Download Managing the Oral Effects of Cancer Treatment

Managing the Oral Effects
of Cancer Treatment:
Diagnosis to Survivorship
Edited by
Marilyn L. Haas, PhD, CNS, ANP-BC
Deborah L. McBride, RN, MSN, CPON®
Oncology Nursing Society
Pittsburgh, Pennsylvania
ONS Publications Department
Interim Publisher and Director of Publications: Barbara Sigler, RN, MNEd
Managing Editor: Lisa M. George, BA
Technical Content Editor: Angela D. Klimaszewski, RN, MSN
Staff Editor II: Amy Nicoletti, BA
Copy Editor: Laura Pinchot, BA
Graphic Designer: Dany Sjoen
Copyright © 2011 by the Oncology Nursing Society. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by an information storage and retrieval system, without written permission from the copyright owner. For information, write to the Oncology Nursing Society, 125 Enterprise Drive, Pittsburgh, PA 15275-1214, or visit www.ons.org/publications.
Library of Congress Cataloging-in-Publication Data
Managing the oral effects of cancer treatment : diagnosis to survivorship /
edited by Marilyn L. Haas and Deborah L. McBride.
p. ; cm.
Includes bibliographical references.
ISBN 978-1-935864-03-5 (alk. paper)
1. Cancer--Nursing. 2. Cancer--Treatment--Complications. 3. Antineoplastic
agents--Side effects. 4. Oral manifestations of general diseases. 5.
Radiotherapy. I. Haas, Marilyn. II. McBride, Deborah L. III. Oncology Nursing
Society.
[DNLM: 1. Neoplasms--nursing. 2. Neoplasms--therapy. 3. Antineoplastic
Agents--adverse effects. 4. Oral Manifestations. 5. Radiotherapy--adverse
effects. WY 156]
RC266.M355 2011
616.99’40231--dc22
2010052059
Publisher’s Note
This book is published by the Oncology Nursing Society (ONS). ONS neither represents nor guarantees that the practices described herein will, if followed, ensure safe and effective patient care. The
recommendations contained in this book reflect ONS’s judgment regarding the state of general knowledge and practice in the field as of the date of publication. The recommendations may not be appropriate for use in all circumstances. Those who use this book should make their own determinations regarding specific safe and appropriate patient-care practices, taking into account the personnel, equipment, and practices available at the hospital or other facility at which they are located. The editors and
publisher cannot be held responsible for any liability incurred as a consequence from the use or application of any of the contents of this book. Figures and tables are used as examples only. They are not
meant to be all-inclusive, nor do they represent endorsement of any particular institution by ONS. Mention of specific products and opinions related to those products do not indicate or imply endorsement
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original English version.
Printed in the United States of America
Oncology Nursing Society
Integrity • Innovation • Stewardship • Advocacy • Excellence • Inclusiveness
Recognizing that our patients travel many different paths during their oncology experience, oncology nurses are blessed to be their traveling companion.
For my husband, who has traveled many of my professional paths, I now travel with him down his own cancer path. May this clinical information help us
and others improve our care for patients dealing with oral oncology problems
as they face their treatments.
—Marilyn Louise Younghouse Haas, PhD, CNS, ANP-BC
This book was inspired by my work caring for children with cancer. I hope
it improves the care of both pediatric and adult patients who are dealing with
the oral effects of cancer. I dedicate this book to my husband, Joe, the man
whom I am blessed to have as a husband. I would like to thank him for his
daily love and support.
