Download Oral Health Care for Patients Undergoing Cancer Therapy 11-13-12

Oral Health Care for Patients Undergoing Cancer Therapy
Speaker: JoAnn R. Gurenlian, RDH, PhD
Date: November 13, 2012
Outline:
Cancer stats and facts
•
Cancer is the 2nd leading cause of death following heart disease
•
Accounts for 23% of all deaths
•
Death rate decreased 1.5% from 2007 to 2008
•
Decreases in cancer deaths for lung, female breast, colorectal and prostate cancer since
1990
•
Increases in last two decades of rates of kidney, thyroid, liver, esophageal
adenocarcinoma, melanoma of the skin, and some throat cancers (linked to HPV
infection)
•
1,638,910 Americans will be diagnosed with cancer in 2012
•
577,190 deaths anticipated in 2012
•
Lifetime risk of developing cancer is 44.85% for all men and women born today
•
Overall survival rate is 63.5%
•
Tobacco use and obesity are estimated to be the two main cancer-causing factors for
2012; each factor accounting for one-third of cancer deaths
•
1 in 95 individuals will be diagnosed with oral and pharyngeal cancer during their lifetime
•
Overall survival rate of oral and pharyngeal cancer is 60.8%;for localized cancer, the
percentage of those who survive is 82%; for distant sites, the survival rate drops to
~33%
Source: Siegel R, Nalshadham D, Jemal A. Cancer statistics, 2012. Ca Cancer J Clin 2012.
Available online at http://cacancerjournal.com. Accessed 1/8/12.
Treating Patients Undergoing Cancer Therapy
•
Identify patients with cancer
•
Post a sign asking patients to inform you they have been diagnosed with cancer
o
Offer last appointment of day for initial appointment after being diagnosed
o
Share common goal of education the patient
o
Allows ample time for patient to ask questions
o
Allows time to develop aggressive plan for reducing negative oral effects of
cancer therapy
o
Allows time to teach patient oral self-exam
Information Gathering
•
•
Identify oncology team members
o
Medical oncologist, radiation oncologist, nurse practitioner, registered dietician,
family practitioner, etc.
o
Must be able to contact the team should oral infection or other side effects occur
Identify cancer protocol to be used
o
Radiotherapy
o
Chemotherapy regimens, procedures, schedule of treatment, effects (seeTables I
and II)
o
Helps to identify best time to schedule dental and dental hygiene appointments
•
Blood studies
•
Performed 24 hours before every dental/dental hygiene appointment
•
Postpone oral procedures if:
•
o
Platelet count is < 75,000/mm3
o
Abnormal clotting factors are present
o
Absolute neutrophil count is < 1000/mm3 (or consider prophylactic antibiotics)
If patients has a central venous catheter, antibiotic prophylaxis may be needed before
any dental treatment
Phases of Care - pretreatment, cancer therapy, end of cancer/recovery
Pretreatment Phase
2
•
Schedule oral health care appointment prior to cancer therapy
•
Educate patient about risk of oral infection, how to recognize signs of oral infection
during cancer treatment, and the need for seeking immediate treatment for oral health
concerns
•
Perform dental treatment to restore or remove any diseased areas and to ensure
meticulous oral hygiene regimen is maintained
•
Assess medications for potential to produce xerostomic side effects
•
Implement fluoride therapy in office and at home to reduce risk of dental caries
•
Advise those with smoking and alcohol addictions to seek cessation programs
It is estimated that approximately one-third of individuals diagnosed with cancer will develop oral
complications from treatment.
Source: Hong CHL, Napeñas JJ, Hodgson BD, Stokman MA, et al. A systematic review of
dental disease in patients undergoing cancer therapy. Support Cancer Care 2010. August;18(8):
1007-1021.
Oral Care Considerations –review of products
Cancer Therapy Phase
•
Maintain regular dental and dental hygiene appointments to manage periodontal health,
assess for signs of infection or mucositis, and provide supportive periodontal therapy to
address xerostomia, etc.
