Psychological outcome of patients following treatment of oral cancer and its relation with functional status and coping mechanisms

BACKGROUND: Traditionally health-care providers have measured outcome of treatment of disease by focusing on tumour response and disease-free survival. However, it has become increasingly apparent that the behavioural and functional impact of treatment on the patient is important. This study investigates the psychological outcome and its relationship with functional status and coping mechanisms following treatment of oral cancer patients. MATERIAL AND METHODS: Sixty-eight patients were evaluated 6 months to 6 years after treatment (from October 1992 to October 1997) for oral cancer. The Hospital Anxiety and Depression Scale (HADS) was used for psychological evaluation, the University of Washington Quality of Life Questionnaire (UW-QOL) and The European Organisation for Research and Treatment of Cancer Questionnaire (EORTC QLQ-C30) for evaluating the head and neck specific and general functional status, respectively. Finally, the "Mental Adjustment to Cancer Questionnaire" (MAC-Q) was used for evaluation of coping mechanisms. RESULTS: The incidence of anxiety and/or depression was 25% and the socio-demographic and medical characteristics showed poor correlation with the psychological outcome in this study. The results indicated that there was a strong association between psychological outcome and head and neck specific and general quality-of-life (QOL) domains, and style of coping. The p-value was less than 0.01 for most of the domains and items of functional status and the effective coping style. CONCLUSION: Deteriorated functional status and ineffective coping strategies are strongly associated with poor psychological outcome in patients with oral cancer.     

General health and oral health self-ratings, and impact of oral problems among older adults

The aim was to assess associations of general and oral health perceptions, and the impact of general and oral health functional problems on general health perceptions. Data were collected from adults, 60-71 yr of age in 2008, and included global self-ratings of general and oral health, Oral Health Impact Profile (OHIP-14) scores, and health problem scores [using the five items from the EuroQol instrument (EQ-5D)]. Responses were collected from 444 subjects (response rate = 68.8%). Self-rated general and oral health showed fair to good agreement (kappa = 0.47). Adjusted estimates of self-rated general health showed that worse ratings were associated with lower social status [prevalence ratio (PR) = 0.42] and with more health problems (PR = 0.64). Adjusted estimates of self-rated oral health also showed that worse ratings were associated with lower social status (PR = 0.48) and with more health problems (PR = 0.63), as well as with higher OHIP scores (PR = 0.21). The interaction of health problems and OHIP scores was significant for self-rated general health, with self-rated general health being worse when both health problems and OHIP score were higher. For older adults, general health and oral health were associated, although oral health impact was only associated with general health for those with more health problems, indicating that those in worse health suffer more impact from oral health problems.     

Changes of general and oral health status of elderly patients receiving home-visit dental services

This study investigated the changes of general and oral health status of elderly patients who received home-visit dental services. The subjects were 51 patients (male: 19, female: 32, age: 83.0+/-9.1). The results of initial and re-examination (5.4 months later) by questionnaire survey, oral status and oral microbes were compared. The following results were obtained. 1. More than half of the subjects were bedridden and about 70% were affected by dementia. Three-quarters needed special care for daily activities. 2. The general health condition of the subjects became worse after 5.4 months. Moreover, 11 subjects died within 6 months after re-examination. However, oral health status, such as status of oral hygiene (p < 0.01), inflammation of gingiva (p < 0.01), tongue coating (p < 0.05) and oral malodor (p < 0.01) improved significantly. 3. There was a significant difference in the rate of people with dysphagic problems between the living and dead groups (p < 0.05). 4. The initial general and oral health status of the people with dysphagic problems was significantly worse than that of those without it. After receiving home-visit dental services, general condition became worse. However oral status, such as status of oral hygiene, inflammation of gingiva, oral malodor, and lactobacillus count significantly improved in both groups. These results suggest that dysphagic problems of elderly patients may affect their general health condition and might increase the risk of death. It is recommended to judge dysphagic problems accurately when performing certification of need for long-term care and to provide professional oral care periodically for the dependent elderly needing care.     

