Risk Assessment of Alcohol Consumption for Oral Cancer: A Case-Control Study in Patients Attending the National Cancer Institute (Apeksha Hospital, Maharagama) of Sri Lanka.

BACKGROUND: Oral squamous cell cancer (OSCC) is one of the commonest cancers in Sri Lanka. OBJECTIVES: This study aimed to determine the use of alcohol, its duration and consuming pattern in relation to the risk of developing OSCC in patients attending the National Cancer Institute of Sri Lanka. METHODS: A case-control study was carried out on 105 patients with a histologically confirmed primary OSCC and 210 age-sex matched controls. Information on alcohol consumption was obtained via an interviewer-administered questionnaire. RESULTS: Participants who had consumed alcohol at some point in their life had a 3.8-fold risk of developing OSCC (p=0.000). Current consumers had a higher risk compared to who have consumed previously. Former consumers had a lower risk of developing OSCC compared to current consumers. Individuals who had consumed alcohol for more than 20 years had a greater risk [Odds ratio (OR)=4.69] of developing OSCC compared to those who had consumed alcohol for less than ten years (OR=3.25). Those who consumed the locally-made illicit liquor (Kasippu) had the greatest risk (OR=8.45; p<0.05) of developing OSCC when considering the type of alcohol consumed. CONCLUSIONS: Alcohol consumption is a risk factor for OSCC. The OSCC risk increased with longer duration of alcohol use, the consumption of locally-made illicit liquor and current consumers of alcohol.

Assessment of the association between periodontal disease and total cancer incidence and mortality: a meta-analysis.

Background: Periodontal disease (PD) is a chronic inflammatory disease that leads to alveolar bone resorption and tooth loss. Many studies have reported the association between periodontal disease and various cancers including oral cancer, lung cancer, breast cancer and so on. However, there is still no specialized meta-analysis that assesses the association between periodontal disease and cancer incidence and mortality in-deepth. Thus, we conducted this meta-analysis. Methods: This meta-analysis was registered with PROSPERO: CRD42020183497. We searched five online databases for observational studies about the association between periodontal disease and breast, prostate, lung and bronchial, colorectal, and total cancers by July 2020. Then we evaluated quality of the included studies by the Newcastle-Ottawa scale. Risk ratios (HRs) and their 95% confidence intervals (CIs) were pooled to evaluate the strength of the association between periodontal disease and four cancers, total cancer incidence and mortality. In addition, we analyzed heterogeneity by subgroup analysis and sensitivity analysis. Finally, we inspected publication bias by Begg's and Egger's tests. Results: None of the studies included in this meta-analysis were of poor quality. PD is not only related to breast cancer incidence (HR = 1.26,95%CI [1.11-1.43], I 2 = 75.8%, P = 0.000), but also connected with total cancer mortality (HR = 1.40,95%CI [1.24-1.58], I 2 = 0.0%, P = 0.718). Subgroup analyses showed that study population, study design, dental status, follow-up period, adjustment for smoking partially explained the heterogeneity between studies. The results of Begg's test and Egger's test were consistent and indicated that there is no publication bias in this study. Conclusion: In conclusion, this meta-analysis revealed a positive relationship between periodontal disease and breast cancer incidence and total cancer mortality. Further well-designed studies with specific inclusion and exclusion criteria are required to strengthen the conclusion of this meta-analysis. However, longer follow-up period, multi-center trials and even multinational studies are required to corroborate the results.

Estimation of Quality-Adjusted Life Expectancy of Patients With Oral Cancer: Integration of Lifetime Survival With Repeated Quality-of-Life Measurements.