•
Effects of cancer therapy: mucositis, herpes, fungal infections, radiation caries,
xerostomia
•
Treatment of mucositis
o
Regular assessment of oral pain
o
Topical anesthetics or other agent used for oral comfort
o
Ongoing assessment of oral cavity through patient self-reports and professional
exams
o
Use of preventive and therapeutic oral care regimens
o
Regular oral hygiene maintenance with brushing, flossing, and bland rinses/
moisturizers
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Source: Mucositis Study Section of the Multinational Association of Supportive Care in Cancer
and the International Society for Oral Oncology (MASCC/ISOO)
MASCC/ISOO Mucositis Recommendations
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Use of midline radiation blocks and 3 dimensional radiation treatment
•
Benzydamine for prevention of radiation-induced mucositis for head and neck cancer
patients
•
Palifermin for those receiving high doses of chemotherapy and total body irradiation with
autologous stem cell transplantation
•
Cryotherapy to prevent mucositis in patients receiving high-dose melphalin and other
forms of chemotherapy
MASCC/ISOO Recommendations – Resources NOT to be used for Mucositis
•
Chlorhexidine
•
Antimicrobial lozenges
•
Sucralfate
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Acyclovir
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Pentoxifylline
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Granulocyte-macrophage-colony stimulating factor (GM-CSF) mouthwashes
Cochrane Collaboration Recommendations for Mucositis Prevention and Treatment
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Cryotherapy
•
Keratinocyte growth methods (for epithelialization of mucosal tissues)
Cochrane Collaboration – Mucositis Findings
Weak, unreliable evidence for use of
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Aloe vera
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Amifostine
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Glutamine (IV)
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GM-SCF
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Honey
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Laser
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Polymixin/tobramycin/amphotericin (PTA) lozenges/paste
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Sucralfate
No evidence supporting any benefit for using chlorhexidine for the treatment of mucositis
Treatment of Herpes
Prevalence is close to 50% among neutropenic cancer patients and among head and neck
cancer patients with ulcerative mucositis
•
Valacyclovir for HSV
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Famciclovir for VZV
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Ganciclovir for acute CMV infection
Treatment of Fungal Infections
Estimated that 38% will experience oral candidiasis during chemotherapy
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Nystatin rinse
•
Clotrimazole troches
•
Systemic antifungal medication
Requires diligent evaluation for other fungal infections, including aspergillus, mucormycosis, and
rhizopus
Source: Lalla RV, Latortue MC, Hong CH, et al.: A systematic review of oral fungal infections in
patients receiving cancer therapy. Support Cancer Care 2010;18(8):993-1006.
Post-Treatment Phase
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Monitor patients frequently for post-treatment effects
•
Patients who have been treated for oral cancer have up to 20X risk for developing a
second cancer
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Post-treatment Effects include:
o
Salivary gland dysfunction
o
Xerostomia
o
Rampant caries
o
Trismus
o
Soft tissue necrosis
o
Osteoradionecrosis
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o
Bisphosphonate osteonecrosis of the jaws
o
Hypersensitivity
o
Taste changes
Hyposalivation and Xerostomia
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Prescriptions – pilocarpine, cevimeline
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OTC sprays, rinses, gels, toothpaste
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Daily fluoride therapy
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Avoid candy, gums, soda (unless sugar-free), spicy or acidic foods, tobacco and alcohol
products
Altered Taste
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Returns within several weeks of completion of chemotherapy
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Taste receptors damaged during radiation take 6-8 weeks or more to become functional
again
•
Use of zinc sulfate supplements may be helpful in recovering sense of taste
Source: Silverman S Jr: Complications of treatment. In Silverman S Jr, ed.: Oral Cancer, 5th ed.
Hamilton, Canada: BC Decker INc, 2003, pp.113-28.