Socio‐economic status,social support,social network,dental status,and oral health reported outcomes in adolescents

This study explored the relationships between sex, socio‐economic status, social support, social network, dental clinical status, dental pain, oral health‐related quality of life (OHRQoL), and self‐rated oral health (SROH) in adolescents. A cross‐sectional study involving 542 adolescents, aged 12–14 yr, was conducted in Dourados, Brazil, to collect dental clinical measures (dental caries, missing teeth, and dental trauma), as well as measures of social support, social network, dental pain, OHRQoL, and SROH. Information on family income and parental education were collected from participant's parents. Structural equation modeling showed that higher income predicted better dental status and better SROH. Greater social support was linked to better dental status and better OHRQoL. Having more social networks was directly linked to better dental status. Poor dental status was linked to dental pain and poor OHRQoL. Dental pain predicted poor OHRQoL and worse SROH. Poor OHRQoL predicted worse SROH. Family income, social support, and social networks indirectly predicted dental pain via dental status. The latter was indirectly linked to OHRQoL and SROH via dental pain. Social support and social networks indirectly predicted OHRQoL and SROH via dental status and dental pain. Socio‐economic factors and social relationships should be considered when planning health promotion and dental care provision to improve an adolescent's oral health.     

口腔癌患者生存质量的影响因素及医学应对方式分析

目的 评价口腔癌患者术后生存质量的影响因素并对患者的应对方式进行分析。方法 采用第4版华盛顿大学生存质量量表（UWQOL）和医学应对问卷（MCMQ）分别对符合纳入标准的131例口腔癌术后患者进行调查,了解患者生存质量的影响因素及应对方式与生存质量之间的相关关系。结果 共回收有效问卷126份,回收率为96.18%（126/131）。单因素分析显示年龄、婚姻状况、文化程度、其他系统性疾病、个人收入水平、牙齿缺失、手术次数、辅助放疗、分期、颈淋巴清扫术、复发及颌骨切除等因素对口腔癌患者生存质量有不同程度的影响（P<0.05）;多重回归分析显示,牙齿缺失、分期、复发及颌骨切除主要在生存质量总得分上的差异有统计学意义（P<0.05）。口腔癌术后患者应对方式中的面对维度得分为（17.54±4.97）分,回避维度得分为（17.79±2.19）分,屈服维度得分为（12.97±5.70）分,与常模比较,差异具有统计学意义（P<0.05）,相关分析表明,面对和回避维度与患者生存质量呈正相关,屈服维度与患者生存质量呈负相关（P<0.05）。结论 年龄、婚姻状况、文化程度、其他系统性疾病、个人收入水平、牙齿缺失、手术次数、辅助放疗、分期、颈淋巴清扫术、复发及颌骨切除在生存质量各方面均有不同程度的影响,而牙齿缺失、分期、复发及颌骨切除是影响患者整体生存质量的主要因素,应加强个性化治疗及护理,全面提高患者的生存质量,改变患者的不良应对方式。     

Quality of life in patients with oral and oropharyngeal cancer

Quality of life (QoL) is an important aspect in the clinical assessment and management of patients with cancer. The aim of the present study was to evaluate QoL at the time of diagnosis in patients with oral and oropharyngeal cancer and to establish the influence of variables such as gender, age, tumor location and tumor staging. The authors studied 149 patients with oral and oropharyngeal cancer for 2 years. QoL was measured using the EORTC QLQ-C30 and its specific modules for head and neck cancer QLQ-H&N 35. Variable deterioration of QoL was observed before therapy. The emotional domain showed the greatest alterations, while pain was the most remarkable symptom variable. QoL seems to be associated with gender (female patients obtained worse scores in most of the functional scales), age (patients < 65 years scored better), tumor location (orpharyngeal tumors showed worse prognosis) and tumor staging (early stages obtained better scores than advances ones). Many patients with oral and oropharyngeal cancer show poor QoL before initiating treatment. The present study of a homogeneous group of patients is the first carried out in Spain following the EORTC QLQ-C30 questionnaire and its results may serve for future reference. These results are similar to those obtained in populations from the north and centre of Europe.     