BACKGROUND: Quality-adjusted life year is widely applied nowadays, which consider both survival and quality of life (QoL). When most diseases are becoming chronic, it is imperative to quantify the overall health impact of a disease in lifetime perspective. OBJECTIVE: The purpose of this study is to introduce methods for estimating quality-adjusted life expectancy (QALE) and loss of QALE in patients with a disease or specific conditions. METHODS: The QALE of an index cohort can be represented as the integration of the product of lifetime survival function and mean QoL function. We introduce a robust extrapolation approach for estimating lifetime survival function and propose an approach for estimating lifetime mean QoL function for studies with limited follow-up. The best part of the proposed method is that the survival data and QoL data can be collected separately. A cohort of patients with a specific condition can be identified by databases that regularly collect data for the control of diseases, and their survival status is verified by linking to a mortality registry. Although nationwide QoL data are not available, researchers can implement a relative short-term follow-up interview on a random sample of patients to collect QoL data. For demonstration, we applied the proposed methods to estimate QALE and loss of QALE of oral cancer patients. RESULTS: The estimates (95% confidence interval) of QALE for oral cancer patients were 11.0 (10.5-11.6) and 14.2 (12.7-15.5) quality-adjusted life years (QALYs) for men and women, respectively. The estimates of loss of QALE for the male and female patients with oral cancer were 14.4 (13.8-14.9) and 7.5 (6.2-9.0) QALYs, respectively. CONCLUSIONS: The methods for estimating QALE and loss of QALE can be applied to economic evaluation of cancer control, including screening.

Assessment of impairment of intelligibility and of speech signal after oral cavity and oropharynx cancer.

BACKGROUND: Perceptual evaluation is a means of assessing speech disorder severity in clinical practice. Although limited in reliability and reproducibility, its ease of application makes it very widely used. Choice of assessment criteria and type of speech sample are key points. OBJECTIVE: To compare a panel's perceptual evaluations on two tasks with different criteria. MATERIAL AND METHOD: The corpus comprised 87 samples from patients treated for oral cavity or oropharynx cancer, assessed by 6 experts on two criteria (impairment of intelligibility and of speech signal) and two kinds of speech sample (semi-spontaneous versus reading speech) RESULTS: Although strong correlations were found between tasks (r>0.8), the speech signal criterion gave a score distribution providing a better metric. Severity was greater in oral cavity (mean, 5.44±2.47) than oropharyngeal cancer (6.46±2.24). Semi-spontaneous speech tended to show less severity score ceiling effect than reading speech (mean, 6.06/10 for picture description and 6.51/10 for reading). CONCLUSION: Speech signal impairment in semi-spontaneous speech seems to be the best clinical measure to assess speech disorder following treatment of oral cavity or oropharynx cancer.

Prevalence, complications and dental management of the oral cancer in the pediatric patients.

INTRODUCTION: The incidence of childhood malignancy is greatest in the 1st year of life, with the second peak to be found at 2-3 years of age. The aim for the study was to investigate the incidence and nature of oral problems occurring in a population of child cancer patients; the other aim was to assess the dental management of the treatment undergoing children. MATERIALS AND METHODS: All child patients between 2 and 15 years old were admitted to the medical hospital for the treatment of newly diagnosed oral cancer over a period of 1 year were included in the study. Hundred children, 50 males and 50 females were examined in the study. Out of the 100 children, 65 children who confirmed; with the diagnosis of oral cancer were included in the study. RESULTS: Twenty children were found to have untreated dental caries at their initial dental screening; five children required dental extractions before chemotherapy. Fifty of the children in the study group did develop oral problems at some stage after their admission to the hospital. CONCLUSIONS: The delay before diagnosis varies from few weeks to approximately 10 months. Children seem particularly susceptible to the stomatotoxic effects of chemotherapy, and therefore, warrant special attention in preventing and treating these problems.

Randomised feasibility study to compare the use of Therabite® with wooden spatulas to relieve and prevent trismus in patients with cancer of the head and neck.

