New Clinical Practice Statements Now Available to Help Cancer Patients' Oral Health
Seven Clinical Practice Statements about managing various oral complications resulting from cancer therapies are now available and can be viewed for free until September 5, 2024, and available by subscription after this date.
The publications are the result of a two year-long effort by global experts, who are members of the Oral Care Study Group (OCSG) of the Multinational Association of Supportive Cancer Care (MASCC) and the International Society of Oral Oncology (ISOO). The entire project was led by Sharon Elad, DMD, MSc, professor and Oral Medicine chair at Eastman Institute for Oral Health, part of the University of Rochester Medical Center. She also serves as the OCSG chair.
A crucial resource for healthcare providers, these Clinical Practice Statements offer a structured approach to managing oral toxicities and improving the quality of life for cancer patients undergoing targeted therapies. The statements reflect the consensus of an international team of experts related to selected topics affecting cancer patients.
By following these guidelines, clinicians can better support their patients through the challenges of treatment, ensuring that oral health is maintained and complications, such as oral mucosal toxicities, graft versus host disease, various oral lesions, oral neuropathy/dysesthesia, dry mouth, and osteonecrosis of the jaw, are managed effectively.
A description of and links to each Clinical Practice Statement are below:
Adjuvant Bone Modifying Agents in Primary Breast Cancer Patients – Prevention of Medication- Related Osteonecrosis of the Jaw
This is the first consensus paper addressing the risk of osteonecrosis of the jaw due to bone modifying agents in patients with primary breast cancer. This patient population has unique considerations for dental treatment due
to the moderate concentration of these agents compared to patients with metastatic disease. This article proposes a formula to assess the risks prior to dental treatment to prevent medication-related osteonecrosis of the jaw.
This society paper builds on the foundations set by other societies’ guideline papers, such as the AAOMS, and expands the awareness and understanding of the needs of this specific patient population.
The Management of Oral Manifestations of Chronic Graft-versus-Host-Disease
While chronic graft-versus-host disease (cGVHD) is a systemic disease, topical treatment may be of great value when the oral manifestations are resistant to systemic treatment, or when the oral tissues are the only system involved with the disease. This article provides the first society update to the clinical approach for treating oral cGVHD since the NIH Consensus Paper published about 10 years ago. This CPS provides the agents that may be applied topically, as well as considerations how to individualize the treatment for the patient’s needs.
This CPS also addresses less commonly manifestations of oral cGVHD, such as exophytic lesions, and the impact of cGVHD on the dentition and gums. It also includes information on new treatment options, such as interventions for dry mouth and photobiomodulation therapy for oral pain.
Clinical Assessment of Salivary Gland Hypofunction and Xerostomia in Cancer Patients
& Management of Salivary Gland Hypofunction and Xerostomia in Cancer Patients
Dry mouth is a common complication of cancer therapy, particularly radiotherapy to the head and neck. It is debilitating to patients, severely impacting oral function and quality of life.
This pair of papers is intended to serve as a toolkit for the assessment and treatment of salivary gland hypofunction and symptoms of dry mouth. Together, they provide a current, concise, and practical overview.
Management of Oral Complications of Targeted Therapy
As targeted molecular therapies continue to revolutionize cancer treatment, they also bring a range of oral toxicities. This CPS provides a detailed overview and practical guidance for clinicians on how to address these oral toxicities. It outlines the various types of oral adverse effects associated with targeted therapies, such as aphthous-like lesions, lichenoid lesions, oral pemphigoid, hyperkeratotic lesions, oral neuropathy/dysesthesia, taste disorder/dysgeusia, and dry mouth, among others.
By defining the oral complications, this CPS provides a tool for differential diagnosis. Likewise, this CPS lists the main components of the management approach, as well as specific topical agents that may be prescribed for oral complications of anti-cancer targeted treatment.
The Risk of Secondary Oral Cancer Following Hematopoietic Cell Transplantation
Studies described a 7-16-fold higher risk of secondary oral cancer (mainly squamous cell carcinoma) in recipients of a hematopoietic cell transplantation with cells derived from a donor (allogeneic HCT), particularly in those who developed chronic Graft versus Host Disease (cGVHD). Risk increases over time and is influenced by several risk factors.
Clinicians should be aware of the higher oral cancer risk in allogeneic HCT survivors and emphasize the importance of life-long oral cancer surveillance, and avoiding cancer promoting life-style factors, particularly of those with a history of cGVHD. A constructive and empathic discussion with the patient about the higher risk for cancer is needed to obtain the patient’s compliance.
Controversies in Basic Oral Care in Hemato-Oncology and Hematopoietic Cell Transplantation
While providing basic oral care to hemato-oncology patients and hematopoietic cell recipients some controversies may arise. This article elucidates selected controversies that have appeared in the literature and during professional discussions.
To highlight some insights that came up during the consensus discussions, it can be noted that (1) chlorhexidine rinse can reduce the risk of oral infections, although it was not found to reduce the risk of oral mucositis; (2) toothbrushing and proficient interproximal cleaning should not be discouraged during HCT; (3) toothbrushes do not need to be replaced daily and are preferred over cleansing swabs; (4) lidocaine rinse, swish and spit, may be considered to palliate oral mucosal pain, if applied in a certain manner.
The OCSG delegates who collaborated with Dr. Elad to develop these CPS papers are Noam Yarom, DMD, MPH, Yehuda Zadik, DMD, MHA, Catherine Hong, BDS, MS, Alessandro Villa, DDS, MPH, PhD, and Judith Raber-Durlacher, DDS PhD. They were consulted by world renowned experts in the subject matter and additional contributors, all members of the OCSG.