Self-perceived oral health status, psychological well-being, and life satisfaction in an older adult population

Numerous studies have demonstrated that many older adults have problems chewing, pain, difficulties in eating, and problems in social relationships because of oral disorders. However, it is not clear if these functional and psychosocial outcomes affect broader psychological well-being and life satisfaction. Consequently, this paper begins to address the question, 'Does poor oral health compromise the quality of life?'. Initial cross-sectional analyses used data derived from the seven-year follow-up of the Ontario Study of the Oral Health of Older Adults. As at baseline and three-year follow-up, oral health was measured by self-ratings of oral health and five oral health indices. Psychological well-being and life satisfaction were assessed according to the Morale Index, the Perceived Life Stress Questionnaire, The Life Satisfaction Scale, and the General Health Questionnaire. All oral health variables were significantly associated with scores from the first three of these measures in the expected direction. These associations remained after we controlled for other potential influences on the quality of life. In addition, prospective analysis indicated that self-perceived oral health at three years had a significant independent effect on psychological well-being and life satisfaction at seven years. These results suggest that poor self-perceived oral health and relatively poor quality of life co-exist in the same subgroup of older adults.     

Loneliness and quality of life after head and neck cancer

Loneliness is associated with a poor quality of life, mental illness, poor physical health, and premature mortality. Patients with head and neck cancer (HNC) are at risk of loneliness because of the effects of the disease and its treatment on important social interactive functions such as appearance, speech, facial expression, and eating. Patients treated for primary squamous cell HNC between January 2015 and December 2016 were surveyed in early 2019 using the University of Washington quality of life questionnaire version 4, the Cancer-related Loneliness Assessment Tool (C-LAT), and four nationally recommended indicator questions. The survey comprised 140 patients, with a mean (standard deviation) age at diagnosis of 63 (11) years. Tumour sites were oropharyngeal (42%), oral (35%), laryngeal (14%), and elsewhere (9%). In response to the question “How often do you feel lonely?” three-quarters said “hardly ever” and only 6% “often”. Similar responses were obtained for the other three indicator questions. It is encouraging that a relatively small proportion had serious issues with loneliness. Similarly, responses to the C-LAT suggested that one-quarter had feelings of loneliness and a minority had serious problems. Patients who were younger, who lived in more deprived circumstances, who had advanced disease and had been treated with chemotherapy or radiotherapy reported greater levels of loneliness. Loneliness was associated with a worse overall quality of life, and worse physical and social-emotional function. Lonely patients need to be identified as early as possible so that support and interventions can be implemented and outcomes improved.     

The prosthodontic pathway of the oral cancer patient

Oral cancer patients undergo life-altering curative treatment that consists of surgery or a combination of surgery and radiotherapy. This can severely alter the functional anatomy of the oral cavity and create a challenging environment for successful oral rehabilitation. A multidisciplinary team approach is required to rehabilitate these patients successfully. It is essential to have assessment by an oral rehabilitation specialist before treatment, especially where primary rehabilitation interventions are being considered. Following cancer treatment, patients may suffer from a range of difficulties, from dento-facial appearance, to chewing, speech and swallowing. This dysfunction often leads to psychosocial problems, such as reduced self esteem, social contact and quality of life. Conventional prosthodontics has a role to play in the management of these patients but osseointegrated implants (OII), can be required to overcome the anatomical and physiological barriers. OII can be used in an environment where there is poor soft tissue function or little bone support, and where there is a dry mouth. CLINICAL RELEVANCE: This paper introduces readers to the prosthodontic pathway taken by some oral cancer patients. It provides an overview of current oral rehabilitation techniques that supplement the supportive dental care provided by general dental practitioners and their team after cancer treatment.     