Our aim was to compare the efficacy of the Therabite® jaw motion rehabilitation system (Atos Medical) with that of wooden spatulas to relieve and prevent trismus in patients who have had radiotherapy for stage three and four oral and oropharyngeal cancer. Secondary aims were to assess the feasibility and the impact of exercise on health-related quality of life (QoL), and the use of health services after treatment. We designed a randomised, open-label, controlled, three-centre feasibility study to compare the effectiveness and cost of the Therabite® and wooden spatulas. We studied compliance with exercises and health-related QoL, assessed cost using three health economics measures, and conducted semistructured interviews with patients. Patients were randomised into two groups: the Therabite® group (n=37) and the wooden spatula group (n=34). All patients had some sense of jaw tightening before the study started. Mean mouth opening after six months increased in both groups, but the difference between the groups was not significant (p=0.39). Completion rates for the three economic measures were good. There was no significant difference between the two groups in frequency of contact with care services or in QoL. Exercises during and after radiotherapy can ameliorate trismus in patients with stage three and four oral and oropharygeal cancers, but differences between groups in efficacy, compliance, QoL, or use of hospital or community health services, were not significant.

The Patient Concerns Inventory integrated as part of routine head and neck cancer follow-up consultations: frequency, case-mix, and items initiated by the patient.

Introduction The National Institute for Health and Care Excellence guidance Improving Supportive and Palliative Care for Adults with Cancer (2004) and the Cancer Reform Strategy (2007) support the premise that assessment and discussion of patients' needs for physical, social, psychological, and spiritual wellbeing should be undertaken during oncology follow-up. We report the use of the Patient Concerns Inventory in a routine head and neck cancer clinic setting over a seven-year period, summarising the number of available clinics, the number of patients completing the inventory within a clinic, the range of clinical characteristics and the concerns they wanted to discuss. Methods The data were analysed from oncology follow-up clinics between 1 August 2007 and 10 December 2014. Audit approval was given by the Clinical Audit Department, University Hospital Aintree. Results There were 386 patients with 1198 inventories completed at 220 clinics, median 6 (range 4-7) per clinic. The most common concerns raised by patients across all the clinic consultations were dry mouth (34%), fear of recurrence (33%), sore mouth (26%), dental health (25%), chewing (22%) and fatigue/tiredness (21%). Conclusions The incorporation of the Patient Concerns Inventory as part of routine oncology clinics allows for a more patient initiated and focused consultation available to the majority of patients throughout their follow-up. The inventory allows for greater opportunity to provide holistic targeted multiprofessional intervention and support.

Screening for psychological distress: A new approach to identify the patient's psychological needs in a pilot study on oral cancer patients.

OBJECTIVE: A new screening tool has been developed to predict the psychological needs of patients with oral cancer. METHOD: The new screening method was developed inductively. Screening was pretested using interviews and implemented with 71 patients with oral cancer. Factor analysis was carried out to shorten the questionnaire. RESULTS: Negative and positive aspects explain forty per cent of the variance in distress, which should be adequate for a first screening. Seventy-nine per cent of the items deal with stable traits such as personality. The patients' objective need for support has to be another important part of this new screening. CONCLUSIONS: Personality and other traits are good predictors for psychological distress. Longitudinal studies need to assess these new aspects of screening cancer patients to find out if they need psycho-oncological support.

High-dose-rate interstitial brachytherapy in oral cancer-Its impact on quality of life.

PURPOSE: The aim of the study was to assess the impact of high-dose-rate (HDR) interstitial brachytherapy on quality of life (QOL) in oral cancer. METHODS AND MATERIALS: Thirty-two patients of oral cancer treated at our institute from January 2010 to December 2014 with radical radiotherapy (external beam radiotherapy + brachytherapy) were included for analysis; 30 patients received external beam radiotherapy (50-54 Gy) and HDR brachytherapy boost (18-24.5 Gy); 2 patients received radical HDR brachytherapy (31.5 Gy). Quality of life (QOL) was assessed by Telugu, Hindi, and English versions of EORTC Quality of Life Core-30 and EORTC Quality of Life Head and Neck Module (QLQ H&N35) before treatment, at 3 months, 6 months, 1 year, and 2 years after treatment. RESULTS: Of the 32 patients, 2 patients died and 1 patient progressed on followup; 2 patients were re-irradiation cases. On excluding these cases, 27 patients were available for analysis. The followup duration was 6-55 months. At the time of analysis, 91% (29) patients were disease free, 3% (1) progressed, and 6% (2) died. At the end of 2 years, none of the QLQ-C30 functional scores fell below the baseline. Pain, swallowing, sensory, speech, social contact, and social eating worsened at 3 months but improved over 2 years (p < 0.001). Sexuality and financial status showed delayed improvement (p < 0.001). Among the head and neck parameters, dry mouth and sticky saliva were significant determinants of QOL with delayed improvement (p < 0.001). The impact of age, sex, and tumor stage and on QOL was analyzed. Women reported a poorer QOL for physical and emotional parameters, social eating, weight loss, and fatigue. Tumor stage significantly affected QOL, with early stages showing a better QOL. CONCLUSIONS: Almost all patients regained normal function after treatment and reported an excellent QOL at 2 years. However, tumor stage significantly affected the QOL.

