{"id":30559,"date":"2020-03-28T11:30:59","date_gmt":"2020-03-28T11:30:59","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=30559"},"modified":"2020-04-22T11:06:45","modified_gmt":"2020-04-22T11:06:45","slug":"oral-health-related-quality-of-life-of-patients-on-chemotheray","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol13no1\/oral-health-related-quality-of-life-of-patients-on-chemotheray\/","title":{"rendered":"Oral-Health Related Quality of Life of Patients on Chemotheray"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

Background of the problem<\/strong><\/p>\n

Chemotherapy is one of the most widely used treatments for cancer.\u00a0 It is used to prevent cancer cells from multiplying, invading or metastasizing.\u00a0 Cancer spreads primarily by direct extension through lymph nodes or the blood stream.\u00a0 Chemotherapy is a systemic treatment that enables the therapy to combat primarily disease sites, metastatic areas and possibly microscopic spread of disease.\u00a0 The goal of chemotherapy is targeted at three areas as cure, control or palliation.1-2<\/sup> Cure is the desired outcome of all patients but the likelihood depends on factors like extent of the disease at the time of diagnosis, functional status of the patients, physiological presentation at diagnosis, and other socioeconomic influences.\u00a0 Control is the goal of most of the therapy when a cure is unrealistic.\u00a0 Control focus on maintaining or improving functional status in the presence of unknown disease without complete elimination of the disease.\u00a0 Chemotherapy for palliation is used when cure or control is not possible because of the extent of the disease.\u00a0 Quality of life (QoL), disease symptom management and end of life issues\/hospice are a primary focus of control as a goal.1-4<\/sup> Chemotherapy may be used as a single agent, combination chemotherapy, adjuvant or neoadjuvant.3<\/sup><\/p>\n

The advances in chemotherapy as a treatment of choice for cancer has greatly reduced the mortality rates and improved the survival of patients with cancer.\u00a0 Chemotherapy acts on the active cells.\u00a0 Along with the cancer cells, many actively dividing normal cells of the body like blood, mouth, digestive system and the hair follicles also get destroyed.4-6<\/sup> Most of the people are aware of the common side effects of chemotherapy such as nausea and hair loss.\u00a0 But most people do not know that one third of the patients on chemotherapy for cancer treatments develop complications that affect mouth.\u00a0 Cancer patients are at high risk for oral complications.\u00a0 Oral complications occur in nearly 40% of the patients who receive chemotherapy.\u00a0 It affects the dental and oral health of the individual.\u00a0 Dental and oral health refers to the well-being of the entire mouth, including the teeth, gums, lining of the mouth (mucosa), and salivary glands.\u00a0 Oral complications caused by chemotherapy include mouth sores (oral mucositis), bleeding in the mouth, dry mouth, tooth decay and gum diseases, infection (bacterial, viral and fungal), pain, difficulty in swallowing\u00a0 (dysphagia), change in taste, neurotoxicity\u00a0 causing constant aching, burning pain similar to tooth ache, change in dental growth and development in children, malnutrition or dehydration.7<\/sup><\/p>\n

Mucositis is one of the most common and dose limiting complications of chemotherapy,4-9<\/sup> which begins 5-10 days after the initiation of chemotherapy and lasts 7-14 days.\u00a0 The combination of mucus, excess saliva and pain can make it difficult or even impossible to eat. \u00a0Younger patients tend to develop oral mucositis (OM) more often than older patients being treated for the same malignancy with the same regimen.\u00a0 This appears to be due to the more rapid rate of basal cell turnover noted in children.\u00a0 However, the healing of OM is also more rapid in the younger age group.\u00a0 Mucositis is further complicated by nausea and vomiting that often occurs with treatment.\u00a0 Patients with damaged oral mucosa and reduced immunity are also prone to mouth infections.10-11 <\/sup>Oral complications make it difficult to eat, talk, chew or swallow.\u00a0 These complications can affect the patients\u2019 quality of life.7,12<\/sup> In some cases, the oral compilations becomes so severe and can significantly affect the cancer treatment like the need to lower the treatment dose, change in the schedule, delay in the treatment, and may even have to stop the treatment.7, 13<\/sup><\/p>\n

Oral health is essential to general health and well-being at every stage of life.\u00a0 A healthy mouth enables not only nutrition of the\u00a0physical body, but also enhances social interaction and promotes self-esteem and feelings of well-being.\u00a0 WHO defines oral health as a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual\u2019s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing.14<\/sup><\/p>\n

The malignancy, effect of chemotherapy on the body, and OM affect both the OHRQoL as well as the general QoL of the individuals.\u00a0 In addition to chemotherapy there are many other factors that contribute to the quality of the oral heath like the presence of dental appliances, history of oral lesions, or smoking, oral hygiene\/care practices,6 \u00a0<\/sup>poor dental health, particularly periodontal disease, has been identified as an environmental factor that may increase the severity of OM.\u00a0 Treatment variables like the type, dose and schedule of systemic cytotoxic drugs delivered, radiation dose and field, and concomitant use of chemotherapy and radiation also contribute to OM.\u00a0 Studies report that the risk of OM increases as the intensity of therapy increases.\u00a0 In addition, patient-related risk factors like age, malnutrition, gender, pre-existing medical conditions, alterations in salivary production and composition, poor oral health and mucosal trauma have been reported to influence the risk of OM.15 <\/sup>\u00a0Chemotherapy induced mucositis pause a serious implication on the patients\u2019 QoL.16-18 <\/sup>\u00a0Strategies need to be developed to suit the individual patient considering the contributing factors for the prevention and appropriate management of mucositis and enhancement of the oral-health and general wellbeing.\u00a0 The global burden of disease study 2016 estimated that oral diseases affected half of the world’s population and reported that oral health is a neglected area of global health that could make a contribution to achieving universal health coverage.19<\/sup> In addition to this, most of the people are unaware about the oral impact of chemotherapy leading to neglect of oral discomfort as a compilation.20<\/sup>\u00a0 So, careful assessment and attention to the existing oral health issues can be done even before starting chemotherapy to help reducing the worsening of the oral problems during chemotherapy.<\/p>\n

Aim of the study<\/strong><\/p>\n

The study is primarily aimed to determine the impact of chemotherapy on the oral-health related quality of life cancer patients receiving chemotherapy.\u00a0 The study further attempted to compare the oral-health related quality at different cycles with the baseline oral-health status.<\/p>\n

