Epstein Joel B, Parker Ira R, Epstein Matthew S, Gupta Anurag, Kutis Susan, Witkowski Daniela M
Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois, MC-838, 801 S. Paulina Street, Chicago, IL, 60612, USA.
Support Care Cancer. 2007 Apr;15(4):357-62. doi: 10.1007/s00520-006-0160-4. Epub 2007 Jan 5.
The oral complications and morbidity resulting from overall cancer therapy utilizing radiation, chemotherapy, and/or stem cell transplantation can have significant impact on a patient's health, quality of life, cost of care, and cancer management. There has been minimal health services research focusing on the status of medically necessary, oral supportive services at US cancer centers.
A pre-tested, survey questionnaire was distributed to the directors of National Cancer Institute (NCI)-designated comprehensive cancer centers to assess each institution's resource availability and clinical practices, as it relates to the prevention and management of oral complications during cancer treatment.
Sixteen of the 39 comprehensive cancer centers responded to the survey. Of the respondents, 56% of the centers did not have a dental department. The sites of delivery of oral supportive care services range from the provision of in-house dental care to community-based, private practice sites. No standard protocols were in place for either oral preventive care or for supportive services for oral complications during or after cancer therapy. Fifty percent of the responding comprehensive cancer centers reported orally focused research and/or clinical trial activities.
Comprehensive cancer care must include an oral care component, particularly for those cancer patients who are at high risk for oral complications. This requires a functional team of oral care providers collaborating closely within the oncology team. Considering the number of cancer patients receiving aggressive oncologic treatment that may result in oral toxicity, the impact of oral conditions on a compromised host, and the potential lack of appropriate resources and healthcare personnel to manage these complications, future research efforts are needed to identify the strengths and weaknesses of present oral supportive care delivery systems at both NCI-designated cancer centers and community-based oncology practices.
利用放疗、化疗和/或干细胞移植进行的整体癌症治疗所导致的口腔并发症和发病率，会对患者的健康、生活质量、护理成本及癌症治疗产生重大影响。针对美国癌症中心必要的口腔支持性服务状况的卫生服务研究极少。
向国立癌症研究所（NCI）指定的综合癌症中心主任发放一份经过预测试的调查问卷，以评估各机构在癌症治疗期间预防和管理口腔并发症方面的资源可用性及临床实践情况。
39家综合癌症中心中有16家回复了调查。在回复的中心中，56%没有牙科科室。口腔支持性护理服务的提供地点从内部牙科护理到社区私人诊所不等。对于癌症治疗期间或之后的口腔预防护理或口腔并发症支持性服务，均未制定标准方案。50%的回复综合癌症中心报告了以口腔为重点的研究和/或临床试验活动。
综合癌症护理必须包括口腔护理部分，尤其是对于那些有口腔并发症高风险的癌症患者。这需要一个口腔护理提供者功能团队在肿瘤学团队中密切协作。考虑到接受可能导致口腔毒性的积极肿瘤治疗的癌症患者数量、口腔状况对受损宿主的影响以及管理这些并发症可能缺乏适当资源和医护人员的情况，未来需要开展研究，以确定NCI指定癌症中心和社区肿瘤学实践中当前口腔支持性护理提供系统的优势和劣势。