—Deborah L. McBride, RN, MSN, CPON®
Contributors
Editors
Marilyn L. Haas, PhD, CNS, ANP-BC
Deborah L. McBride, RN, MSN,
CPON®
Nurse Practitioner
Carolina Clinical Consultant and CarePartners Supportive and Palliative Services
Asheville, North Carolina
Chapter 10. Developing a Nursing-Centered
“Spray and Weigh” Program
Assistant Professor of Nursing
Samuel Merritt University
Staff Nurse
Kaiser Permanente Oakland Medical Center
Oakland, California
Chapter 15. Special Considerations in Pediatric Populations
Authors
Mary J. Bacon, MA, CCC-SLP, BRS-S
Patricia C. Buchsel, MSN, RN, OCN®,
FAAN
Associate Professor/Clinical Educator
Communication Disorders and Sciences
Rush University Medical Center
Chicago, Illinois
Chapter 8. Speech, Voice, and Swallowing
Problems: The Speech Pathologist’s Role
Clinical Instructor
Seattle University College of Nursing
Seattle, Washington
Chapter 17. Oral Health Across the Continuum of Care: A Symptom Cluster Model
Ingrid Bowser, MS, APRN-BC,
AOCNP®, ADM-BC
Carrie F. Daly, RN, MS, AOCN®
Oncology Nurse Manager/Advanced Practice Nurse
Radiation Oncology Department
Rush University Medical Center
Chicago, Illinois
Chapter 6. Xerostomia and Cytoprotection
Nurse Practitioner
Indiana University Health
Goshen Center for Cancer Care
Goshen, Indiana
Chapter 7. Pain Management
Susan D. Bruce, RN, MSN, OCN®
Oncology Clinical Nurse Specialist
Duke Raleigh Cancer Center
Raleigh, North Carolina
Chapter 3. Treatment of Side Effects
v
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MANAGING THE ORAL EFFECTS OF CANCER TREATMENT: DIAGNOSIS TO SURVIVORSHIP
Sarah D’Angelo, RN, BSc, BScN,
MN, CON(C)
Miranda J. Kramer, RN, MS, ACNP,
CNS
Vanna M. Dest, MSN, APRN, BC,
AOCN®
Kristen W. Maloney, MSN, RN,
AOCNS®
Oncology Nurse Practitioner
CyberKnife Coordinator
Cancer Genetics Testing Coordinator
Hospital of Saint Raphael/Radiation Oncology Specialists of Southern Connecticut
New Haven, Connecticut
Chapter 1. Oral Health: The Basics
Clinical Nurse Specialist, Rhoads Three
Nursing Unit—Medical Oncology
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania
Chapter 14. Considerations for Older Cancer
Survivors—Aging, Comorbidity, and
Cancer Treatment
Catherine H.L. Hong, BDS, MS
Maurene McQuestion, RN, BA,
BScN, MSc, CON(C)
Advanced Practice Nurse Educator
Princess Margaret Hospital, University
Health Network
Toronto, Ontario, Canada
Chapter 4. Evidence-Based Practice: Tools to
Measure Progress
Assistant Professor
Department of Preventive Dentistry
Faculty of Dentistry
National University of Singapore
Singapore
Chapter 2. Fundamental Skills: Oral Assessment and Dental Hygiene
Maureen B. Huhmann, DCN, RD,
CSO
Assistant Professor
Department of Nutrition Sciences, School
of Health Related Professions
University of Medicine and Dentistry of
New Jersey
Cancer Institute of New Jersey
New Brunswick, New Jersey
Chapter 12. Paradigms of Eating
Sarah H. Kagan, PhD, RN, AOCN
®
Lucy Walker Honorary Term Professor of
Gerontological Nursing
School of Nursing
Clinical Nurse Specialist
Abramson Cancer Center
University of Pennsylvania
Philadelphia, Pennsylvania
Chapter 14. Considerations for Older Cancer
Survivors—Aging, Comorbidity, and
Cancer Treatment
Nurse Practitioner/Clinical Nurse Specialist
Assistant Clinical Professor, Physiological
Nursing
University of California, San Francisco
San Francisco, California
Chapter 11. Sexuality and Quality of Life
Clinical Nurse Specialist, Advanced Practice
Nurse
Princess Margaret Hospital, University
Health Network
Toronto, Ontario, Canada
Chapter 4. Evidence-Based Practice: Tools to
Measure Progress
Katherine Katen Moore, MSN, ANP-C,
AOCN®
Associate Director, Student Health Services
Drew University
Madison, New Jersey
Chapter 9. Complementary and Alternative
Medicine and the Mouth
Joel J. Napeñas, DDS
Director, General Practice Residency
Department of Oral Medicine
Carolinas Medical Center
Charlotte, North Carolina
Chapter 2. Fundamental Skills: Oral Assessment and Dental Hygiene
Maria Q.B. Petzel, RD, CSO, LD, CNSC
Senior Clinical Dietitian
Department of Clinical Nutrition
University of Texas MD Anderson Cancer
Center
Houston, Texas
Chapter 5. Nutrition Management Strategies for Oral Effects of Cancer Treatment
CONTRIBUTORS
vii
Erika Schroeder, RN, MS, OCN®, CNL
Mary Ellyn Witt, RN, MS, AOCN®
Pamela Hallquist Viale, RN, MS, CS,
ANP, AOCNP®
M. Renee Yanke, ARNP, MN, AOCN®
Manager, Clinical Trials
Anne Arundel Health Systems Research
Institute
Annapolis, Maryland
Chapter 13. Psychosocial Challenges
Editor in Chief
Journal of the Advanced Practitioner in
Oncology
Oncology Nurse Practitioner and Consultant
Goleta, California
Chapter 16. Second Primary Cancers and
Recurrence
Clinical Research Nurse
Radiation Oncology
University of Chicago Medical Center
Chicago, Illinois
Chapter 13. Psychosocial Challenges
Oncology Program Manager, Oncology
Advanced Practice Nurse
Whidbey General Hospital
Coupeville, Washington
Chapter 9. Complementary and Alternative
Medicine and the Mouth
Disclosure
Editors and authors of books and guidelines provided by the Oncology Nursing Society
are expected to disclose to the readers any significant financial interest or other relationships
with the manufacturer(s) of any commercial products.