Hypersensitivity
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Associated with nausea, waterbrash, and frequent vomiting from chemotherapy causing
erosion
Soft Tissue Changes
•
•
Anemia, neutropenia, leukopenia, and thrombocytopenia result from myelosuppression
association with chemotherapy resulting in
o
Spontaneous gingival bleeding
o
Petechiae of lips, palate, and mucosa
o
Eccyhomosis
Patients may safely perform routine oral hygiene measures and should do so to reduce
biofilm accumulation and control periodontal problems
Bone Infections – ONJ, BONJ
Treatment for ONJ
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Topical antibiotics
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Antiseptics
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Analgesics
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Local resection of bone sequestra
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Hyperbaric oxygen therapy
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Partial mandibulectomy may be warranted
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Prevention via careful evaluation of periodontium and mucosa and elimination of
disease during pretreatment including restorative care and extractions
BONJ
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ADA recommendations
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CTX blood test
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Teriparatide – aides in the resolution of BONJ by augmenting effective bone remodeling
under osteoanabolic conditions
Source: Subramanian G, Cohen HV & Quek SYP. A model for the pathogenesis of
bisphosphonate-associated osteonecrosis of the jaw and teriparatide’s potential role in its
resolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:744-753.
Carotid Atheroma
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Patients who received ≥ 45 Gy of radiation are more likely to develop carotid artery
atheroma than those who have not been irradiated
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Lesions may be detected by panoramic radiography
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Represents a risk factor for stroke
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Concerns warrant referral to a physician for further evaluation
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Table I: Chemotherapy Drug Types
Drug
Action
Differentiating agents
Acts on cancer cells to
Retinoids (Atralin®)
make them mature into
Bexarotene (Targretin®)
normal cells
Arsenic trioxide (Arsenox®)
Alter the action or
Anti-estrogens (tamoxifen)
production of female or
Aromatase inhibitors
male hormones
(Arimidex®)
Prevents the cancer cell
Progestins (Megace®)
from using the hormone it Estrogens
needs to grow
Anti-androgens (Casodex®)
Prevents the body from
Gonadotropin-releasing
making the hormones
hormone (GnRH)
Stimulates natural immune Monoclonal antibody therapy
systems to more effectively (Rituxan®)
recognize and attack cancer
cells
Directly damage DNA to
Nitrogen mustards
prevent the cancer cell from (mechlorethamine, Cytoxan®)
reproducing
Nitrosoureas (streptozocin)
Can cause long-term
Alkyl sulfonates (busulfan)
damage to bone marrow
Triasines (dacarbazine)
Increases risk of leukemia Ethylenimines (thiotepa and
altretamine)
Interferes with DNA and
5-fluorouracil (5-FU)
RNA growth
methotrexate
Damages cells during the S
phase
Interfere with enzymes
Daunorubicin
involved in DNA replication Doxorubicin (Adriamycin®)
Works in all phases of the Actinomycin-D
cell cycle
Mitomycin-C
Interfere with enzymes
Topotecan
called topoisomerases
Irinotecan (CPT-11)
which help separate strands Etoposide (VP-16)
of DNA so they can be
copied
Hormone therapy
Immunotherapy
Alkylating agents
Antimetabolites
Anti-tumor antibiotics
Topoisomerase inhibitors
Examples
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Mitotic inhibitors
Stops mitosis or inhibits
Taxanes (Taxol®, Taxotere®)
enzymes from making
Epothilones (Ixempra®)
proteins needed for cell
Vinca alkaloids (vinblastine)
reproduction
Works during the M phase
of the cell cycle; can
damage cells in all phases
Source: American Cancer Society. Chemotherapy principles: an in-depth discussion.
Available at: http://www.cancer.org. Accessed September 3, 2011.