口腔癌患者心理健康状况的调查分析

为探讨口腔癌发生与心理健康状况的关系。根据1:1配对原则,应用深入访谈法和症状自评量表,对41例口腔癌患者和41例正常人进行评定。结果,不良人际关系、不幸遭遇和不良应对策略与个体口腔癌的发生有非常明显的关系,不良家庭气氛和缺少社会支持,与其发生有一定关系。口腔癌患者的SCL-90总分及躯体化、忧郁、焦虑因子显著高于正常人(P<0.01),人际敏感因子显著低于正常人(P<0.05)。因此认为口腔癌的发生与个体的心理健康状况有一定关系,及时正确的心理治疗和干预,对口腔癌的发生有重要意义。     

Influences of social support on the oral health of older people in Britain

A national UK study involving a random sample of 876 non-institutionalized older people (aged 65 or older) were recruited, to identify the association between social support (living alone), self-reported oral health status and oral health behaviour (use of services). Home interviews were undertaken exploring oral health behaviour (time and reason for last dental visit) and oral health status measures (self-reported number of teeth possessed and denture status). In addition, socio-demographic characteristics were collected. Bivariate analysis identified that social support was associated with time since last dental visit (P < 0.01), reason for last dental visit (P < 0.01), self-reported number of teeth possessed (P < 0.01) and denture status (P < 0.01). In regression analysis, social support emerged as an important predictor of reason for last dental visit and denture status having accounted for other factors in the model (age, gender, social class and educational attainment). Social support is associated with oral health status and oral health behaviour of older people in Britain and is likely to influence both the decision making process of when to seek dental care and what type of treatment to opt for.     

Predictors of health-related quality of life in Serbian patients with head and neck cancer

Background The aim of this study was to identify predictors of the Health-Related Quality of Life (HRQoL) in patients with head and neck cancers (HNCs).Material and Methods In total, 345 patients with HNCs were interviewed. A self-report questionnaire was administered to collect data about demographic characteristics, health status, smoking, alcohol consumption habits, and HRQoL. It were used the EORTC Instruments - Quality of Life Questionnaire-Core 30-questions (QLQ-C30), Quality of Life Questionnaire - Head and Neck Module 35-questions (QLQ-H&N 35) and OHIP-14 instrument for HRQoL assessments. Clinical information and treatment data were collected from medical records.Results Five groups of HRQoL predictors were identified: demographic, socioeconomic, behavioral, psychophysical, and clinical/treatment. These HRQoL predictors had a strong (i.e., age, level of social support and social contact, level of education, depression, fatigue, presence of gastrostomy, comorbidities, and use of pain medications and supplements), a moderate (i.e., marital status, smoking, sexuality problems, time since diagnosis, presence of tracheostomy, and side effects outcomes of radio and chemotherapy) and a small impact (i.e., employment/financial difficulties, tumor site and stage, and surgical procedure).Conclusions Study identified nineteen predictors that had significant, moderate and small impact on the HRQoL of patients with HNCs. Some of the predictors, like levels of social support and social contact, depression, and comorbidities could be targets for innervations to improve HRQoL. Key words:Quality of Life, oral health, combined modality therapy, treatment outcome.     

Pretherapy dental status of patients with malignant conditions of the head and neck

Maxillofacial problems after radiotherapy to this region are common and have at least a temporal relationship to preexisting odontogenic disease. This study was undertaken to determine the dental status of patients before multimodality therapy for head and neck cancer. One hundred thirty-one patients were examined during their initial visit to a head and neck tumor clinic. The majority of dentulous patients were noncompliant with routine dental care (76%) and oral hygiene (65%). There was a high incidence of alveolar bone loss (66%), clinical caries (71%), and failing restorations (91%). Overall, 73 (97%) of the dentulous patients needed dental care before radiotherapy; however, follow-up visits revealed that 59 (81%) of these patients did not seek the indicated treatment. These data suggest that thorough oral examinations should be performed on all patients before radiotherapy that involves the oral cavity.     

Temporomandibular disorder subtypes according to self-reported physical and psychosocial variables in female patients: a re-evaluation