A vested interest may be considered to exist if a contributor is affiliated with or has a
financial interest in commercial organizations that may have a direct or indirect interest in the
subject matter. A “financial interest” may include, but is not limited to, being a shareholder in
the organization; being an employee of the commercial organization; serving on an organization’s speakers bureau; or receiving research from the organization. An “affiliation” may
be holding a position on an advisory board or some other role of benefit to the commercial
organization. Vested interest statements appear in the front matter for each publication.
Contributors are expected to disclose any unlabeled or investigational use of products
discussed in their content. This information is acknowledged solely for the information of the
readers.
The contributors provided the following disclosure and vested interest information:
Marilyn L. Haas, PhD, CNS, ANP-BC: MedPharma and Meniscus Educational Institute, honoraria
Carrie F. Daly, RN, MS, AOCN®: Roche, consultant; IMER, honoraria
Vanna M. Dest, MSN, APRN, BC, AOCN®: EUSA Pharma and Myriad Laboratories, honoraria
Pamela Hallquist Viale, RN, MS, CS, ANP, AOCNP®: Meniscus Educational Institute and Novartis, consultant; Amgen, Bristol-Myers Squibb, IMER, Meniscus Educational Institute, Merck,
and Novartis, honoraria
M. Renee Yanke, ARNP, MN, AOCN®: Novartis, consultant, honoraria
Contents
Preface...................................................................................................................................................... xv
Chapter 1. Oral Health: The Basics
1
Introduction............................................................................................................................................. 1
History of Oral Care.............................................................................................................................. 1
Epidemiology of Oral Diseases......................................................................................................... 2
Anatomy of the Oral Cavity................................................................................................................ 5
Common Oral Conditions................................................................................................................... 8
Oral Health and Overall General Health.....................................................................................11
Common Oral Manifestations of Systemic Medical Diseases.............................................12
Oral Manifestations During Women’s Reproductive Years..................................................20
Maintenance of Oral Hygiene and Health..................................................................................21
Conclusion..............................................................................................................................................21
References...............................................................................................................................................22
Chapter 2. Fundamental Skills: Oral Assessment and
Dental Hygiene 25
Introduction...........................................................................................................................................25
History Taking........................................................................................................................................25
Diagnostic and Assessment Tools.................................................................................................32
Dental Care in Patients With Cancer ...........................................................................................39
Barriers to Dental Care.......................................................................................................................43
Conclusion..............................................................................................................................................44
References...............................................................................................................................................44
Chapter 3. Treatment of Side Effects 47
Introduction...........................................................................................................................................47
Oral Mucositis.......................................................................................................................................47
Xerostomia and Hyposalivation.....................................................................................................52
Chronic Graft-Versus-Host Disease...............................................................................................55
Dental Caries and Periodontal Disease ......................................................................................56
ix
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MANAGING THE ORAL EFFECTS OF CANCER TREATMENT: DIAGNOSIS TO SURVIVORSHIP
Taste Changes........................................................................................................................................57
Persistent Dysphagia..........................................................................................................................60
Trismus.....................................................................................................................................................60
Fungal Infections..................................................................................................................................62
Osteoradionecrosis..............................................................................................................................62
Osteonecrosis........................................................................................................................................63
Conclusion..............................................................................................................................................64
References...............................................................................................................................................64
Chapter 4. Evidence-Based Practice: Tools to Measure Progress
69
Introduction...........................................................................................................................................69
Evidence-Based Practice...................................................................................................................70
Types of Tools........................................................................................................................................71
Description and Critique of Specific Tools ................................................................................78
Special Populations and Considerations.....................................................................................85
Naturopathic, Complementary, and Alternative Medicine..................................................86
Conclusion..............................................................................................................................................87
References...............................................................................................................................................88
Chapter 5. Nutrition Management Strategies for
Oral Effects of Cancer Treatment
93
Introduction...........................................................................................................................................93
Mucositis.................................................................................................................................................94
Xerostomia.............................................................................................................................................97
Dysgeusia and Hypogeusia..............................................................................................................98
Dysphagia...............................................................................................................................................99
Other Oral Effects of Treatment.....................................................................................................99
Nutrition Support............................................................................................................................. 100
