Mercadante Sebastiano, Aielli Federica, Adile Claudio, Ferrera Patrizia, Valle Alessandro, Fusco Flavio, Caruselli Amanda, Cartoni Claudio, Massimo Pizzuto, Masedu Francesco, Valenti Marco, Porzio Giampiero
Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy.
Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Support Care Cancer. 2015 Nov;23(11):3249-55. doi: 10.1007/s00520-015-2720-y. Epub 2015 Apr 3.
Oral symptoms can be a sign of an underlying systemic condition and have a significant impact on quality of life, nutrition, and cost of care, while these lesions are often studied in the context of cancer treatment. However, information regarding oral symptoms in advanced cancer patients is poor. The aim of this multicenter study was to determine the prevalence and the characteristics of oral symptoms in a large population of advanced cancer patients.
A consecutive sample of patients with advanced cancer for a period of 6 months was prospectively assessed for an observational study. At time of admission, the epidemiological characteristics, surgery-radiotherapy of head and neck, and oncologic treatments in the last month were recorded. The presence of mucositis, dry mouth, and dysphagia was assessed by clinical examination and patients' report and their intensity recorded. Patients were also asked whether they had limitation on nutrition of hydration due to the local condition.
Six hundred sixty-nine patients were surveyed in the period taken into consideration. The mean age was 72.1 years (SD 12.3), and 342 patients were males. The primary tumors are listed in Table 1. The prevalence of mucositis was 22.3 %. The symptom relevantly reduced the ingestion of food or fluids and was statistically associated with the Karnofsky level and head and neck cancer. The prevalence of dry mouth was 40.4 %, with a mean intensity of 5.4 (SD 2.1). Several drugs were concomitantly given, particularly opioids (78 %), corticosteroids (75.3 %), and diuretics (70.2 %). Various and nonhomogeneous treatments were given for dry mouth, that was statistically associated with current or recent chemotherapy, and hematological tumors. The prevalence of dysphagia was 15.4 % with a mean intensity of 5.34 (SD 3). Dysphagia for liquids was observed in 52.4 % of cases. A high level of limitation for oral nutrition due to dysphagia was found, and in 53.4 % of patients, alternative routes to the oral one were used. Dysphagia was statistically associated with the Karnofsky level and head and neck cancer. A strong relationship between the three oral symptoms was found.
In advanced cancer patients, a range of oral problems significantly may impact on the physical, social, and psychological well-being of advanced cancer patients to varying degrees. These symptoms should be carefully assessed early but become imperative in the palliative care setting when they produce relevant consequences that may be life-threatening other than limiting the daily activities, particularly eating and drinking.
口腔症状可能是潜在全身性疾病的征兆，对生活质量、营养状况及护理成本有重大影响，然而这些病变通常在癌症治疗背景下进行研究。不过，关于晚期癌症患者口腔症状的信息匮乏。这项多中心研究的目的是确定大量晚期癌症患者口腔症状的患病率及特征。
对连续6个月的晚期癌症患者样本进行前瞻性观察研究评估。入院时，记录流行病学特征、头颈部手术 - 放疗情况以及上个月的肿瘤治疗情况。通过临床检查和患者报告评估口腔黏膜炎、口干和吞咽困难的存在情况，并记录其严重程度。还询问患者是否因局部状况而存在营养或水合作用受限的情况。
在考虑的时间段内共调查了669名患者。平均年龄为72.1岁（标准差12.3），男性患者342名。原发肿瘤情况列于表1。口腔黏膜炎的患病率为22.3%。该症状显著减少了食物或液体的摄入量，且与卡氏评分及头颈癌在统计学上相关。口干的患病率为40.4%，平均严重程度为5.4（标准差2.1）。同时使用了多种药物，尤其是阿片类药物（78%）、皮质类固醇（75.3%）和利尿剂（70.2%）。针对口干采用了多种且不均一的治疗方法，口干与当前或近期化疗以及血液系统肿瘤在统计学上相关。吞咽困难的患病率为15.4%，平均严重程度为5.34（标准差3）。52.4%的病例存在液体吞咽困难。发现因吞咽困难导致口腔营养受限程度较高，53.4%的患者采用了非经口途径。吞咽困难与卡氏评分及头颈癌在统计学上相关。发现三种口腔症状之间存在密切关系。
在晚期癌症患者中，一系列口腔问题可能在不同程度上显著影响晚期癌症患者的身体、社会和心理健康。这些症状应尽早仔细评估，但在姑息治疗环境中，当它们除了限制日常活动（尤其是饮食）外还产生可能危及生命的相关后果时，就变得至关重要。
