Chinese Oral Cancer Patients' Pain Beliefs: An Application of Leventhal's Common-Sense Model.

BACKGROUND: Patients' pain beliefs are the main obstacle to effective pain management. Assessing and correcting negative perceptions is important for improving pain intensity and quality of life of patients with cancer pain. AIMS: To explore pain beliefs among oral cancer patients using the Common-Sense Model of Self-Regulation as a theoretical framework. The primary components of the model, cognitive representations, emotional representations, and coping responses, were examined. DESIGN: A qualitative method was used. SETTINGS: PARTICIPANTS/SUBJECTS:   METHODS: Semi-structured, qualitative, in-depth interviews were conducted with patients newly diagnosed with oral cancer in a tertiary care hospital. The interviews were analyzed using thematic analysis. RESULTS: Interviews with 15 patients revealed that the pain beliefs of patients with oral cancer included three themes: pain cognitive representations of oral cancer, pain emotional representations of oral cancer, and pain coping responses. CONCLUSIONS: Negative pain beliefs are common among oral cancer patients. This novel application of the self-regulatory model demonstrates that it can be used to capture the key pain beliefs (i.e., cognitions, emotions, and coping responses) of oral cancer patients within a single, unifying framework.

Quality of Life: determinant of success of head and neck cancer therapy in the battle of survival vs. rehabilitation.

BACKGOUND: Surgical treatment for cancers in the oral and maxillofacial region significantly impacts a patient's physical, social, functional, and psychological well-being, which can in-turn affect the Quality of Life (QoL) negatively. The goal of our study was to assess the Quality of Life (QoL) of patients who underwent surgery in our hospital, and we attempted to extrapolate the data which could in the future help improve the QoL of other patients who undergo similar treatments. METHODS: This was a retrospective study, including patients who have been treated for oral cancer in the last few years in the institute. The standard EORTC Questionnaires QLQ C-30 (version 3.0) and QLQ H and N-35 (version 1.0) were used in this study. RESULTS: GHS scores were lower in patients with T3 stage tumor than in patients with T1 stage tumor. Patients who underwent surgery along with radiotherapy and those who underwent surgery, radiotherapy, and chemotherapy showed a substantial difference in their GHS and FS ratings when their treatment options were compared. Patients who had undergone surgery, radiation, and chemotherapy had higher scores on the symptom scale and QoL H&N-35 than patients who had just undergone surgery and radiotherapy There was no statistically significant difference in the scores, pertaining to the location, age, gender and stage of the tumor but when the comparison was made on the basis of treatment modality chosen, there was a significant difference in the scores. CONCLUSIONS: The aim of any treatment is to improve the Quality of Life. The EORTC questionnaires QLQ 30 and QLQ H and N-35 proved to be very appropriate instruments to evaluate QoL in patients with oral cancer. Assessment of QoL should always receive adequate attention in treatment planning and rehabilitation. Choice of treatment modality plays a significant role in QoL of patients treated for oral cancer. Henceforth, any treatment modality should be selected not only with a curative intent but also with the goal of improving the Quality of Life as this ultimately decides the success of the therapy from the patient's perspective.

Qualidade de vida relacionada à deglutição em pacientes com câncer de cabeça e pescoço / Quality of life related to swallowing in patients with head and neck cancer / Calidad de vida relacionada con la deglución en pacientes con cáncer de cabeza y cuello

Introdução: No câncer de cabeça e pescoço (CCP), as sequelas relacionadas aos tratamentos e à própria localização do tumor podem trazer alterações físicas e funcionais, com impacto na qualidade de vida (QV) destes pacientes. Objetivo: mensurar o impacto do câncer de boca sobre a qualidade de vida relacionada à deglutição e saúde bucal em pacientes com câncer de cabeça e pescoço, após tratamento médico com radioterapia e/ou cirurgia. Métodos: participaram do estudo dez pacientes em pós-tratamento médico para o CCP e que foram submetidos aos questionários de qualidade de vida M.D. Anderson Dysphagia Inventory (MDAD),Oral Health Impact Profile (OHIP-14) e Questionário de Qualidade de Vida da Universidade de Washington(UW-QOL). Resultados: Os resultados dos domínios emocional e funcional do protocolo MDADI demonstraram médias positivas, enquanto o domínio físico apresentou médias que demonstraram baixo funcionamento do dia-a-dia e qualidade de vida. A partir do questionário OHIP-14, verificou-se que 40% dos participantes foram classificados com alto índice de impacto na saúde bucal. As dimensões ''desconforto psicológico'' e ''deficiência'' impactam negativamente na QV dos pacientes. "Atividade'' e "saliva" foram os problemas mais relatados, mostrando que, ''saliva'', ''humor'' e ''mastigação'' foram os três domínios mais importantes na visão dos pacientes, verificado a partir do protocolo UW-QOL. Conclusão: Apesar do número reduzido de pacientes e da heterogeneidade de localização dos tumores, os resultados demonstram que o CCP e as sequelas de seu tratamento podem impactar de maneira significativa a QV dos pacientes em diversos domínios.