Conclusion........................................................................................................................................... 101
References............................................................................................................................................ 101
Chapter 6. Xerostomia and Cytoprotection
103
Introduction........................................................................................................................................ 103
Sjögren Syndrome of the Oral Cavity........................................................................................ 106
Review of Oral Cancers................................................................................................................... 107
Treatment for Oral Cancers........................................................................................................... 109
Advances in Radiation Therapy................................................................................................... 111
Cytoprotection................................................................................................................................... 114
Quality of Life..................................................................................................................................... 118
Conclusion........................................................................................................................................... 118
References............................................................................................................................................ 119
Chapter 7. Pain Management
125
Introduction........................................................................................................................................ 125
Causes of Oral Pain.......................................................................................................................... 125
CONTENTS
xi
Assessment.......................................................................................................................................... 127
Interventions for Oral Pain............................................................................................................ 128
Other Treatments.............................................................................................................................. 135
Barriers to Pain Management....................................................................................................... 140
Conclusion........................................................................................................................................... 143
References............................................................................................................................................ 143
Chapter 8. Speech, Voice, and Swallowing Problems:
The Speech Pathologist’s Role
147
Introduction........................................................................................................................................ 147
Common Speech, Voice, and Swallowing Problems Related to Radiation
Therapy and Chemotherapy for Oral and Oropharyngeal Cancers........................ 148
Pretreatment Involvement of Speech Pathology.................................................................. 149
Speech Pathology Evaluations..................................................................................................... 149
Speech Pathology Treatment....................................................................................................... 151
Conclusion........................................................................................................................................... 154
References............................................................................................................................................ 155
Chapter 9. Complementary and Alternative Medicine
and the Mouth
157
Introduction........................................................................................................................................ 157
Definitions............................................................................................................................................ 159
Evidence for Use................................................................................................................................ 159
Interventions for Dysgeusia.......................................................................................................... 160
Interventions for Oral Mucositis................................................................................................. 160
Interventions for Orofacial Pain (Excluding Oral Mucositis)............................................. 168
Interventions for Xerostomia....................................................................................................... 168
Conclusion and Nursing Implications....................................................................................... 170
References............................................................................................................................................ 171
Chapter 10. Developing a Nursing-Centered “Spray and Weigh”
Program175
Introduction........................................................................................................................................ 176
Oral Cavity Assessment.................................................................................................................. 177
Symptom Assessment..................................................................................................................... 182
Dental Health...................................................................................................................................... 183
Oral Hygiene at Home.................................................................................................................... 183
Conclusion........................................................................................................................................... 183
References............................................................................................................................................ 184
Chapter 11. Sexuality and Quality of Life
185
Introduction........................................................................................................................................ 185
Factors in Sexuality........................................................................................................................... 185
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MANAGING THE ORAL EFFECTS OF CANCER TREATMENT: DIAGNOSIS TO SURVIVORSHIP
Patient Oral Symptoms and Their Effects on Sexuality and Intimacy........................... 186
Assessing Sexual Health................................................................................................................. 188
Assessments and Interventions................................................................................................... 189
Conclusion........................................................................................................................................... 191
References............................................................................................................................................ 191
Chapter 12. Paradigms of Eating
193
Introduction........................................................................................................................................ 193
Diet Following Chemotherapy..................................................................................................... 193
Bisphosphonate-Associated Osteonecrosis........................................................................... 194
Stem Cell Transplantation and Oral Development............................................................... 194
Diet Following Radiation Therapy.............................................................................................. 196
Diet Following Surgery: Dysphagia............................................................................................ 199
Conclusion........................................................................................................................................... 200
References............................................................................................................................................ 200
Chapter 13. Psychosocial Challenges