Materials and Methods<\/strong><\/p>\n

The present study was a descriptive survey to assess the impact of chemotherapy on the OHRQoL of patient receiving chemotherapy.\u00a0 The study was conducted among 60 patients scheduled to receive chemotherapy who were selected by total enumeration sampling.\u00a0 The data regarding socio-demographic and clinical variables were collected using a self-developed questionnaire and OHRQoL using Oral Health Impact Questionnaire (OHIQ) which has seven domains and 49 items.\u00a0 Data on oral health impact was assessed before starting the chemotherapy (baseline) and at third and fifth cycle.\u00a0 Ethical Clearance from the Institutional Review Board and informed consent from each of subjects were obtained before starting the data collection.\u00a0 Data on socio-demographic and clinical variables were analyzed using descriptive statistics – frequency and percentage.\u00a0 Comparison of the OHRQoL at baseline, cycle III and V were assessed using Wilcoxon Signed Rank test and correlation by Mann Whitney U test.\u00a0 The statistical package SPSS 21 was used for the data analysis.\u00a0\u00a0<\/strong><\/p>\n

Results and Discussion<\/strong><\/p>\n

Results<\/strong><\/p>\n

Sample Characteristics<\/strong><\/p>\n

Table 1: Sample characteristics based on socio demographic data\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0n=60<\/strong>\u00a0 \u00a0\u00a0<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Sl. No<\/strong><\/td>\nVariables<\/strong><\/td>\nFrequency (f)<\/strong><\/td>\nPercentage (%)<\/strong><\/td>\nTotal<\/strong><\/td>\n<\/tr>\n
1\u00a0\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Age (yrs)<\/strong><\/td>\n60<\/td>\n<\/tr>\n
\u00a021- 30<\/td>\n3<\/td>\n5.0<\/td>\n<\/tr>\n
\u00a031- 40<\/td>\n4<\/td>\n6.7<\/td>\n<\/tr>\n
\u00a041-50<\/td>\n9<\/td>\n15.0<\/td>\n<\/tr>\n
51-60<\/td>\n17<\/td>\n28.3<\/td>\n<\/tr>\n
\u00a061-70<\/td>\n27<\/td>\n45.0<\/td>\n<\/tr>\n
2\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Gender<\/strong><\/td>\n60<\/td>\n<\/tr>\n
Male<\/td>\n24<\/td>\n40.0<\/td>\n<\/tr>\n
Female<\/td>\n36<\/td>\n60.0<\/td>\n<\/tr>\n
3\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Income (\u20b9)<\/strong><\/td>\n60<\/td>\n<\/tr>\n
< 5000<\/td>\n5<\/td>\n8.3<\/td>\n<\/tr>\n
5000 – 9999<\/td>\n11<\/td>\n18.3<\/td>\n<\/tr>\n
10,000 – 19,999<\/td>\n14<\/td>\n23.3<\/td>\n<\/tr>\n
20,000 and above<\/td>\n30<\/td>\n50.0<\/td>\n<\/tr>\n
4\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Smoking status<\/strong><\/td>\n60<\/td>\n<\/tr>\n
Never<\/td>\n46<\/td>\n76.7<\/td>\n<\/tr>\n
Present smoker<\/td>\n3<\/td>\n5.0<\/td>\n<\/tr>\n
Ex-smoker<\/td>\n11<\/td>\n18.3<\/td>\n<\/tr>\n
5\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Alcohol intake<\/strong><\/td>\n60<\/td>\n<\/tr>\n
Yes<\/td>\n11<\/td>\n18.3<\/td>\n<\/tr>\n
No<\/td>\n49<\/td>\n81.7<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Table 1 showed that majority (27, 45%) of the subjects were between 61-70 years with 44 (73.3%) constituting age between 51-70 years.\u00a0 Females outnumbered males (36, 60% females vs 24, 40%) males).\u00a0 Half (30, 50%) of the subjects had an income of Rs. 20,000 and above.\u00a0 More than 3\/4th<\/sup> of the subjects never smoked while 11(18.3%) were ex-smokers and 11 (18.3%) had the habit of alcohol consumption.<\/p>\n

Table 2: Sample characteristics based on oral health related factors\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0n = 60<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Sl. No<\/strong><\/td>\nVariables<\/strong><\/td>\nFrequency (f)<\/strong><\/td>\nPercentage (%)<\/strong><\/td>\nTotal<\/strong><\/td>\n<\/tr>\n
1\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Oral hygiene<\/strong><\/td>\n60<\/td>\n<\/tr>\n
Good<\/td>\n33<\/td>\n55.0<\/td>\n<\/tr>\n
Average<\/td>\n26<\/td>\n43.3<\/td>\n<\/tr>\n
Poor<\/td>\n1<\/td>\n1.7<\/td>\n<\/tr>\n
2\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Tooth brushing practice<\/strong><\/td>\n60<\/td>\n<\/tr>\n
Once daily<\/td>\n23<\/td>\n38.3<\/td>\n<\/tr>\n
Twice daily<\/td>\n36<\/td>\n60.0<\/td>\n<\/tr>\n
After each meal<\/td>\n1<\/td>\n1.7<\/td>\n<\/tr>\n
3\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Brushing with <\/strong><\/td>\n60<\/td>\n<\/tr>\n
Paste and brush<\/td>\n55<\/td>\n91.7<\/td>\n<\/tr>\n
Tooth powder (commercial)<\/td>\n5<\/td>\n8.3<\/td>\n<\/tr>\n
Husk of paddy<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Others<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
4\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Availing dental service<\/strong><\/td>\n<\/td>\n<\/td>\n60<\/td>\n<\/tr>\n
Regularly<\/td>\n10<\/td>\n16.7<\/td>\n<\/tr>\n
Only with indication<\/td>\n50<\/td>\n83.3<\/td>\n<\/tr>\n
5\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Use of<\/strong><\/td>\n60<\/td>\n<\/tr>\n
Betel leaves<\/td>\n3<\/td>\n5.0<\/td>\n<\/tr>\n
Tobacco chewing<\/td>\n1<\/td>\n1.7<\/td>\n<\/tr>\n
Any other<\/td>\n56<\/td>\n93.3<\/td>\n<\/tr>\n
6\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Conditions of oral health<\/strong><\/td>\n60<\/td>\n<\/tr>\n
No. of decayed tooth<\/td>\n14<\/td>\n23.3<\/td>\n<\/tr>\n
No. of missing tooth<\/td>\n26<\/td>\n\u00a043.3<\/td>\n<\/tr>\n
No. of filled tooth<\/td>\n12<\/td>\n\u00a020<\/td>\n<\/tr>\n
No. of sensitive tooth<\/td>\n6<\/td>\n\u00a010<\/td>\n<\/tr>\n
7\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Use of prosthesis<\/strong><\/td>\n60<\/td>\n<\/tr>\n
No<\/td>\n51<\/td>\n85.0<\/td>\n<\/tr>\n
Fixed prosthesis<\/td>\n3<\/td>\n5.0<\/td>\n<\/tr>\n
Partially removable<\/td>\n1<\/td>\n1.7<\/td>\n<\/tr>\n
Fully removable<\/td>\n5<\/td>\n8.3<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Variables related to oral health presented in table 2 indicated that 26(43.3%) had only average oral hygiene and another 1(1.7%) had poor oral hygiene.\u00a0 More than half (36, 60%) used to brush the teeth twice daily and, paste and brush were the main items (55, 91.7%) used to clean the teeth.\u00a0 Majority (50, 83.3%) availed dental service only when there was an indication.\u00a0 Decayed teeth was reported by 14(23.3%), missing teeth by 26(43.3 %), filled teeth by 12(20%) and sensitive teeth by 6(10%).\u00a0 A few (9, 15%) used prosthesis out of which five were using fully removable and three using fixed prosthesis.<\/p>\n