Table II: Examples of Chemotherapeutic Agents and Side Effects
Agent
General Side Effects
Cyclophosphamide
(Cytoxan®)
Myelosuppression
Oral mucosal ulceration
Leukopenia
Increased risk of infection
Moderate to severe emesis
Anorexia
Abdominal discomfort/pain
Diarrhea
Hemorrhagic colitis
Jaundice
Alopecia
Skin or nail pigmentation
Hemorrhagic cystitis
Interstitial pulmonary fibrosis and pneumonitis
Acute cardiac toxicity
Congestive heart failure
Sterility
Asthenia, dizziness, depression or headache
Musculoskeletal pains and rheumatic
syndromes
Nausea, vomiting, constipation, diarrhea
Mouth or tongue sores
Headache, fatigue, asthenia, fever, back pain
Convulsions, hemiparesis, dizziness, amnesia,
insomnia
Peripheral cardiac edema
Viral infection
Adrenal hypercorticism
Urinary tract infection
Upper respiratory tract infection, pharyngitis
Diffuse erythematous skin rash
Anxiety, depression
Weight gain
Myalgia
Abnormal and double vision
Opportunistic infections
Leukemia, glioblastoma multiforme
Temosolomide
(Temodar®)
Oral Side Effects
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Carboplatin
Cisplatin
5-fluorouracil (5-FU)
Methotrexate
Bone marrow suppression
Mucositis
Thrombocytopenia
Stomatitis
Vomiting, abdominal pain
Peripheral neuropathies
Abnormal liver function tests
Ototoxicity
Dehydration
Nephrotoxicity
No significant effects
Emesis, nausea, diarrhea
reported
Sensory polyneuropathy
Ototoxicity, headache, strokes
Tinnitus, hearing loss
Myelosuppression
Anemia
Optic neuritis, cortical blindness, blurred vision
Myocardial infarction, CVA, cerebral arteritis
Anaphylactic-like reactions
Transient elevated liver enzymes
Soft tissue toxicity
Rash, alopecia, digital necrosis
Esophagopharyngitis, anorexia, nausea,
Stomatitis
vomiting, diarrhea,
Leukopenia (principally granulocytopenia),
thrombocytopenia, anemia, Alopecia,
dermatitis (principally pruritic maculopapular
rash
Myelosuppression
Speech impairment
Anemia, aplastic anemia, thrombocytopenia Ulcerative stomatitis
Nausea, vomiting, diarrhea
Gingivitis
Anorexia, GI bleeding
Pharyngitis
Acute hepatitis, chronic fibrosis and cirrhosis
Opportunistic infections
Headache, dizziness, drowsiness, blurred
vision, moodiness, tinnitus
Pulmonary toxicity
Interstitial pneumonitis
Renal insufficiency
Malaise, fatigue, chills
TEN, Stevens-Johnson syndrome, erythema
multiforme
Alopecia
Pericarditis, pericardial effusion, myocardial
ischemia, hypotension
Conjunctivitis
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Doxorubicin
(Adriamycin®)
Mitoxantrone
Irinotecan (CPT-11)
Paclitaxel (Taxol®)
Heart failure, late cardiomyopathy, congestive
heart failure
Myelosuppresion resulting in suprainfection
and/or hemorrhage
Alopecia
Hyperpigmentation of nailbeds
Oncholysis
Nausea,vomiting, bleeding, local infection,
colonic ulceration
Renal insufficiency
Secondary leukemia
Myelosuppression
Secondary leukemia
Nausea, vomiting, diarrhea
Left ventricular systolic function and
congestive heart failure
Blue streaking in or around the vein and of
skin
Renal insufficiency
Drug rash with eosinophilia and systemic
signs (DRESS)
Green urine
Amenorrhea
“Early” diarrhea, diaphoresis, stomach
cramping
Late diarrhea can be life threatening
Ulcerative and ischemic coliltis
Nausea, vomiting
Leukopenia, anemia, neutropenia
Asthenia, fever, pain, headache, chills, minor
infections, edema abdominal enlargement
Minor upper respiratory infections
Weight loss
Dehydration
Alopecia, sweating, rash, parasthesias
Dyspnea, increased coughing, rhinitis
Insomnia, dizziness
Myocardial ischemia
Renal insufficiency
Muscular contractions and cramps
Bone marrow suppression
Fever
Bleeding episodes
Sinus bradycardia, tachycardia, and
premature beats
Neurotoxicity
Nausea, vomiting, diarrhea
Hepatic toxicity
Edema
Transient skin changes
Alopecia (usually irreversible)
Myalgia and/or arthralgia