Leukoplakia, Oral Cavity Cancer Risk, and Cancer Survival in the U.S. Elderly.

Screening for oral leukoplakia, an oral cavity cancer (OCC) precursor, could lead to earlier detection of OCC. However, the progression rate from leukoplakia to OCC and the benefits of leukoplakia screening for improving OCC outcomes are currently unclear. We conducted a case-cohort study of U.S. adults ages ≥65 years in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linkage. We identified leukoplakia diagnoses through Medicare claims, and OCC diagnoses through SEER cancer registries. Weighted Cox regression was used to estimate leukoplakia associations with OCC incidence, and the absolute OCC risk following leukoplakia diagnosis was calculated. Among OCC cases, we compared OCC stage and OCC survival between cases with a prior leukoplakia diagnosis versus those without prior leukoplakia. Among 470,266 individuals in the SEER-Medicare subcohort, 1,526 (0.3%) had a leukoplakia diagnosis. Among people with leukoplakia, the cumulative OCC incidence was 0.7% at 3 months and 2.5% at 5 years. OCC risk was most increased <3 months after leukoplakia diagnosis (HR, 115), likely representing the diagnosis of prevalent cancers. Nonetheless, risk remained substantially increased in subsequent follow-up [HR ≥ 3 months, 24; 95% confidence interval (CI), 22-27; HR ≥ 12 months, 22, 95% CI, 20-25]. Among OCC cases (N = 8,927), those with prior leukoplakia were less likely to be diagnosed at regional/distant stage (OR, 0.36; 95% CI, 0.30-0.43), and had lower mortality (HR, 0.74; 95% CI, 0.65-0.84) when compared with OCC cases without a prior leukoplakia. Individuals with leukoplakia have substantially elevated risk of OCC. Lower stage and better survival after OCC diagnosis suggest that leukoplakia identification can lead to earlier OCC detection and reduced mortality.

Assessment of Tumor Associated Tissue Eosinophilia (TATE) in Oral Squamous Cell Carcinoma Using Carbol Chromotrope Stain / Evaluación de la Eosinofilia Tisular Asociada al Tumor (TATE) en el Carcinoma Oral de Células Escamosas Mediante la Tinción de Carbol Cromótropo

Tumor related tissue eosinophilia (TATE) is a known phenomenon but its role in prognostics and correlation with size of the primary tumor is still controversial. Using a stain, like Carbol chromotrope, that targets eosinophils exclusively and vividly, offers an advantage over haematoxylin and eosin, which was used in most of the studies. Forty-nine cases of oral squamous cell carcinoma, where the TNM staging has been recorded in their history, was taken and stained with Lendrum's carbol chromotrope. Significant difference in the eosinophil count with varying size of the tumor and a parallel increase in the number noted, with increase in size. There is a corresponding increase in the number of eosinophils infiltrating the tumor with increase in size of oral squamous cell carcinoma.

La eosinofilia tisular asociada a tumores (TATE) es un fenómeno conocido, sin embargo su pronóstico y correlación con el tamaño del tumor primario aún es tema de controversia. El uso de cromotropo como tinción dirigida exclusivamente a los eosinófilos, ofrece una ventaja sobre la hematoxilina-eosina, que ha sido utilizada en la mayoría de los estudios. Se estudiaron células escamosas en 49 casos de carcinoma oral, con registro del estadio TNM. Las células fueron teñidas con carbol cromotropo de Lendrum. Se observó una diferencia significativa en el recuento de eosinófilos con el tamaño del tumor y un aumento paralelo en número, con el aumento de tamaño. Hay un aumento correspondiente en el número de eosinófilos que infiltran el tumor con aumento en el tamaño de carcinoma de células escamosas orales.