Several studies support the relevance of psychological and psychosocial factors in the assessment and management of chronic musculoskeletal pain disorders, including temporomandibular pain disorders (TMDs). The aim of this study was to re-evaluate subtyping approach used in an earlier study (TI Suvinen, KR Hanes, JA Gerschman, PC Reade. J Orofac Pain 1997;11:200) and to compare perceived physical symptoms, psychological, coping and psychosocial variables between subtypes of patients who seek treatment for their temporomandibular pain and dysfunction. A total of 41 consecutive female patients were assessed multiaxially for physical symptoms, coping style and effectiveness and illness behaviour by a previously validated Temporomandibular Pain Dysfunction Questionnaire (TI Suvinen, KR Hanes, JA Gerschman, PC Reade. J Orofac Pain 1997;11:200). Additional measures of psychosocial variables included the global scores of the Beck Depression and Anxiety Inventory and Part I of the Multidimensional Pain Inventory. Subtypes were generated using an iterative partitioning method, k-means cluster analysis. Three clusters were identified and termed as Simple (22%), Intermediate (41%) and Complex (37%) temporomandibular disorders subtypes. Significant differences (P < 0.05) were found between clusters in psychological (coping style and effectiveness, disease conviction and affective disturbance) and in psychosocial variables (daily interference and social, work and family satisfaction), but not between physical variables. The results support previous studies that have shown differences in psychosocial variables in the presentation and subtyping of TMDs and the biopsychosocial orientation in assessment. The findings need to be reverified in a larger sample along specific physical diagnoses, but it is tentatively proposed how the three subtypes could be used in the classification of temporomandibular pain patients to guide management, based on the constellation of predominant psychological and psychosocial illness impact variables.     

Oral cancer and precancer: after-care and terminal care

This paper looks at the social and psychological effects of cancer on patients and their families, and discusses the support and after-care required by a patient who has been treated for an oral cancer. The role of the dental practitioner in the maintenance of oral health and comfort is discussed, and the management of the side-effects of the different treatment modalities is described. The particular problems and needs of patients, and the relatives of patients, in the terminal stages of oral cancer are also discussed.     

A comparative study of oral health status in a migrant/Japanese sample

OBJECTIVES: The aim of this study was to compare the oral health status of migrants to Japan with that of Japanese using the questionnaire and the Oral Health Status Index (OHSI). METHODS: The questionnaire for collecting demographic and behavioral variables and the OHSI were applied in a mixed migrant/Japanese sample of patients from a dental clinic in Yokohama. A sample of 224 subjects, 52% of whom were migrants, was selected from new patients. RESULTS: The mean OHSI scores were 78.56 for migrants and 83.16 for Japanese (p<0.01). Multiple regression analysis of OHSI showed that the statistically significant contributors were: age, status (migrants / Japanese), reason for initial visit, perceived oral health, and flossing behavior. CONCLUSION: The oral health status of migrants was worse than that of Japanese even though they were younger than Japanese. The present public support system for foreign patients and their self-care behavior were considered to be the factors for the inequity in oral health status.     

股前外侧穿支皮瓣修复口腔癌术后缺损患者的生活质量评估

目的 评估应用游离股前外侧穿支皮瓣（ALTF）修复口腔颌面部恶性肿瘤切除术后组织缺损患者的生活质量（QOL）。方法 以2012年1月-2013年7月应用ALTF修复口腔颌面部恶性肿瘤切除术后组织缺损的32例患者为研究对象,应用口腔健康影响程度量表（OHIP-14）和简明健康状况调查问卷（SF-36）对患者术后12个月的QOL进行调查和评估。结果 SF-36问卷得分位于前3的项目是躯体疼痛、生理功能和躯体角色,得分分别是78.58±14.82、72.08±27.86和60.00±42.63;得分较低的是情感角色（41.67±39.62）、心理健康（50.75±13.07）和健康变化（54.17±21.75）。分析OHIP-14量表得分,恢复较好的项目是社交障碍和残障,得分分别为34.50±11.32和36.04±12.05;恢复较差的项目是生理性疼痛和心理不适,得分分别为73.50±18.96和60.17±25.66。结论 采用ALTF修复口腔颌面部恶性肿瘤切除术后组织缺损,能够恢复患者外形、语言和咀嚼功能的基本需求,提高患者的QOL。     

Health-related quality of life of parotid carcinoma patients—a comparative study with parotid adenoma patients and assessment of the influence of demographic,treatment, and pathological factors

