis of oral health promotion in South Africa. Global Health Promotion. 2010;17(1):16–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20357348.
Chi AC, Day TA, Neville BW. Oral Cavity and Oropharyngeal Squamous Cell Carcinoma—An Update. CA Cancer J Clin. 2015;65:401–21.
Aaronson N, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez N, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute. 1993;85(5):365–76.
Bjordal K, de Graeff A, Fayers P., Hammerlid E, van Pottelsberghe C, Curran D, et al. A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients. European Journal of Cancer. 2000;36(14):1796–807. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0959804900001866
Singer S, Ignacio J, Hofmeister A, KeszteDirk W-CC, Fisher SE, Galalae R, et al. Performance of the EORTC questionnaire for the assessment of quality of life in head and neck cancer patients EORTC QLQH&N35: a methodological review. Qual Life Res.
Rettig EM, D’Souza G. Epidemiology of Head and Neck Cancer. Surg Oncol Clin N Am. 2015;24(3):379–96. Available from: http://dx.doi.org/10.1016/j.soc.2015.03.001.
Alam M, Siddiqui S, Perween R. Epidemiological profile of head and neck cancer patients in Western Uttar Pradesh and analysis of distributions of risk factors in relation to site of tumor. J Can Res Ther. 2017;13:430–5. Available from: http://www.cancerjournal.net/preprintarticle.asp?id=180687.
Joshi P, Dutta S, Chaturvedi P, Nair S. Head and Neck Cancers in Developing Countries. Rambam Maimonides Medical Journal. 2014;5(2):e0009:1–6. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4011474&tool=pmcentrez&r
National Cancer Registry. Cancer in South Africa 2013 Full Report. 2013. Available from: http://www.nioh.ac.za/assets/files/2013NCR.pdf.
Parkin DM, Bray F, Ferlay J, Pisani P. Global Cancer Statistics, 2002. CA Cancer Journal for Clinicians. 2005;55(2):74–108.
Carlsen K, Dalton SO, Diderichsen F, Johansen C. Risk for unemployment of cancer survivors: A Danish cohort study. European Journal of Cancer. 2008;44(13):1866–74.
Stokman M, Burlage F, Spijkervet F. The effect of a calcium phosphate mouth rinse on (chemo) radiation induced oral mucositis in head and neck cancer patients: a prospective study. International Journal of Dental Hygiene. 2012;10(3):175–80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23046006.
Maria O., Eliopoulos N, Muanza T. RadiationInduced Oral Mucositis. Frontiers in Oncology. 2017; 7, 89. Available from: http://journal.frontiersin.org/article/10.3389/fonc.2017.00089/full.
Pattanayak L, Panda N, Dash MK, Mohanty S, Samantaray S. Management of ChemoradiationInduced Mucositis in Head and Neck Cancers With Oral Glutamine. Journal of Global Oncology. 2016;2(4):200–6. Available from: http://jgo.ascopubs.org/cgi/doi/10.1200/JGO.2015.000786.
Starmer HM. Dysphagia in head and neck cancer: prevention and treatment. Current Opinion in 606 > RESEARCH www.sada.co.za / SADJ Vol. 77 No. 10Otolaryngology and Head and Neck Surgery. 2014;22:195–200.
Johnson J, Johansson M, Rydén A, Houltz E, Finizia C. Impact of trismus on health-related quality of life and mental health. Head and Neck.
;37(11):1672–1679. Accepted article. Available from: http://doi.wiley.com/10.1002/hed.23816.
Steiner F, Evans J, Marsh R, Rigby P, James S, Sutherland K, et al. Mouth opening and trismus in patients undergoing curative treatment for head and neck cancer. International Journal of Oral and Maxillofacial Surgery. 2015;44(3):292–6. Available from: http://dx.doi.org/10.1016 /j.ijom.2014.12.009.
Rapidis AD, Dijkstra PU, Roodenburg JLN, Rodrigo JP, Rinaldo A, Strojan P, et al. Trismus in patients with head and neck cancer: etiopathogenesis, diagnosis and management. Clinical Otolaryngology. 2015;40(6):516–26. Available from: http://www.ncbi.nlm.nih.gov /pubmed /26098612%0Ahttp://doi.wiley.com/10.1111/coa.12488
Beetz I, Schilstra C, Burlage F, Koken P, Doornaert P, Bijl H, et al. Development of NTCP models for head and neck cancer patients treated with three-dimensional conformal radiotherapy for xerostomia and sticky saliva: The role of dosimetric and clinical factors. Radiotherapy and Oncology. 2012;105(1):86–93. Available from: http://dx.doi.org/10.1016/j.radonc.2011.05.010.
Villa A, Connell CL, Abati S. Diagnosis and management of xerostomia and hyposalivation. Therapeutics and Clinical Risk Management.
Sultana N, Sham EM. Xerostomia : An overview. International Journal of Dental Clinics. 2011;3(2):58–61.
Irune E, Dwivedi RC, Nutting CM, Harrington KJ.Treatment-related dysgeusia in head and neck cancer patients. Cancer Treatment Reviews.
;40:1106–17. Available from: http://dx.doi.org/10.1016/j.ctrv.2014.06.011.
Najafizade N, Hemati S, Gookizade A, Berjis N, Hashemi M, Vejdani S, et al. Preventive effects of zinc sulfate on taste alterations in patients under irradiation for head and neck cancers: A randomized placebo-controlled trial. Journal of Research in Medical Sciences: Official Journal of Isfahan Univiversity of Medical Sciences. 2013;18(2):123–6. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3724372&tool=pmcentrez&rendertype=abstract.
Murtaza B, Hichami A, Khan A., Ghiringhelli F, Khan N. Alteration in Taste Perception in Cancer: Causes and Strategies of Treatment. Frontiers in Physiology. 2017;8:134
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