Rehabilitation of a patient with an elusive medical history and loss of occlusal vertical dimension.

In this clinical report, we describe the medical history, diagnosis and prosthodontic treatment of a 61-year-old man with a previous history of oral cancer. Loss of a full upper denture and severe erosion of his teeth prompted the patient to seek treatment at the dental clinic at the British Columbia Cancer Agency. Although he stated that he was being treated for a sleeping disorder, hospital records revealed multiple recent admissions for alcoholism and depression. The patient's limited finances prevented complex restoration of worn lower dentition; thus, definitive treatment consisted of extraction of teeth with a poor prognosis, removal of a glandular odontogenic cyst and fabrication of a full maxillary prosthesis and a removable mandibular cast-metal overlay.

Positive association between hepatitis C infection and oral cavity cancer: a nationwide population-based cohort study in Taiwan.

OBJECTIVES: The association between viral hepatitis (B and C) and oral cavity cancer has been widely debated. This nationwide, population-based cohort study assessed the subsequent risk of oral cavity cancer among patients with chronic viral hepatitis infection. MATERIALS AND METHODS: Data were retrieved from insurance claims data of 1,000,000 randomly sampled individuals covered under the Taiwan National Health Insurance system. We identified a total of 21,199 adults with chronic viral hepatitis infection (12,369 with HBV alone, 5,311 with HCV alone, and 3,519 with HBV/HCV dual infections) from 2000-2005. Comparison group comprised 84,796 sex- and age-matched subjects without viral hepatitis during the same study period. Incidence and risk of subsequent oral cavity cancer were measured until 2008. RESULTS: The incidence of oral cavity cancers was 2.28-fold higher among patients with HCV alone than non-viral hepatitis group (6.15 versus 2.69 per 10,000 person-years). After adjusting for sociodemographic covariates, HCV alone was significantly associated with an increased risk for oral cavity cancer (hazard ratio (HR) = 1.90, 95% confidence interval (CI) = 1.20-3.02). This positive association was highest among individuals in the 40-49-year age group (HR = 2.57, 95% CI = 1.21-5.46). However, there were no significant associations between HBV alone or HBV/HCV dual infections and risk for oral cavity cancer. CONCLUSION: Our data suggest that HCV but not HBV infection is a risk factor for oral cavity cancer. In addition, subjects with HCV infection tend to be at early onset risk for oral cavity cancer. This finding needs to be replicated in further studies.

Prevalence and impact of complications on outcomes in patients hospitalized for oral and oropharyngeal cancer treatment.

OBJECTIVE: We studied the association between presence of complications and hospitalization outcomes, including hospital charges, length of stay in hospital, and in-hospital mortality. METHODS: The Nationwide Inpatient Sample for 2008 was used. All hospital discharges with a primary diagnosis of oral and oropharyngeal cancers were selected. Presence of complications was determined by using ICD-9-CM codes. The association between the presence of complications and outcomes (hospital charges, length of stay, and in-hospital mortality) was examined by multivariable linear and multivariable logistic regression analyses. The effects of several patient- and hospital-related confounders were adjusted in the regression analyses. RESULTS: A total of 17,632 hospitalizations were attributed to oral and oropharyngeal cancers. A total of 519 (2.9%) patients died in the hospitals. The total hospitalization charges were close to $1.08 billion. Oral and oropharyngeal cancers accounted for 117,472 hospitalization days (mean length of stay 6.6 days). The overall complication rate was 14.95%. The most frequently present complication was hemorrhagic complications. Among the different complications, septicemia was associated with the worst outcomes. Patients with septicemia were associated with the highest odds for in-hospital mortality (OR = 13.06, 95% CI = 3.81-48.50, P = .0001). CONCLUSIONS: Presence of complications was associated with poor outcomes, such as high in-hospital mortality rates, excess hospitalization charges, and longer length of stay in hospital. Among the different complications, septicemia was associated with the worst outcomes.