The aim of this study was to compare the health-related quality of life (HRQoL) of patients treated for parotid carcinoma (PC) and parotid adenoma (PA). The impact of demographic, treatment, and pathological factors was analyzed within the PC group. The EORTC QLQ-C30 and QLQ-H&N35 questionnaires were completed by 45 PC patients and 46 PA patients. A number of HRQoL domains were significantly worse in the PC group than in the PA group: global health status, pain, insomnia, loss of appetite, mouth opening, swallowing problems, dry mouth, sticky saliva, problems with senses and speech, social eating, and cognitive functioning (P < 0.05). In the PC group, significantly worse scores were found for age >55 years, radical parotidectomy, neck dissection, radiotherapy, recurrence of the disease, pT3/T4 stage, pN+ status, and high-grade tumour (P < 0.05). Worse results were related to global health status, social contact, mouth opening, weight and appetite loss, physical, role, emotional, and social functioning, fatigue, speech problems, social eating, and financial difficulties. The study results demonstrate worse HRQoL in PC patients in comparison to PA patients. Older age, radical parotidectomy, neck dissection, radiotherapy, T3/T4 stage, pN+, high-grade tumours, and recurrence had a significant influence on HRQoL in PC patients.     

Food intake and oral health status of inpatients with dysphagia in acute care settings

Adequate oral status and functional assessments are important for dysphagia rehabilitation in acute care inpatient settings, especially to establish individualised oral intake. However, the association between food intake levels and oral function has not been elucidated in acute care inpatients. This cross-sectional study clarified the association between oral intake levels and the oral status/function of patients with dysphagia admitted to acute care settings. Admitted patients aged ≥40 years (n = 459; men: 288; mean age: 70.8 ± 12.0) examined at the Department of Dysphagia Rehabilitation at the Iwate Medical University Hospital from April 2007 to March 2014 were included. The oral health status was evaluated by the tongue coating, oral dryness severity, plaque control, posterior occlusal support and a repetitive saliva swallowing test (RSST). Dysphagia severity was determined from the Dysphagia Severity Scale. Oral intake levels were evaluated using the Functional Oral Intake Scale (FOIS) at the time of the initial dental examination (FOIS-I), and they were re-evaluated after the revision of levels according to the participants’ general condition and oral health status (FOIS-R). Divergence between FOIS-I and FOIS-R was noted in >40% patients. Multiple regression analysis showed significant associations between FOIS-R and consciousness level, activities of daily living, tongue coating, RSST and posterior occlusal support. Patients with dysphagia in acute care settings require detailed assessments of their oral status and function, including swallowing, to determine the most suitable feeding methods and dental interventions to improve oral intake levels.     

Malocclusion traits and oral health–related quality of life in children with osteogenesis imperfecta: A cross-sectional study

BackgroundThe incidence of malocclusion is higher among people with osteogenesis imperfecta (OI) than the general population, and treatment options are limited due to the weak structure of bones and teeth. Focusing on those malocclusion traits that might have a high impact on a patient’s oral health–related quality of life (OHRQoL) is warranted.MethodsA total of 138 children and adolescents with OI were examined for malocclusion traits. OHRQoL was measured using age-specific versions (8 through 10 years and 11 through 14 years) of the Child Perceptions Questionnaire (CPQ), considering the following domains: oral symptoms, functional limitation, emotional well-being, and social well-being. Higher scores implied worse OHRQoL. Multivariable ordinal logistic regression was used to estimate the association between malocclusion traits and OHRQoL.ResultsAmong children aged 8 through 10 years (n = 56), the CPQ and its constituent domain scores were relatively similar between those with malocclusion (higher scores) and those without. In the adolescent (n = 82) group aged 11 through 14 years; however, those with posterior crossbite (odds ratio, 5.01; 95% confidence interval, 1.40 to 12.41) or open bite (odds ratio, 3.21; 95% confidence interval, 1.21 to 10.23) experienced statistically significantly higher degrees of functional limitations (a higher functional limitation score) than those without.ConclusionsAdolescents with OI and posterior open bites or crossbites have substantial self-reported functional limitations and worse oral symptoms, which warrants additional investigation and therapeutic trials in an attempt to improve the malocclusion. In addition, the authors found that the CPQ can be a useful tool in a clinical trial of orthodontic interventions in OI.