Oral adverse effects during and after treatment in patients and survivors of cancers outside the ...

88 Pages·2016·0.66 MB·English

by  Petter Wilberg

University of Oslo
Oral adverse effects
during and after
treatment in patients and
survivors of cancers
outside the head and neck
region
A descriptive clinical study

Petter Wilberg
Oslo 2016

Academic dissertation
© Petter Wilberg, 2016
Series of dissertations submitted to the
Faculty of Dentistry, University of Oslo
ISBN 978-82-8327-022-8
All rights reserved. No part of this publication may be
reproduced or transmitted, in any form or by any means, without permission.
Cover: Hanne Baadsgaard Utigard.
Print production: Reprosentralen,University of Oslo.
To Maren
Without your support, this would not have been possible!

CONTENTS
SUPERVISORS ......................................................................................................................................... 5
ACKNOWLEDGEMENTS .......................................................................................................................... 7
LIST OF ORIGINAL PUBLICATIONS ......................................................................................................... 11
ABBREVIATIONS ................................................................................................................................... 13
SUMMARY ............................................................................................................................................ 15
INTRODUCTION .................................................................................................................................... 17
Incidence, prevalence, survival, and mortality of cancer in Norway ................................................ 18
Incidence ...................................................................................................................................... 18
Prevalence and survival ................................................................................................................ 18
Mortality ...................................................................................................................................... 19
Main treatment principles of cancer ................................................................................................ 20
Surgical interventions ................................................................................................................... 20
Radiation therapy ......................................................................................................................... 20
Chemotherapy .............................................................................................................................. 20
Palliative care ............................................................................................................................... 21
Oral adverse effects of chemotherapy and symptom management ................................................ 25
Mucositis ...................................................................................................................................... 26
Oral pain ....................................................................................................................................... 26
Xerostomia and hyposalivation .................................................................................................... 27
Altered perception of taste and smell ........................................................................................... 28
Oral infection ................................................................................................................................ 29
Fungal infections ...................................................................................................................... 29
Bacterial infections ................................................................................................................... 30
Caries .................................................................................................................................... 30
Gingivitis/Periodontitis ......................................................................................................... 31
Sialadenitis ........................................................................................................................... 31
Viral infections .......................................................................................................................... 31
Swallowing dysfunction ................................................................................................................ 31
Dental developmental defects ...................................................................................................... 32
AIMS OF THE THESIS ............................................................................................................................. 33
MATERIALS AND METHODS ................................................................................................................. 35
Study design ..................................................................................................................................... 35
Subjects ............................................................................................................................................ 36
1
Registration forms and questionnaire .............................................................................................. 38
ESAS .............................................................................................................................................. 38
Evaluation of general condition .................................................................................................... 38
Registration form ......................................................................................................................... 39
Oral examination .............................................................................................................................. 40
Teeth ............................................................................................................................................ 40
Plaque and periodontium ............................................................................................................. 40
Oral mucosa ................................................................................................................................. 40
Radiological examination ................................................................................................................. 41
Root-crown ratio .......................................................................................................................... 41
Individual defect index .................................................................................................................. 42
Statistical analyses ........................................................................................................................... 43
Ethical considerations ...................................................................................................................... 44
RESULTS................................................................................................................................................ 45
Paper I: Chemotherapy-associated oral sequelae in patients with cancers outside the head and
neck region ....................................................................................................................................... 45
Paper II. Oral health is an important issue in end-of-life cancer care ............................................... 46
Paper III: Dental abnormalities after chemotherapy in long-term survivors of childhood acute
lymphoblastic leukemia; 7-40 years after diagnosis ......................................................................... 47
DISCUSSION .......................................................................................................................................... 49
Methodological considerations ........................................................................................................ 49
Subjects ........................................................................................................................................ 49
Registration forms and questionnaire .......................................................................................... 51
Response rate ............................................................................................................................... 52
Clinical/radiological examination ................................................................................................. 53
Discussion of major findings ............................................................................................................. 56
Self-reported oral adverse effects ................................................................................................. 56
Oral Pain ................................................................................................................................... 56
Xerostomia ............................................................................................................................... 56
Altered perception of taste ...................................................................................................... 57
Swallowing dysfunction ............................................................................................................ 58
Clinically/radiologically manifest oral adverse effects .................................................................. 59
Mucositis .................................................................................................................................. 59
Oral infections .......................................................................................................................... 60
Candidiasis ............................................................................................................................ 60
2
Caries .................................................................................................................................... 60
Comparison to the Norwegian population: ...................................................................... 61
Comparison within study populations: ............................................................................. 62
Gingivitis ............................................................................................................................... 62
Dental developmental defects ................................................................................................. 63
Individual Defect Index (IDeI) ............................................................................................... 63
Hypodontia ........................................................................................................................... 64
Microdontia .......................................................................................................................... 65
Arrested root development .................................................................................................. 65
Enamel hypoplasia ................................................................................................................ 66
Information regarding oral adverse effects .................................................................................. 66
Economic impact of long-term oral adverse effects ..................................................................... 67
CONCLUSIONS ...................................................................................................................................... 69
Oral health and adverse effects: ...................................................................................................... 69
Information: ..................................................................................................................................... 69
Economic impact: ............................................................................................................................. 69
REFERENCES ......................................................................................................................................... 71
ORIGINAL PAPERS................................................................................................................................. 82

3
4
SUPERVISORS

Main supervisor:
(cid:120) Associate professor Bente Brokstad Herlofson, DDS, Dr. Odont
Department of oral surgery and oral medicine
Institute of clinical odontology
Faculty of dentistry
University of Oslo, Norway
Co-supervisor:
(cid:120) Professor Marianne Jensen Hjermstad, cand.mag., Master of Public Health, Dr. Philos
Regional Advisory Unit for Palliative Care, Department of Oncology
Oslo University Hospital, Ullevål, Oslo, Norway.
and
European Palliative Care Research Centre
Department of Cancer Research and Molecular Medicine, Faculty of Medicine
Norwegian University of Science and Technology, Trondheim, Norway.
5
6