Pretreatment swallowing assessment in head and neck cancer patients.

OBJECTIVES/HYPOTHESIS: To discuss patient variables associated with swallowing dysfunction in head and neck cancer (HNCA) patients prior to intervention. STUDY DESIGN: Prospective, multi-institutional cohort study. METHODS: All patients included had newly diagnosed head and neck malignancies. Patients undergoing instrumental swallowing evaluations prior to oncologic management were included for analysis. Pretreatment Penetration Aspiration Scores (PAS) were analyzed by primary tumor site, tumor stage, and standard demographic variables. RESULTS: The final study sample was comprised of 204 consecutive individuals with newly diagnosed HNCA. Patients with advanced primary tumor (T) stage laryngeal/hypopharyngeal tumors had higher mean PAS scores (5.18) in contrast to early stage larynx/hypopharynx (1.93), advanced stage oral cavity/oropharynx (2.24), and early stage oral cavity/oropharynx (1.54, P < .0001), indicative of poorer function. Age, race, and sex were not associated with PAS scores. Multivariate logistic regression revealed significantly poorer PAS scores in patients with advanced primary tumors (odds ration [OR] = 3.83, 95% confidence interval [CI], 1.84-8.00, P < .0001) and laryngeal/hypopharyngeal primary site disease (OR = 3.04, 95% CI, 1.41-6.54, P = .004), after controlling for all other variables. CONCLUSIONS: This series demonstrates that swallowing dysfunction in high-risk patients may be present in the pretreatment state and should be considered when determining candidacy for organ preservation modalities. These data highlight the importance of instrumental swallowing evaluations prior to intervention, particularly for those individuals with advanced stage and/or laryngeal/hypopharyngeal tumors.

Cancer-related oral health care services and resources: a survey of oral and dental care in Canadian cancer centres.

PURPOSE: Prevention and management of oral complications of cancer and cancer therapy will improve oral function and quality of life, and reduce morbidity and the cost of care. Oral assessment, and oral and dental care have been strongly recommended before cancer therapy and should be continued during and after cancer therapy. The purpose of this survey was to assess the resources available for oral care in Canadian cancer centres. METHODS: Provincial cancer centres were assessed by questionnaire to determine the resources available for oral care in these facilities. RESULTS: Wide variability in oral and dental care of patients with cancer across Canada and a lack of documented standards of care were reported. Very few cancer centres had institutionally supported dental staff to support the oral care of patients with cancer, and few had dental treatment capability on site. The majority of centres managed oral care needs in the community with the patient's prior dentist. CONCLUSIONS: We recommend that national guidelines be developed for medically necessary oral and dental care for patients with cancer.

Colour Doppler ultrasound in preoperative assessment of the neck vessels in patients with tumours of the oral cavity and the neck region.

BACKGROUND: The aim of the study was not only to establish the applicability of color Doppler ultrasound of the neck vessels in patients with tumors of the oral cavity and the neck region but also to check whether the coexistence of sclerotic changes in the carotid arteries is essential in determination of the sequence of surgical procedure. MATERIAL/METHODS: Color Doppler ultrasound was performed on 110 patients, aged 15 -71 years with tumors of the oral cavity and the neck. The localization, size, echogenicity, as well as the tumor relationship to the surrounding structures and big vessels of the neck region was analyzed. RESULTS: Compression of the veins was observed in 27 cases, and of the arteries only in 20 cases. Infiltration of the jugular vein was observed in 8 patients, whereas infiltration of the carotid artery were seen only in 6 patients. Severe internal carotid artery stenosis, due to arteriosclerosis, was observed in 10 patients. Three persons were suggested to be operated on, first due to carotid artery stenosis, later on, due to the oral cavity tumor. CONCLUSIONS: It was found that color Doppler ultrasound is useful in deciding upon the method of treatment, while the examination of the neck vessels is helpful in establishing the sequence of surgical procedures in patients with tumors and coexisting arteriosclerosis.