Oral Health Problems Among Palliative and Terminally Ill Patients

An Integrated Systematic Review

Munikumar Ramasamy Venkatasalu; Zaidah Rizidah Murang; Divya Thirumalai Rajam Ramasamy; Jagjit Singh Dhaliwal

Disclosures

BMC Oral Health. 2020;20(79) 

In This Article

Abstract and Introduction

Abstract

Background: High incidence of treatable oral conditions has been reported among palliative patients. However, a large proportion of palliative patients lose their ability to communicate their sufferings. Therefore, it may lead to under-reporting of oral conditions among these patients. This review systematically synthesized the published evidence on the presence of oral conditions among palliative patients, the impact, management, and challenges in treating these conditions.

Methods: An integrative review was undertaken with defined search strategy from five databases and manual search through key journals and reference list. Studies which focused on oral conditions of palliative patients and published between years 2000 to 2017 were included.

Results: Xerostomia, oral candidiasis and dysphagia were the three most common oral conditions among palliative patients, followed by mucositis, orofacial pain, taste change and ulceration. We also found social and functional impact of having certain oral conditions among these patients. In terms of management, complementary therapies such as acupuncture has been used but not well explored. The lack of knowledge among healthcare providers also posed as a challenge in treating oral conditions among palliative patients.

Conclusions: This review is first in its kind to systematically synthesize the published evidence regarding the impact, management and challenges in managing oral conditions among palliative patients. Although there is still lack of study investigating palliative oral care among specific group of patients such as patients with dementia, geriatric or pediatric advanced cancer patients, this review has however provided baseline knowledge that may guide health care professionals in palliative settings.

Introduction

High incidence of oral conditions were often reported among palliative patients either direct or indirect primary cause such as salivary gland dysfunction in non-Hodgkin's lymphoma or fatigue which may affect patient's ability to undertake oral care hygiene.[1,2] Medical management of palliative conditions such as chemotherapy were often reported which can produce oral complications among these patients.[2] For example, the National Cancer Institute at the National Institutes of Health, United States of America reported that 80% of patients receiving myeloablative chemotherapy will develop oral complications, and palliative drugs such as bisphosphonates and analgesics were associated with oral mucositis and taste disturbance.[3]

Early diagnosis and treatment of oral conditions among palliative patients could minimize their pain and suffering.[2] However, evidence shows that 40% of palliative patients lose their ability to communicate their oral health needs. Therefore, they may suffer treatable oral conditions for a prolonged period of time,[4] or they may not complain of discomfort in their oral cavity which they believe to be an inevitable effect of their treatment.[5] This may contribute to under-reporting as well as underestimation of oral conditions among palliative patients, which may result in failure among health professionals to completely appreciate the problem. A literature review of oral care for cancer patients in 2001 reported that oral care is given by junior staffs with less experience and the practice needs to be transferred to oncology nurses.[6] Furthermore, a survey of international supportive health care providers (n = 212) (with 35% response rate) recommended to develop evidence-based practice protocol for oral care management.[7]

This systematic review aimed to synthesize the published evidence on oral conditions among palliative patients, impact, management and challenges in managing oral conditions among palliative patients.

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