205
Introduction........................................................................................................................................ 205
Oral Complications of Survivorship .......................................................................................... 207
Financial Challenges........................................................................................................................ 209
Assessment Tools.............................................................................................................................. 212
Screening Tools for Patients With Oral Complications....................................................... 214
Additional Resources....................................................................................................................... 217
Conclusion........................................................................................................................................... 218
References............................................................................................................................................ 218
Chapter 14. Considerations for Older Cancer Survivors—
Aging, Comorbidity, and Cancer Treatment
221
Introduction........................................................................................................................................ 221
Oral Health and the Aging Population..................................................................................... 222
Oral Health Problems Among Older Adults........................................................................... 223
Considerations in Assessment and Intervention for Oral Effects in Older
Survivors......................................................................................................................................... 231
Conclusion........................................................................................................................................... 232
References............................................................................................................................................ 232
Chapter 15. Special Considerations in Pediatric Populations
237
Introduction........................................................................................................................................ 237
Oral Complications Associated With Cancer Treatment in Children............................. 238
Pediatric Oral Assessment Tools.................................................................................................. 242
Infections Associated With Cancer Treatment....................................................................... 242
Salivary Gland Dysfunction........................................................................................................... 244
Oral and Dental Management..................................................................................................... 244
Oral Care After Cancer Treatment.............................................................................................. 245
CONTENTS
xiii
Conclusion........................................................................................................................................... 247
References............................................................................................................................................ 247
Chapter 16. Second Primary Cancers and Recurrence
251
Introduction........................................................................................................................................ 251
Scope of the Problem...................................................................................................................... 251
Chemoprevention............................................................................................................................. 255
Fear of Recurrence and Psychosocial Effect on Patients With Oral Cancer................ 256
Nursing Implications........................................................................................................................ 257
Conclusion........................................................................................................................................... 258
References............................................................................................................................................ 259
Chapter 17. Oral Health Across the Continuum of Care:
A Symptom Cluster Model
263
Introduction........................................................................................................................................ 263
Major Advances in Treatment of Oral Problems in Cancer Treatments....................... 264
Clinical and Functional Impairments......................................................................................... 265
Prevention and Early Detection of Oral Complications .................................................... 265
Oral Care Protocols ......................................................................................................................... 266
Symptom Clusters ........................................................................................................................... 271
Case Study in an Allogeneic Hematologic Stem Cell Transplant Recipient................ 272
Conclusion........................................................................................................................................... 276
References............................................................................................................................................ 276
Index281
Preface
The mouth is a “mirror”: the oral cavity can reflect the general health of a
patient and reveal toxicities from oncology treatments.
Oral diseases may not be life threatening, but they can have systemic effects and greatly affect a person’s quality of life. Oral cancers can be devastating, and the toxicities from oncology treatments can compound problems
already experienced by patients who suffer from poor oral health and periodontal diseases. Concomitant high-dose radiation therapy and chemotherapy (targeted therapies) improves locoregional control of cancers but increases toxicities. Oral health becomes one of the primary responsibilities of the
entire multidisciplinary team. Healthcare providers should employ interventions that prevent oral problems or anticipate oral side effects and be aggressive in treating the problems so as to not delay or interrupt therapy. Once
the patient has completed therapy, follow-up over time is extremely important to maintain oral health.
This is the first oncology textbook available to guide physicians, nurse practitioners/physician assistants, and nurses who care for patients with cancer
through the management of oral health problems. Comprehensive information about evidence-based principles and practice guidelines in caring for the
oncology patient who has developed oral problems is presented. Managing
the Oral Effects of Cancer Treatment: Diagnosis to Survivorship begins with an indepth discussion about the fundamental skills of oral assessment and dental
hygiene, treatment side effects as they relate to the oral cavity, management
strategies, and insight into survivorship issues.
Initial chapters will discuss general overall oral health care, explain the
necessary fundamental skills to perform a comprehensive oral assessment,
and explain oral side effects from oncology treatments. Evidence-based tools
to describe the progress back toward oral health will be shared. The second
section will discuss management strategies to improve nutrition status, identify advantages of cytoprotection interventions, and gain control over pain issues. Speech therapy resources, complementary therapies, and an innovative
mini-oral clinic will be discussed to improve the patient’s tolerance with onxv
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MANAGING THE ORAL EFFECTS OF CANCER TREATMENT: DIAGNOSIS TO SURVIVORSHIP
cology treatments. Finally, the third section will provide in-depth insight into
survivorship issues, sexuality, changing eating habits, psychosocial issues, older adult and pediatric challenges, recurrent cancers, and a symptom cluster
model of care.
This textbook shares the efforts of many authors to synthesize scientific information to support patients toward better oral health care. Applying oral
healthcare principles will improve the quality of care for patients with cancer.