Table 3: Sample characteristics based on clinical variables\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 n = 60<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Sl. No<\/strong><\/td>\nVariables<\/strong><\/td>\nFrequency<\/strong><\/td>\nPercentage<\/strong><\/td>\n<\/tr>\n
1<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

BMI\u00a0<\/strong><\/td>\n<\/tr>\n
Under weight<\/td>\n2<\/td>\n3.3<\/td>\n<\/tr>\n
Normal weight<\/td>\n35<\/td>\n58.4<\/td>\n<\/tr>\n
Overweight<\/td>\n21<\/td>\n35.0<\/td>\n<\/tr>\n
Obese Class I<\/td>\n2<\/td>\n3.3<\/td>\n<\/tr>\n
2<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

TNM Staging<\/strong><\/td>\n<\/tr>\n
T staging<\/td>\n4<\/td>\n6.7<\/td>\n<\/tr>\n
MN staging<\/td>\n42<\/td>\n70.0<\/td>\n<\/tr>\n
Metastasis<\/td>\n14<\/td>\n23.3<\/td>\n<\/tr>\n
3<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Chemotherapeutic agent used*<\/strong><\/td>\n<\/tr>\n
Doxitaxel<\/td>\n4<\/td>\n6.7<\/td>\n<\/tr>\n
Oxaliplatin<\/td>\n6<\/td>\n10.0<\/td>\n<\/tr>\n
Carboplatin<\/td>\n2<\/td>\n3.3<\/td>\n<\/tr>\n
Paclitaxel<\/td>\n3<\/td>\n5.0<\/td>\n<\/tr>\n
5-Flurouracil<\/td>\n1<\/td>\n1.7<\/td>\n<\/tr>\n
Cisplatin<\/td>\n3<\/td>\n5.0<\/td>\n<\/tr>\n
Doxorubicin,\u00a0 Cyclophosphamide<\/td>\n3<\/td>\n5.0<\/td>\n<\/tr>\n
Paclitaxel, Carboplatin<\/td>\n7<\/td>\n11.7<\/td>\n<\/tr>\n
“Paclitaxel, Oxaliplatin”<\/td>\n3<\/td>\n5.0<\/td>\n<\/tr>\n
“Adreamicin, Cyclophosphamide”<\/td>\n3<\/td>\n5.0<\/td>\n<\/tr>\n
4<\/strong><\/td>\nLength of chemotherapy<\/strong><\/td>\n<\/tr>\n
4 weeks<\/td>\n13<\/td>\n21.7<\/td>\n<\/tr>\n
6 weeks<\/td>\n28<\/td>\n46.7<\/td>\n<\/tr>\n
7 weeks<\/td>\n2<\/td>\n3.3<\/td>\n<\/tr>\n
>7 weeks<\/td>\n17<\/td>\n28.3<\/td>\n<\/tr>\n
5<\/strong><\/td>\nLaboratory data<\/strong><\/td>\n<\/tr>\n
a<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Haemoglobin (Hb)<\/strong><\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Below normal<\/td>\n21<\/td>\n35.0<\/td>\n<\/tr>\n
Normal<\/td>\n36<\/td>\n60.0<\/td>\n<\/tr>\n
Above normal<\/td>\n3<\/td>\n5.0<\/td>\n<\/tr>\n
b<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

WBC<\/strong><\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Below Normal<\/td>\n23<\/td>\n38.3<\/td>\n<\/tr>\n
Normal<\/td>\n25<\/td>\n41.7<\/td>\n<\/tr>\n
Above Normal<\/td>\n12<\/td>\n20.0<\/td>\n<\/tr>\n
c<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Neutrophil<\/strong><\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Below normal<\/td>\n11<\/td>\n18.3<\/td>\n<\/tr>\n
normal<\/td>\n46<\/td>\n76.7<\/td>\n<\/tr>\n
Above normal<\/td>\n3<\/td>\n5.0<\/td>\n<\/tr>\n
d<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Platelet<\/strong><\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Below normal<\/td>\n5<\/td>\n8.3<\/td>\n<\/tr>\n
Normal<\/td>\n54<\/td>\n90.0<\/td>\n<\/tr>\n
Above normal<\/td>\n1<\/td>\n1.7<\/td>\n<\/tr>\n
6<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Co-morbidity<\/strong><\/td>\n<\/tr>\n
Nil<\/td>\n29<\/td>\n48.33<\/td>\n<\/tr>\n
Hypertension<\/td>\n11<\/td>\n18.3<\/td>\n<\/tr>\n
Anaemia<\/td>\n3<\/td>\n5.0<\/td>\n<\/tr>\n
Kidney disease<\/td>\n1<\/td>\n1.7<\/td>\n<\/tr>\n
Others<\/td>\n16<\/td>\n26.7<\/td>\n<\/tr>\n
7<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Previous malignancy<\/strong><\/td>\n<\/tr>\n
Yes<\/td>\n6<\/td>\n10<\/td>\n<\/tr>\n
No<\/td>\n54<\/td>\n90<\/td>\n<\/tr>\n
8<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Oral risk factors<\/strong><\/td>\n<\/tr>\n
Previous oral ulcers<\/td>\n16<\/td>\n27<\/td>\n<\/tr>\n
Presence of dental caries<\/td>\n7<\/td>\n12<\/td>\n<\/tr>\n
Dental procedures<\/td>\n5<\/td>\n8<\/td>\n<\/tr>\n
Use of dentures<\/td>\n1<\/td>\n2<\/td>\n<\/tr>\n
None<\/td>\n30<\/td>\n50<\/td>\n<\/tr>\n
Total<\/strong><\/td>\n60<\/strong><\/td>\n100<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*n more than 60<\/p>\n