Cellulitis
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Stomatitis
Mucositis
Tongue
hyperpigmentation
Mucositis
Stomatitis
Mouth pain
Increased salivation
Mucositis
Stomatitis
Mucositis
Stomatitis
Sores of the lips
Vinblastine (Velban®) Leukopenia and septicemia
Leukemia
Alopecia
Nausea, vomiting, anorexia,
Pharyngitis, diarrhea, rectal bleeding
Myocardial infarction, CVA, Raynaud’s
phenomenon
Shortness of breath, severe bronchospasm,
progressive dyspnea
Malaise, bone pain, weakness, dizziness,
myalgia, ototoxicity
Estramustine
Gynecomastia, impotence, breast tenderness
(Emcyt®)
and enlargement
Exacerbation of pre-existing heart disease
Nausea, diarrhea, GI upset
Dyspnea
Leukopenia
Lethargy, insomnia
Easy bruising, pruritis, dry skin
Dexamethasone
Bradycardia, cardiac arrest, cardiac
(Decadron®)
arrhythmias, cardiac enlargement, congestive
heart failure
Muscle weakness, steroid myopathy,
osteoporosis, compression fractures, aseptic
necrosis of femoral and humeral heads,
pathologic bone fractures, tendon rupture
Peptic ulcer, bowel perforation, abdominal
distention, nausea, increased appetite,
esophagitis
Cushingoid state
Convulsions, increased intracranial pressure,
vertigo, malaise, headache, psychic
disturbances
Weight gain, hirsutism,
Cataracts, glaucoma, increased intraocular
pressure, exophthalmos
Impaired wound healing, petechiae,
ecchymosis, dry skin, thinning scalp hair,
increased sweating, rash, urticaria
Euphoria, insomnia, mood swings, personality
changes, severe depression, psychosis
Reversible hepatomegaly
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Stomatitis
Metallic taste
Jaw pain
Vesiculation of the mouth
Hoarseness
Sore throat
Angioedema
Bortezomib
(Velcade®)
Imatinib (Gleevec®)
Tretinoin (ATRA or
Atralin®)
Asthenia, pyrexia, headache, insomnia,
Abnormal taste
dizziness, dehydration
Stomatitis
Nausea, diarrhea, constipation, decreased
Angioedema and
appetite, vomiting, pain
Laryngeal edema
Thrombocytopenia, neutropenia
Oral candiasis
Peripheral neuropathy, neuralgia, hemorrhagic
stroke, motor dysfunction
Arthralgia, pain in limb, back pain, bone pain
Hypotension (orthostatic)
Edema, hypertension, aggravated atrial
fibrillation and atrial flutter
Dyspnea, cough, upper and lower respiratory
tract infections
Rash, herpes zoster, pruritis
Dysgeusia, impaired hearing, bacteremia,
herpes viral infections,, septic shock
Blurred vision
Hepatitis
Anorexia, agitation, confusion, psychotic
disorder, mental status change, suicidal
ideation
Nausea, vomiting, edema, tumor necrosis,
Mouth ulceration
muscle cramps
Taste Disturbance
Neutropenia, thrombocytopenia, anemia
Angioedema
Cardiac edema
Headache, CNS hemorrhage
Skin rash, pruritis, petechiae, alopecia
Nasopharyngitis, cough, upper respiratory
tract infection
weight increase
renal failure
depression, anxiety, memory impairment
breast enlargement
periorbital edema, conjunctivitis, blurred vision
Peeling, dry skin, burning, stinging, erythema, Xerostomia
pruritis
Stinging of the eye
Isolated vaginal bleeding
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Tamoxifen
Hot flashes, nausea, vomiting
No significant effects or
Endometrial abnormalities – adenocarcinoma, complications reported
uterine sarcoma, hyperplasia, endometrial
polyps
Endometriosis, vaginal bleeding, discharge,
altered menses
Bone pain, severe hypercalcemia
Jaundice, hepatitis
Ocular toxicity
CVA, edema, phlebitis, thromboembolism
Pulmonary embolism
Depression, delusional syndromes
Anorexia,
Hair loss
Visual memory, word fluency, processing
speed tasks problems
Leuprolide (Lupron®) Hot flashes, gynecomastia, breast
Gingival hemorrhage
enlargement and tenderness
Gingivitis
Depression, emotional lability
Dry mucous membranes
Headache, dizziness, blurred vision
Dysphagia
Vaginal dryness, urinary frequency, hematuria,
