Introduction Assessing knowledge of oral health and practice of evidence-based guidelines among oncology teams is crucial in oral management of oncology patients

INTRODUCTION Oral complications can be profound in patients undergoing cancer therapy, negatively impacting quality of life, and potentially postponing or disrupting treatment. While oncology team members seek to deliver optimal oral care, evidence-based management of oral complications and knowledge in the provision of oral care poses a challenge to attaining satisfactory reductions in complications such as oral mucositis, xerostomia and rampant dental caries. METHODS A cross-sectional, random sample (N=2,000) of members of the Oncology Nursing Society were surveyed via a Web-based questionnaire to identify knowledge of oral care, oral health management practices and factors influencing provision of oral care for patients being treated for cancer. Frequencies were calculated for demographic and categorical data. Education, years of experience, and comfort levels were measured and correlated to identified subscales of knowledge, management of oral complications, and use of evidence-based protocols for high-risk patients. RESULTS Over 75% of respondents reported some to little oral health content in their primary education. Significant correlations were found between the three subscales and the variables years of experience and comfort levels (p≤0.05). Use of evidence-based protocols and oral management increased with levels of oral healthcare education and years of experience (p≤0.05). CONCLUSION Results of this investigation suggest a need for the inclusion of more education in general nursing programs addressing oral healthcare of cancer patients, as well as continuing education for practicing oncology professionals. Additionally, findings support the inclusion of dental hygienists, oral health/disease prevention experts, as members of interdisciplinary teams caring for cancer patients. Received: 04/55/2013 Accepted: 09/18/2013 Published: 10/07/2013 © 2013 Tranmer et al. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP & Oral Care in Cancer Therapy ORIGINAL RESEARCH 2(1):eP1049 | 2 Introduction Assessing knowledge of oral health and practice of evidence-based guidelines among oncology teams is crucial in oral management of oncology patients (Barker et al., 2005; McGuire, 2003; McGuire, Johnson, & Migliorati, 2006; Southern, 2007; Vissink et al., 2003). Annually, over one million Americans are diagnosed with cancer and 40% of patients receiving systemic chemotherapy develop oral problems (American Cancer Society, [ACS], 2013; National Cancer Institute, [NCI], 2013; National Institute of Dental and Craniofacial Research, [NIDCR], 2011). Patients undergoing cancer therapy are immediately at risk for shortand long-term oral complications when treatment begins (ACS, 2013; NIDCR, 2011). Oral complications can be profound, negatively impacting quality of life, and potentially postponing or disrupting cancer therapy (ACS, 2013; NIDCR, 2011). Shortand long-term complications associated with head and neck radiotherapy and/or systemic chemotherapies include oral mucositis, a painful inflammation and ulcerations in the oral tissue; xerostomia, severe dry mouth resulting from reduced or absent saliva flow; trimus, a condition limiting opening of jaw with painful muscle spasms; rampant dental caries, tooth decay that affects multiple teeth and progresses rapidly ; and osteoradionecrosis, a necrosis of the jaw bone following radiation (ACS, 2013; NCI, 2013; NIDCR, 2011; Trotti et al., 2003). Oral mucositis is a common complication among patients with cancer undergoing systemic chemotherapy and/or head and neck radiotherapy (Arora, Keerthilatha, Maiya, Vidysagar, & Rajeev, 2008; Stokman et al., 2006; Trotti et al., 2003). The Mucositis Study Group of the Multinational Association of Supportive Care in Cancer (MASCC) and International Society for Oral Oncology (ISOO) published guidelines for care of mucositis based upon a systematic review of the literature (Keefe et al., 2007). These guidelines are similar to those found in other cancer resources, such as those published by NCI and NIDCR. A systematic review by Keefe et al. (2007) concluded, depending on severity, mucositis can cause serious complications to a patient’s ability to eat and maintain a healthy weight. The author also reported cancer treatment may be suspended or discontinued due to severity of mucositis (Keefe et al., 2007). Xerostomia is another common short-term complication resulting from systemic chemotherapy, head and neck radiation, medication, and/or illness. It results from reduction of salivary output (chemical composition) and flow from salivary glands (Al Nawas & Grötz, 2006). In a clinical trial by Papas, Russell, Singh, Kent, Triol & Winston (2007) dramatic reduction of saliva was noted within the first weeks of high-dose systemic cytotoxic agents or head and neck radiotherapy (Papas et al., 2007). Without regular oral Implications for Interprofessional Practice • Emphasizes the presence of specialized oncology members with knowledge and training in oral health, or utilizing an oral health liaison, as being crucial for the implementation of evidence-based oral management of oncology patients. • Describes a need to increase access to and use of current evidence-based guidelines and validated assessment tools for oral complications, as well as modalities for management of oral complications. • Provides published oral management guidelines to assist oncology professionals in the provision of standardized care for patients. • Stresses importance of knowledge of oral health throughout all phases of cancer therapy and the use of guidelines for oral care among oncology teams as critical to the overall management of these patients. H IP & ISSN 2159-1253 Health & Interprofessional Practice | commons.pacifi cu.edu/hip 1(5):eP1049 | 3 assessment and preventive measures, xerostomia can be directly related to rampant dental caries. If xerostomia is not managed eff ectively, teeth can be destroyed in a matter of months and can lead to osteoradionecrosis if not addressed properly. (ACS, 2013; NCI, 2013; NIDCR, 2011; Shiboski, Hodgson, Ship, & Schiødt, 2007).