Oral Health Related Quality of Life of Patients Receiving Chemotherapy<\/strong><\/p>\n

The data regarding clinical variables (table 3) indicated that among the study subjects, over half (35, 58.4%) had normal BMI, whereas 21(35%) were overweight.\u00a0 Majority (42, 70%) had lymph node metastasis and 14(23.3%) had distant metastasis.\u00a0 A variety of chemotherapeutic agents were used with maximum receiving the single agent oxaliplatin (6, 10%) followed by doxitaxel (4, 6.7%).\u00a0 Paclitaxel and carboplatin were the most commonly used (7, 11.7%) combination chemotherapy.\u00a0 A good number (28, 46.7%) were scheduled to receive six (6) cycles of chemotherapy.\u00a0 The laboratory investigation indicated that 36(60%) had normal Hb count, 25(41.7%) had normal WBC count and almost an equal number (23, 38.3%) had below normal WBC count (46, 76.7%), more than three quarter had normal neutrophil count (46, 76.7%) and 54(90%) had a normal platelet count.\u00a0 Hypertension was the major co-morbidity (11, 18%) reported by the subjects while almost half of the subjects did not report any co-morbidities (29, 48.3%).\u00a0 Previous malignancy was reported by 6(10%), presence of oral risk factors by 30(50%).\u00a0 Previous oral ulcer (16, 27%) was the major oral risk factor reported.\u00a0<\/strong><\/p>\n

Table 4: Mean and Standard deviation of Overall Oral Health Related Quality of Life at baseline and 3rd<\/sup> and 5th<\/sup> cycle of chemotherapy<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n
\u00a0Measurement <\/strong><\/td>\nMean<\/strong><\/td>\nMean Difference<\/strong><\/td>\nStd. Deviation<\/strong><\/td>\np- values<\/strong><\/td>\n<\/tr>\n
I<\/td>\nBaseline<\/td>\n21.7833<\/td>\n6.2334<\/td>\n23.43407<\/td>\n<0.001<\/td>\n<\/tr>\n
Cycle III<\/td>\n28.0167<\/td>\n21.23915<\/td>\n<\/tr>\n
II<\/td>\nBaseline<\/td>\n21.7833<\/td>\n12.5500<\/td>\n23.43407<\/td>\n<0.001<\/td>\n<\/tr>\n
Cycle V<\/td>\n34.3333<\/td>\n21.45446<\/td>\n<\/tr>\n
III<\/td>\nCycle III<\/td>\n28.0167<\/td>\n6.3166<\/td>\n21.23915<\/td>\n<0.001<\/td>\n<\/tr>\n
Cycle V<\/td>\n34.3333<\/td>\n21.45446<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*Wilcoxon Signed Rank Test<\/p>\n

Data presented in table 4 showed that the mean overall oral health of patients who received chemotherapy had significantly reduced from the baseline to third and fifth cycle with a mean difference of 6.23 between baseline and Cycle III, 12.55 between baseline and Cycle V and 6.32 between cycle III and V (p<0.001).<\/p>\n

Table 5: Comparison of the Oral health Related Quality of Life at Baseline, Cycle III and V\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0n = 60<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Sl. No.<\/strong><\/td>\nDomains<\/strong><\/td>\nMeasurements<\/strong><\/td>\nMean +<\/u>SD<\/strong><\/td>\nPaired Comparison<\/strong><\/td>\np Value<\/strong><\/td>\n<\/tr>\n
I<\/strong><\/td>\nOverall OHRQoL<\/strong><\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\n\u00a0<\/strong><\/td>\nBaseline<\/td>\n21.78\u00a0 + <\/u>\u00a023.43<\/td>\nBaseline & Cycle III<\/td>\n0.001<\/td>\n<\/tr>\n
Cycle III<\/td>\n28.02 + <\/u>21.4<\/td>\nBaseline & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n
Cycle V<\/td>\n34.33 + <\/u>21.45<\/td>\nCycle III & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n
II<\/strong><\/td>\nDomain wise Oral Health Related Quality of Life<\/strong><\/td>\n<\/tr>\n
1<\/td>\nFunctional Limitation<\/strong><\/td>\nBaseline<\/td>\n3.57 + <\/u>4.92<\/td>\nBaseline & Cycle III<\/td>\n0.001<\/td>\n<\/tr>\n
Cycle III<\/td>\n4.45 + <\/u>4.78<\/td>\nBaseline & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n
Cycle V<\/td>\n5.35 + <\/u>5.43<\/td>\nCycle III & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n
2<\/td>\nPhysical Pain<\/strong><\/td>\nBaseline<\/td>\n2.23 +<\/u> 3.06<\/td>\nBaseline & Cycle III<\/td>\n0.01**<\/td>\n<\/tr>\n
Cycle III<\/td>\n2.72 +<\/u> 2.61<\/td>\nBaseline & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n
Cycle V<\/td>\n2.63 +<\/u> 2.85<\/td>\nCycle III & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n
3<\/td>\nPsychological Discomfort<\/strong><\/td>\nBaseline<\/td>\n3.02 +<\/u> 3.32<\/td>\nBaseline & Cycle III<\/td>\n0.001<\/td>\n<\/tr>\n
Cycle III<\/td>\n3.47 +<\/u> 3.27<\/td>\nBaseline & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n
Cycle V<\/td>\n3.93 +<\/u> 3.35<\/td>\nCycle III & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n
4<\/td>\nPhysical Discomfort<\/strong><\/td>\nBaseline<\/td>\n2.33 +<\/u>4.73<\/td>\nBaseline & Cycle III<\/td>\n0.001<\/td>\n<\/tr>\n
Cycle III<\/td>\n3.43 +<\/u> 4.59<\/td>\nBaseline & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n
Cycle V<\/td>\n4.18 +<\/u>4.71<\/td>\nCycle III & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n
5<\/td>\nPsychological Disability<\/strong><\/td>\nBaseline<\/td>\n3.68 +<\/u> 4.37<\/td>\nBaseline & Cycle III<\/td>\n0.001<\/td>\n<\/tr>\n
Cycle III<\/td>\n4.85 +<\/u>4.33<\/td>\nBaseline & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n
Cycle V<\/td>\n5.87 +<\/u> 4.27<\/td>\nCycle III & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n
6<\/td>\nSocial Disability<\/strong><\/td>\nBaseline<\/td>\n2.00 +<\/u>2.42<\/td>\nBaseline & Cycle III<\/td>\n0.001<\/td>\n<\/tr>\n
Cycle III<\/td>\n3.02 +<\/u> 1.94<\/td>\nBaseline & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n
Cycle V<\/td>\n4.07 + <\/u>1.74<\/td>\nCycle III & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n
7<\/td>\nHandicap<\/strong><\/td>\nBaseline<\/td>\n4.95 + <\/u>4.81<\/td>\nBaseline & Cycle III<\/td>\n0.001<\/td>\n<\/tr>\n
Cycle III<\/td>\n6.08 + <\/u>4.27<\/td>\nBaseline & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n
Cycle V<\/td>\n7.30 +<\/u>3.83<\/td>\nCycle III & Cycle V<\/td>\n0.001<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