testicular and breast soreness/pain, testicular
atrophy, erectile dysfunction
Peripheral edema, hypertension, hypotension,
murmur, phlebitis, deep vein thrombosis,
stroke, sudden cardiac death, myocardial
infarction
Constipation, anorexia, nausea, vomiting
Skin rash, hair loss, ecchymosis
Bone pain
Anemia, leukopenia, hemoptysis
Dyspnea, sinus congestion, cough, pulmonary
fibrosis
Granulomas
Fibromyalgia, hearing disorder, hard nodule in
throat, weight gain, increased uric acid
Difficulty with/painful urination, bladder spasm
Hyperglycemia
Rituximab (Rituxan®) Fever, chills, asthenia, headache, abdominal Throat irritation
pain
Angioedema
Hepatitis
Myocardial infarction, ventricular fibrillation,
cardiogenic shock
Rhinitis, bronchospasm, pneumonitis
Nausea, vomiting
Leukopenia, thrombocytopenia, neutropenia
Myalgia, dizziness, pruritis, rash, urticarial
Renal insufficiency
Disease progression of Kaposi’s sarcoma
Bilateral conjunctivitis
Pyelonephritis
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Interleukin-2 (IL-2)
Hypotension
Generalized body edema
Ascites
Pulmonary edema
Chills, fever
Headache, malaise
Nausea, vomiting
Loss of appetite, diarrhea
Renal failure if severe hypotension occurs
Stomatitis
Mucositis
Sources: Winn RL, Meiller TF, Crossley HL. Drug information handbook for dentistry,
15th ed. 2009. Hudson, Oh: Lexicomp; Drugs.com. Drug information online. Available
at:www.drugs.com. Accessed 9/3/11.
Additional References
1. Howlander N, Noone Am, Krapcho M, Neyman N, etal. (eds.) SEER Cancer
Statistics Review, 1975-2008, National Cancer Institute. Bethesda, MD, http://
seer.cancer.gov/csr/1975_2008/, based on November 2010 SEER data
submission, posted to the SEER web site, 2011.
2. National Institute of Dental & Craniofacial Research. National Institutes of Health.
Oral complications of cancer treatment: what the dental team can do. Date last
modified March 25, 2011. Available at: www.nidcr.nih.gov/OralHealth/Topics/
CancerTreatment/OralComplicationsCancerOral.htm. Accessed September 4,
2011.
3. Campaign targets oral complications of cancer treatment. January 1999. U.S>
Department of Health and Human Services, National Institutes of Health,
15
National Institute of Dental and Craniofacial Research Website. Available at
http://www.nidcr.nih.gov/NewsAnd Reports/NewsReleases/News
Release0111271999.htm. Accessed July 20,2011.
4. Hong, CHL, Napeñas JJ, Hodgson BD, Stokman MA, et al. A systematic review
of dental disease in patients undergoing cancer therapy. Support Cancer Care
2010, August;18(8):1007-1021.
5. McClure D, Essary D, Gurenlian JR: A collaborative team approach for symptom
management for head and neck cancer patients. Grand Rounds 2007;2(7):43-51.
6. The Oral Cancer Foundation web site. Oral Cancer Facts. Available at: http://
oralcancerfoundation.org/facts/index/htm. Accessed June 28, 2011.
7. American Cancer Society. Chemotherapy principles: an in-depth discussion.
Available at http://www.cancer.org. Accessed September 3, 2011.
8. The Cleveland Foundation. Cleveland Clinic Cancer Center. Chemotherapy
drugs-drug names. Available at: www.chemocare.com. Accessed September 2,
2011.
9. Winn RL, Meiller TF, Crossley HL. Drug information handbook for dentistry, 15th
ed. 2009. Hudson, Oh: Lexicomp.
10. Drugs.com. Drug information online. Available at:www.drugs.com. Accessed
9/3/11.
11. The Cleveland Foundation. Cleveland Clinic Cancer Center. Managing
chemotherapy side effect. Available at www.chemocare.com. Accessed
September 2, 2011.
12. Keefe DM, Schubert MM, Elting LS, Sonis ST, et al. Updated clinical practice
guidelines for the prevention and treatment of mucositis. Cancer
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13. McGettigan S, Tompkins C. Managing mucositis in head and neck cancer
patients undergoing radiation therapy. Community Oncology 2006;3:653-656.
