MASCC/ISOO expert opinion on the management of oral problems in patients with advanced cancer

Abstract

Purpose The Palliative Care Study Group in conjunction with the Oral Care Study Group of the Multinational Association for Supportive Care in Cancer (MASCC) formed a sub-group to develop evidence-based guidance on the management of common oral problems in patients with advanced cancer. Methods This guidance was developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews and trials, respectively. Guidance was categorised by the level of evidence, and “category of guideline” (i.e., “recommendation”, “suggestion” or “no guideline possible”). Results Twelve generic suggestions (level of evidence – 5), three problem-specific recommendations and 14 problem-specific suggestions were generated. The generic suggestions relate to oral hygiene measures, assessment of problems, principles of management, re-assessment of problems and the role of dental/oral medicine professionals. Conclusions This guidance provides a framework for the management of common oral problems in patients with advanced cancer, although every patient requires individualised management.

Oral hygiene care and the management of oral symptoms in patients with cancer in palliative care: a mixed methods systematic review protocol

“… 17 The symptom management strategy can be a self-care strategy or care provided by others. 17 All patients need daily oral hygiene care; dependent patients need appropriate support for this care, 18 and nurses are the health care professionals who usually deliver oral hygiene care to hospitalized patients. 15 In specialist palliative care services, oral symptoms can be managed by nurses and physicians with appropriate training and dental/oral medicine professionals.…”

Management of Oral Hygiene in Head-Neck Cancer Patients Undergoing Oncological Surgery and Radiotherapy: A Systematic Review

“…In the post-surgical phase, the patient should perform home oral hygiene using the following aids: Small-headed soft-bristled toothbrush, using an atraumatic brushing technique [ 38 ]; Fluoride toothpaste [ 38 , 39 ]; Topical application of fluoride gel with special trays one time a day for 5 min (two times a day during radiotherapy) [ 38 , 39 ]; Alcohol-free 0.12% chlorhexidine rinses [ 38 , 39 ]; Saline solution rinses; Interdental hygiene with dental floss or interdental brush [ 38 ]; Tongue cleansing with soft toothbrush or gauze [ 38 ]. …”

“…Topical application of fluoride gel with special trays one time a day for 5 min (two times a day during radiotherapy) [ 38 , 39 ];…”

“…Artificial saliva tends to have a long duration of action and differs in formulation (e.g., spray, gel), pH, lubricant (e.g., mucin, carboxymethyl cellulose), and other ingredients (e.g., flavoring, fluoride). Ideally, artificial saliva should have a neutral pH and contain fluoride [ 38 ].…”

“…Marseille soap and disinfecting it by soaking it daily in a solution with water and 2% sodium hypochlorite or chlorhexidine is recommended [ 38 ].…”