@ Wilcoxon Signed Rank test; *p<0.01<\/p>\n

Comparison of the OHRQoL of patients at baseline, Cycle III and V using Wilcoxon Signed Rank test presented in table 5 indicated that there was a significant difference between the overall OHRQoL of patients receiving chemotherapy between the baseline and Cycle III, baseline and Cycle V and Cycle III and Cycle V (p<0.001).\u00a0 Such a difference existed in all the domains [p<0.001 for all the seven domains except in the domain \u2018physical pain\u2019 between baseline and cycle III (p<0.01)].\u00a0 So this data suggested that the OHRQoL significantly differ between the baseline and different cycles as well as in the overall QoL in patients receiving chemotherapy.<\/p>\n

In addition to the overall and domain wise analysis, an item wise (n=49) comparison of the OHRQoL was done between the baseline and cycle III and V of chemotherapy.\u00a0 In the domain functional limitation, the items \u2018taste worse\u2019 and \u2018food catchy\u2019 were the most affected.\u00a0 The number of subjects whose taste affected had increased from 18(30%) at baseline to 33(55%) at cycle V.\u00a0 The subjects who felt \u2018food catchy\u2019 during the course of chemotherapy increased from 15(25%) at baseline to 27(45%) at cycle V.\u00a0 Other items which were affected in functional limitation was \u2018breathe sale\u2019 which increased from 20(33.3%) at baseline to 30(50%) at cycle V.\u00a0 In the domain of physical pain, the item sensitivity of the tooth was the most affected where the number has increased from 10(16.7%) at baseline to 43(71.7%) at cycle V.\u00a0 Number of subjects with painful aching had increased from 20(33.3%) at baseline to 24(56.7%) at cycle V.\u00a0 The subjects who felt uncomfortable to eat had increased from 13(21.7%) to 21(35%).\u00a0 Data in the domain psychological discomfort showed that majority (35, 58.3%) were self conscious right from the baseline itself and it had increased to 48(80%) at cycle V.\u00a0 A good proportion of subjects (27, 45%) expressed that they felt tensed at baseline which increased to 40(66.7%) at cycle V.\u00a0 Among the items in the domain \u2018physical discomfort\u2019, \u2018avoid eating\u2019 was very often reported where the number of subjects who avoided eating had increased from 20(33.3%) at baseline to 38(63.3%) at cycle V.\u00a0 Diet was felt unsatisfactory by 13(21.7%) and this had increased to 24(40%) at cycle V.\u00a0 The meals were interrupted for 7(11.7%) at baseline and 13(21.7%) at cycle V.\u00a0 Data concerning the psychological domain indicated that depression was the most serious issue present among the subjects where 35(58.3%) felt depressed at the baseline and 51(85%) at cycle V.\u00a0 Sleep was interrupted for 15(41.7%) at baseline and 46(76.7%) at cycle V.\u00a0 As many as 27(45%) were upset at the baseline which increased to 48(80%) at cycle V.\u00a0 Difficulty to relax was expressed by 24(40%) at baseline and 34(56.7%) at cycle V.\u00a0 In the domain of social disability, majority of the subjects avoided going out during the chemotherapy.\u00a0 At the baseline itself, 31(51.7%) reported that they avoided going out which increased to 53(88.7%) at cycle III and 57(95%) at cycle V.\u00a0 Difficulty doing job was reported by 27(45%) at baseline and 47(79.3%) at cycle V.\u00a0 The general health was reported to be worsened at baseline for 36(60%) which increased to 43(71.7%) at cycle V; 37(61.7%) felt it unable to work at baseline, which increased to 56(93.3%) at cycle V; 23(38.3%) of the subjects reported that they were unable to function at baseline and 35(58.3%) at cycle V.\u00a0 So, among all the 49 items distributed among seven domains, all the items in the domain handicap was rated low by the subjects at the baseline itself.\u00a0 This had decreased in subsequent cycles of chemotherapy too.\u00a0 Hence it is evident that chemotherapy had resulted in significant difference in the OHRQoL of patients in all the seven domains.<\/p>\n