14. Washington HV, Clarkson JE, Bryan G, Furness S, et al. Interventions for
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2011, Issue 4. The Cochrane Collaboration. John Wiley & Sons. Available at
http://www.thecochranelibrary.com. Accessed September 4, 2011.
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15. National Cancer Institute: PDQ® Oral Complications of Chemotherapy and Head/
Neck Radiation. Bethesda, MD: National Cancer Institute. Date last modified
March 24, 2011. Available at: http://cancer.gov/cancertopics/pdq/supportivecare/
oralcomplications/HealthProfessional. Accessed July 20, 2011.
16. Lalla RV, Latortue MC, Hong CH, et al.: A systematic review of oral fungal
infections in patients receiving cancer therapy. Support Cancer Care 2010; 18(8):
985-992.
17. Ellis ME, Clink H, Ernst P, et al.: Controlled study of fluconazole in the prevention
of fungal infections in neutropenic patients with haematological malignancies and
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18. Elad S, Zadik Y, Hewson I, et al: A systematic review of viral infection associated
with oral involvement in cancer patient: a spotlight on Herpesviridea. Support
Care Cancer 2010;18(8):993-1006.
19. Nicolatou-Galitis O, Athanassiadow P, Kouloulias V, et al. Herpes simplex virus-1
(HSV-1) infection in radiation induced oral mucositis. Support Care Cancer
2006;14:753-762.
20. Leflore S, Anderson PL, Fletcher CV: A risk-benefit evaluation of acyclovir for the
treatment and prophylaxis of herpes simplex infections. Drug Saf 2000;23(2):
131-142.
21. Reusser P: Management of viral infections in immunocompromised cancer
patients. Swiss Med Wkly 2002;132(27-28):374-378.
22. Naesens L, De Clercq E: Recent developments in herpesvirus therapy. Herpes
2001;8(1):12-16.
23. Jublet B: Valacyclovir and famciclovir therapy in herpes zoster. Curr Neurol
Neurosci Rep 2002;2(6):477-478.
24. Burns LJ, Miller W, Kandaswamy C, et al: Randomized clinical trial of ganciclovir
vs acyclovir for prevention of cytomegalovirus antigenemia after allogenic
transplantation. Bone Marrow Transplant 2002;30(12):945-951.
25. Zaia JA: Prevention of cytomegalovirus disease in hematopoietic stem cell
transplantation. Clin Infect Dis 2002;35(8):999-1004.
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26. Peterson DE, Doerr W, Hovan A, et al.: Osteoradionecrosis in cancer patients:
the evidence base for treatment-dependent frequency, current management
strategies, and future studies. Support Care Cancer 2010;18(8):1089-98.
27. Silverman S Jr: Complications of treatment. In Silverman S Jr, ed.: Oral Cancer.
5th ed. Hamilton, Canada: BC Decker Inc, 2003, pp.113-28.
28. Ripamonti C, Zecca E, Bruncelli C, et al.: A randomized controlled clinical trial to
evaluate the effects of zinc sulfate on cancer patients with taste alterations
caused by head and neck irradiation. Cancer 1998;82(10):1938-1945.
29. Oral Cancer Self-Examination. Available at: http://www.floss.com/
oral_cancer_self-test.htm. Accessed 9/4/11.
30. National Institute of Dental & Craniofacial Research, National Insitutes of Health.
Detecting oral cancer: a guide for health care professionals. Bethesda, MD.
Available at: www.nidcr.nih.gov. Accessed September 5, 2011.
31. Pacak DK. Developing a documentation protocol. Dimensions Dent Hyg. 2011.
April;38-43.
Other Resources:
“Detecting Oral Cancer: A Guide for Health Care Professionals and can be
downloaded through www.nidcr.nih.gov.
“Maintaining Oral Health During Cancer Treatment” available through Young Dental
through www.richmondinstitute.com.
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*The information contained within this handout is the intellectual property of JoAnn R.
Gurenlian, RDH, PhD. This information may not be reproduced in any manner nor
distributed without written permission from the author.
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