Table 6: Association of Related factors with OHRQoL\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/strong>n = 60<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Sl. No<\/strong><\/td>\nParameter<\/strong><\/td>\nMean +<\/u> SD<\/strong><\/td>\nMean +<\/u> SD<\/strong><\/td>\np value<\/strong><\/td>\n<\/tr>\n
1<\/strong><\/td>\nAge<\/strong><\/td>\n<<\/u><\/strong>50 (n = 16)<\/strong><\/td>\n>50 (n = 44)<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
Baseline<\/td>\n30.88 +<\/u>36.47<\/td>\n41.43 +<\/u> 45.45<\/td>\n0.316<\/td>\n<\/tr>\n
Cycle 3<\/td>\n40.44 +<\/u> 30.35<\/td>\n53.41 +<\/u> 41.66<\/td>\n0.189<\/td>\n<\/tr>\n
Cycle 5<\/td>\n52.19 +<\/u> 27.59<\/td>\n64.70 +<\/u> 43.43<\/td>\n0.336<\/td>\n<\/tr>\n
2<\/strong><\/td>\nGender<\/strong><\/td>\nMale (n = 24)<\/strong><\/td>\nFemale (n = 36)<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
Baseline<\/td>\n24.21 +<\/u> 19.09<\/td>\n48.22 +<\/u> 51.66<\/td>\n0.089<\/td>\n<\/tr>\n
Cycle 3<\/td>\n36.88 +<\/u> 15.21<\/td>\n58.67 +<\/u> 47.28<\/td>\n0.139<\/td>\n<\/tr>\n
Cycle 5<\/td>\n49.63 +<\/u> 20.90<\/td>\n69.19 +<\/u> 47.45<\/td>\n0.163<\/td>\n<\/tr>\n
3<\/strong><\/td>\nSmoking history<\/strong><\/td>\nNever smokers (n = 46)<\/strong><\/td>\nSmokers (n = 14)<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
Baseline<\/td>\n42.04 +<\/u> 47.88<\/td>\n27.36 +<\/u>18.81<\/td>\n0.727<\/td>\n<\/tr>\n
Cycle 3<\/td>\n53.93 +<\/u> 43.20<\/td>\n36.86 +<\/u> 15.94<\/td>\n0.271<\/td>\n<\/tr>\n
Cycle 5<\/td>\n64.65 +<\/u> 43.68<\/td>\n50.57 +<\/u> 22.16<\/td>\n0.392<\/td>\n<\/tr>\n
4<\/strong><\/td>\nUse of alcohol<\/strong><\/td>\nYes (n = 11)<\/strong><\/td>\nNo (n= 49)<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
Baseline<\/td>\n38.00 +<\/u> 20.60<\/td>\n38.76 +<\/u> 46.96<\/td>\n0.184<\/td>\n<\/tr>\n
Cycle 3<\/td>\n47.45 +<\/u> 18.37<\/td>\n50.51 +<\/u> 42.56<\/td>\n0.497<\/td>\n<\/tr>\n
Cycle 5<\/td>\n63.64 +<\/u> 22.96<\/td>\n60.86 +<\/u> 43.06<\/td>\n0.316<\/td>\n<\/tr>\n
5<\/strong><\/td>\nOral Hygiene<\/strong><\/td>\nGood (n=33)<\/strong><\/td>\nAverage (n=27)<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
Baseline<\/td>\n35.48 +<\/u>46.24<\/td>\n42.44 +<\/u> 39.68<\/td>\n0.262<\/td>\n<\/tr>\n
Cycle 3<\/td>\n44.82 +<\/u> 42.38<\/td>\n56.22 +<\/u> 34.52<\/td>\n0.043<\/td>\n<\/tr>\n
Cycle 5<\/td>\n56.24 +<\/u> 43.83<\/td>\n67.63 +<\/u> 34.50<\/td>\n0.037*<\/td>\n<\/tr>\n
6<\/strong><\/td>\nTooth brushing practice<\/strong><\/td>\nOnce daily(n= 23)<\/strong><\/td>\nTwice daily (n = 27)<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
Baseline<\/td>\n36.52 +<\/u> 37.6<\/td>\n39.92 +<\/u> 46.79<\/td>\n0.988<\/td>\n<\/tr>\n
Cycle 3<\/td>\n47.57 +<\/u> 32.18<\/td>\n51.43 +<\/u> 43.27<\/td>\n0.988<\/td>\n<\/tr>\n
Cycle 5<\/td>\n59.09 +<\/u> 32.05<\/td>\n62.78 +<\/u> 44.59<\/td>\n0.976<\/td>\n<\/tr>\n
7<\/strong><\/td>\nAvailing dental service<\/strong><\/td>\nRegularly (n = 10)<\/strong><\/td>\nOnly when indicated (n= 50)<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
Baseline<\/td>\n60.90 +<\/u> 72.98<\/td>\n34.16 +<\/u> 33.86<\/td>\n0.377<\/td>\n<\/tr>\n
Cycle 3<\/td>\n64.70 +<\/u> 67.70<\/td>\n47.00 +<\/u> 30.82<\/td>\n0.945<\/td>\n<\/tr>\n
Cycle 5<\/td>\n73.4 +<\/u> 70.71<\/td>\n58.96 +<\/u> 31.18<\/td>\n0.819<\/td>\n<\/tr>\n
8<\/strong><\/td>\nDecayed teeth<\/strong><\/td>\n<\/= 1(n = 46))<\/strong><\/td>\n>1(n = 14)<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
Baseline<\/td>\n27.76 +<\/u> 27.54<\/td>\n74.29 +<\/u> 63.68<\/td>\n0.003**<\/td>\n<\/tr>\n
Cycle 3<\/td>\n38.63 +<\/u> 23.78<\/td>\n87.14 +<\/u> 55.26<\/td>\n0.001**<\/td>\n<\/tr>\n
Cycle 5<\/td>\n50.20 +<\/u> 25.51<\/td>\n98.07 +<\/u> 55.79<\/td>\n0.001**<\/td>\n<\/tr>\n
9<\/strong><\/td>\nMissing teeth<\/strong><\/td>\n<\/= 1 (n = 34)<\/strong><\/td>\n>1 (n = 26)<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
Baseline<\/td>\n31.35 +<\/u> 45.13<\/td>\n48.12 +<\/u> 39.37<\/td>\n0.017*<\/sup><\/td>\n<\/tr>\n
Cycle 3<\/td>\n44.88 +<\/u> 41.13<\/td>\n56.58 +<\/u> 36.09<\/td>\n0.073<\/td>\n<\/tr>\n
Cycle 5<\/td>\n58.03 +<\/u> 43.35<\/td>\n65.73 +<\/u> 35.48<\/td>\n0.165<\/td>\n<\/tr>\n
10<\/strong><\/td>\nFilled teeth<\/strong><\/td>\n<\/= 1(n = 48)<\/strong><\/td>\n>1(n = 12)<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
Baseline<\/td>\n40.73+<\/u> 46.67<\/td>\n30.17 +<\/u> 24.61<\/td>\n0.732<\/td>\n<\/tr>\n
Cycle 3<\/td>\n51.48 + <\/u>41.9<\/td>\n43.83 +<\/u> 25.74<\/td>\n0.767<\/td>\n<\/tr>\n
Cycle 5<\/td>\n63.75 +<\/u> 42.53<\/td>\n51.83 +<\/u> 26.96<\/td>\n0.494<\/td>\n<\/tr>\n
11<\/strong><\/td>\nSensitive teeth<\/strong><\/td>\n<\/= 1 (n = 54) <\/strong><\/td>\n>1(n = 6)<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
Baseline<\/td>\n34.07 +<\/u> 40.20<\/td>\n79.50 +<\/u> 51.55<\/td>\n0.018*<\/sup><\/td>\n<\/tr>\n
Cycle 3<\/td>\n46.19 +<\/u> 37.11<\/td>\n83.83 +<\/u> 18.05<\/td>\n0.014*<\/sup><\/td>\n<\/tr>\n
Cycle 5<\/td>\n58.37 +<\/u> 39.21<\/td>\n88.33 +<\/u> 40.08<\/td>\n0.043*<\/sup><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Table 6 depicted that there was a significant difference in the OHRQoL between those who had good and average oral hygiene.\u00a0 Presence\/number of decayed teeth (<<\/u>1 and >1) showed a significant difference in the OHRQoL of patients at the baseline (p<0.003) and at cycle III and V (p<0.001).\u00a0 Presence\/number of missing teeth had a significant impact at the baseline (p<0.05).\u00a0 There was also a significant difference in the OHRQoL of patients who had more than and less than one sensitive tooth (p<0.05).\u00a0 Other factors like age, gender, smoking history, alcohol consumption, tooth brushing practice, availing dental service and presence of filled teeth did not show any statistically significant difference in the OHRQoL of patients on chemotherapy.<\/p>\n

Table 7: Correlation between Oral Health Related Quality of Life and Selected factors<\/strong>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0n = 60<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Sl. No<\/strong><\/td>\nParameter<\/strong><\/td>\nMean +<\/u> SD<\/strong><\/td>\nMean +<\/u> SD<\/strong><\/td>\np value<\/strong><\/td>\n<\/tr>\n
1<\/strong><\/td>\nPlatelet count<\/strong><\/td>\nNormal (n = 54)<\/strong><\/td>\nNot normal (n = 6)<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
Baseline<\/td>\n41.59 +<\/u> 44.53<\/td>\n11.83 +<\/u>6.74<\/td>\n0.043*<\/sup><\/td>\n<\/tr>\n
Cycle 3<\/td>\n51.72 +<\/u> 40.64<\/td>\n34.00 +<\/u> 15.35<\/td>\n0.306<\/td>\n<\/tr>\n
Cycle 5<\/td>\n62.37 +<\/u> 41.51<\/td>\n52.33 +<\/u> 22.24<\/td>\n0.758<\/td>\n<\/tr>\n
2<\/strong><\/td>\nWBC Count<\/strong><\/td>\nNormal (n = 35)<\/strong><\/td>\nNot normal (n = 25)<\/strong><\/td>\n<\/td>\n<\/tr>\n
Baseline<\/td>\n29.64 +<\/u> 25.17<\/td>\n45.03 +<\/u> 51.87<\/td>\n0.422<\/td>\n<\/tr>\n
Cycle 3<\/td>\n39.32 +<\/u> 23.43<\/td>\n57.54 +<\/u> 46.14<\/td>\n0.152<\/td>\n<\/tr>\n
Cycle 5<\/td>\n47.24 +<\/u> 23.14<\/td>\n71.46 +<\/u> 46.32<\/td>\n0.033*<\/sup><\/td>\n<\/tr>\n
3<\/strong><\/td>\nCo-morbidity<\/strong><\/td>\nNo (n = 29)<\/strong><\/td>\nYes (n= 31)<\/strong><\/td>\n<\/td>\n<\/tr>\n
Baseline<\/td>\n29.41 +<\/u> 30.61<\/td>\n47.23 +<\/u> 51.34<\/td>\n0.127<\/td>\n<\/tr>\n
Cycle 3<\/td>\n40.83 +<\/u> 26.41<\/td>\n58.48 +<\/u> 46.97<\/td>\n0.107<\/td>\n<\/tr>\n
Cycle 5<\/td>\n50.34 +<\/u> 27.61<\/td>\n71.68 +<\/u> 46.97<\/td>\n0.034*<\/sup><\/td>\n<\/tr>\n
4<\/strong><\/td>\nOral risk factors<\/strong><\/td>\nNo (n = 30)<\/strong><\/td>\nYes (n= 30)<\/strong><\/td>\n<\/td>\n<\/tr>\n
Baseline<\/td>\n23.53 +<\/u> 28.78<\/td>\n53.70 +<\/u> 50.31<\/td>\n0.002**<\/sup><\/td>\n<\/tr>\n
Cycle 3<\/td>\n37.23 +<\/u> 24.7<\/td>\n62.67 +<\/u> 46.61<\/td>\n0.005**<\/sup><\/td>\n<\/tr>\n
Cycle 5<\/td>\n48.40 +<\/u> 26.54<\/td>\n74.33 +<\/u> 46.92<\/td>\n0.006**<\/sup><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

@Mann Whitney U test; *p<0.05; **p<0.01<\/p>\n

Data in table 7 indicated that OHRQoL of patients receiving chemotherapy had a significant correlation with the platelet count at baseline, WBC count and presence of co-morbidity at cycle V of chemotherapy and presence of oral risk factors at baseline, cycle III\u00a0 and Cycle V of chemotherapy (p<0.05).<\/p>\n

Factors like BMI, TNM staging, length of chemotherapy, haemoglobin level, neutrophil count, presence of previous malignancies were not correlated with OHRQoL of patient on chemotherapy (p>0.05).<\/p>\n

Discussions<\/strong><\/p>\n

Health-related quality of life\u00a0(HRQoL) is a multi-dimensional concept that includes domains\u00a0related\u00a0to physical, mental, emotional, and social functioning.\u00a0 It goes beyond direct measures of population\u00a0health,\u00a0life\u00a0expectancy, causes of death and focuses on the impact\u00a0health\u00a0status has on\u00a0QoL21\u00a0 <\/sup>and includes both positive and negative aspects.22 <\/sup><\/p>\n

Though there was no statistically significant difference in the OHRQoL between patients below and above 50 years of age in this study, majority (53, 88.3%) of the subjects were above 50years of age.\u00a0 Studies23-24 <\/sup>reported that advancing age was significantly associated with the OHRQoL.\u00a0 Females outnumbered the males (60% females vs. 40% males), which was also reported to be negatively correlated with OHRQoL.25<\/sup> However, gender too did not have significant contribution to the OHRQoL in the present study.\u00a0 Clinical studies suggest that smokers have more than average risk for periodontal disease and poor oral health.\u00a0 Smoking status was independently associated with worse OHRQoL after adjusting with a range of social demographic predictors, clinical status and self-reported general health.\u00a0 In a study conducted among 33,777 subjects, 24% of respondents were current cigarette smokers, 43% were former smokers and 33% had never smoked.\u00a0 When age, sex, household income and dental insurance were controlled in a multivariate logistic regression model, current smokers and former smokers had higher Odds of reporting oral-facial pain than people who had never smoked.\u00a0 Prevention of smoking onset and support for cessation of smoking could contribute to improved oral health status.26<\/sup>\u00a0 There are various other reports indicating that the smoking status is significantly associated with the number of teeth, where ex-smokers had significantly fewer teeth than non-smoker and current smoker had significantly fewer number of teeth than ex-mokers.26-28<\/sup> Studies reported that consumption of alcohol increase the risk for oral and other cancers, cardiovascular disease, liver cirrhosis and trauma.\u00a0 Alcohol increase the periodontal diseases, dental caries, plaques, mucosal lesions and lower salivary pH.29-30 <\/sup>Study findings support the association between clinically diagnosed periodontal diseases and OHRQoL with a dose-response relationship demonstrated.\u00a0 In summation, periodontal diseases play a significant role in oral health and impact on the QoL of affected individuals.31-32<\/sup> In the current study, there were 14(23.3%) smokers and 11 (18.3%) who consumed alcohol.<\/p>\n

The study reported that 27(45%) had only average oral hygiene, 23(38.3%) who brushed teeth only once daily and 1(1.7%) who brushed after each meal and 50(83.3% who availed dental service only on indication.\u00a0 Various oral risk factors like decayed teeth (14, 23.3%), missing teeth (26, 43.3%), filled teeth (12, 20%) and sensitive teeth (6, 10%) were reported by the subjects under study.\u00a0 Except 35(58.4%) of subjects, all others fell under the category of overweight\/obesity (23, 38.3%) or underweight (2, 3.3%).\u00a0 Study results were consistent with various studies where behavioural risk factors for oral diseases such as an unhealthy diet high in free sugars, tobacco use and harmful use of alcohol, poor oral hygiene and inadequate exposure to fluoride had negative effects on oral health.\u00a0 Malnutrition was also reported to be an independent risk factor for poor oral health. 33-34<\/sup><\/p>\n

The present study report showed that the OHRQoL of patients who were on chemotherapy was significantly different from the baseline to cycle III and V.\u00a0 The difference is obvious in the overall QoL and in all the seven domains of oral health such as functional limitation, physical pain, psychological discomfort, physical discomfort, psychological disability, social disability and handicap.\u00a0 The findings are consistent with reports of various other studies.\u00a0 Study conducted among head and neck cancer patients regarding the OHRQoL reported that about 45.57% felt that life in general was less satisfying because of problems with teeth, mouth or dentures.35<\/sup><\/p>\n

The study observed that the OHRQoL of the patients who received chemotherapy had declined from the baseline to the subsequent cycles (Cycle III and Cycle V).\u00a0 The decline was observed both in the overall OHRQoL and in all the seven domains of oral health related quality of life.<\/p>\n

Clinical application<\/strong><\/p>\n

Finding of this study has wide clinical application.\u00a0 It is a known fact that chemotherapy is an effective treatment for cancer.\u00a0 But chemotherapy is associated with many side effects including that of the dental and oral.\u00a0 Evidences form clinical studies state that oral and dental problem add to the risk for oral complications from chemotherapy.\u00a0 The oral health issues become so severe that at times there is a need to lower the dose of the chemotherapy, delay to start or even to discontinue the same.\u00a0 So, the nurses or the health professionals should make it mandatory to include assessment of the oral cavity in the routine assessment of patients before starting the chemotherapy and also to refer the patients to dentist in case any of the oral or dental problems are exist.\u00a0 It is advisable to take treatment for the existing oral problems before chemotherapy so that the oral complications can be minimized or even can have an uninterrupted course of chemotherapy.\u00a0 So, the study suggests need for a comprehensive oral assessment using standard questionnaire.<\/p>\n

Conclusion <\/strong><\/p>\n

Oral-health is very important for the general health of any individual.\u00a0 Chemotherapy affects the oral health of individual which has an impact on the overall\/general health related quality of life.\u00a0 Patients may experience a variety of issues related to oral health as a consequence of chemotherapy.\u00a0 But it may not be given the required attention as the focus is mainly on the disease aspect and its treatment.\u00a0 Oral health of patients on chemotherapy must be identified early in the treatment itself so that appropriate individualized therapy can be planned.\u00a0 More researches on oral health issues and its intervention have to be planned in future for the patients on chemotherapy.<\/p>\n

Limitations of the Study<\/strong><\/p>\n

The study assessed the oral health of the patients receiving any chemotherapeutic drug and combinations.\u00a0 It didn\u2019t study the effect of different combinations or single agent which limits the generalization.\u00a0 Future studies need to be undertaken using single agent or different combinations or a comparative study of different combinations.<\/p>\n

Acknowledgement<\/strong><\/p>\n

The investigators profoundly thank the subjects for their co-operation and participation.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ms. Vineetha V, Ms. Vimithamol E and Ms. Sherin Rajan\u2019s initial contributions is fondly acknowledged.<\/p>\n

Conflicting Interest<\/strong>\u00a0\u00a0 <\/strong><\/p>\n

No conflicting of interest to report.<\/p>\n

Funding Resources<\/strong><\/p>\n

The project is not funded by any external agency, institution or group.<\/p>\n

Statement of Informed Consent<\/strong><\/p>\n

The study was conducted after obtaining informed consent from each of the subjects involved in the study.\u00a0 A formal ethical clearance too was obtained from the Institutional Review Board.<\/p>\n

References<\/strong><\/p>\n

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