Introducción: En el cáncer de cabeza y cuello (CCC), las secuelas relacionadas con el tratamiento y la propia localización del tumor pueden traer cambios físicos y funcionales, con impacto en la calidad de vida (CV) de estos pacientes. Objetivo: medir el impacto del cáncer bucal en la calidad de vida relacionada con la deglución y la salud bucal en pacientes con cáncer de cabeza y cuello después del radioterapia y/o cirurgía. Metodos: participaron del estudio diez pacientes en postratamiento médico por cáncer de cabeza y cuello y fueron sometidos a cuestionarios de calidad de vida M.D. Anderson Dysphagia Inventory (MDADI), Oral Health Impact Profile (OHIP-14) y cuestionario de calidad de vida de la Universidad de Washington (UW-QOL). Resultados: Los resultados de los dominios emocional y funcional del protocolo MDADI mostraron medias positivas, mientras que el dominio físico mostró medias que evidenciaron bajo funcionamiento cotidiano y calidad de vida. Del cuestionario OHIP-14 se encontró que 40% de los participantes fueron clasificados como de alto impacto en la salud bucal. Las dimensiones "malestar psicológico" y "discapacidad" tienen un impacto negativo en la calidad de vida de los pacientes. "Actividad" y "saliva" fueron los problemas más reportados, mostrando que "saliva", "estado de ánimo" y "masticar" eran los tres dominios más importantes en la opinión de los pacientes verificado a partir del protocolo UW-QOL. Conclusión: A pesar del pequeño número de pacientes y la heterogeneidad de la localización del tumor, los resultados demuestran que el CCP y las secuelas de su tratamiento pueden impactar significativamente la calidad de vida de los pacientes en varios dominios.

Introduction: In head and neck cancer (HNC), the sequelae related to the treatment and the location of the tumor itself can bring physical and functional changes, with an impact on the quality of life (QoL) of these patients. Objective: measure the impact of oral cancer on quality of life related to swallowing and oral health in patients with head and neck cancer after radiotherapy and/or surgery. Methods: 10 patients participated on study in medical post-treatment for head and neck cancer and they were submitted the quality of life questions M.D. Anderson Dysphagia Inventory, Oral Health Impact Profile (OHIP-14) and University of Washington quality of life questionnaire (UW-QOL). Results: The results of the emotional and functional domains of the MDADI protocol showed positive means, while the physical domain showed low day-to-day functioning and quality of life means. From the OHIP-14 questionnaire, it was found that 40% of participants were hated with a high index of impact on oral health. The dimensions "psychological discomfort" and "deficiency" negatively impact on patients QOL. "Activity" and "spittle" were the problems most reported, showing that, "spittle", "humor" and "chewing" were the three most important domains on patient's view verified from the UW-QOL protocol. Conclusion: Despite the small number of patients and the heterogeneity of tumor location, the results demonstrate that the CCP and the sequelae of its treatment can significantly impact the QoL of patients in several domains.

Gender-specific differences concerning psychosocial aspects and functional impairments that influence quality of life in oral cancer treatment.

PURPOSE: Patients with oral cancer have gender-specific differences with respect to health-related quality of life (HRQoL) and psychosocial variables (PV). The aim of the present study was to evaluate HRQoL and PV outcomes in patients treated for oral squamous cell carcinoma. METHODS: Data of 1234 patients were collected from a multicenter rehabilitation study of the German-Austrian-Swiss Cooperative Group on Tumours of the Maxillofacial Region (DÖSAK). Patient characteristics, oncological variables, post-treatment impairments, general quality of life (QoL), and PV (coping strategies, control beliefs, personal traits, perceived social support, depression, anxiety, and fear of tumor recurrence) were recorded. RESULTS: After treatment, HRQoL was similar between genders concerning general QoL, but men experienced significantly more treatment-related functional impairments influencing HRQoL. PV revealed gender-specific coping strategies, with women reporting significantly more "depressive coping," "religiosity," "fatalistic externality," and higher "social burden." Owing to their religious coping strategies, fatalistic attitude, and perceived higher social integration, women demonstrated superior disease acceptance, despite higher depression, anxiety, and lower psychosocial resilience. Conversely, men reported more introverted personal traits and lower social integration. CONCLUSION: Interventions during oral cancer treatment should address PV and have gender-specific elements to improve HRQoL after therapy.

Risk of depression in patients with oral cancer: a nationwide cohort study in Taiwan.

This study investigates an association between oral cancers and the risk of developing depression. We conducted a total of 3031 patients with newly diagnosed oral cancers and 9093 age-, sex-, and index year-matched controls (1:3) from 2000 to 2013 were selected from the National Health Insurance Research Database (NHIRD) of Taiwan. After adjusting for confounding factors, multivariate Cox proportional hazards analysis was used to compare the risk of depression over a 13-year follow-up. Of the patients with oral cancer, 69 (2.28%, or 288.57 per 105 person-years) developed depression compared to 150 (1.65%, 135.64 per 105 person-years) in the control group. The Cox proportional hazards regression analysis showed that the adjustment hazard ratio (HR) for subsequent depression in patients with oral cancer diagnosed was 2.224 (95% Confidence Interval [CI] 1.641-3.013, p < 0.001). It is noteworthy that in the sensitivity analysis is the adjusted HR in the group with depression diagnosis was 3.392 and in the oral cancer subgroup of "Tongue" was 2.539. This study shows oral cancer was associated with a significantly increased risk for developing subsequent depression and early identification and treatment of depression in oral cancer patients is crucial.

Evaluation of Malnutrition and Quality of Life in Patients Treated for Oral and Oropharyngeal Cancer.

BACKGROUND: Oral and oropharyngeal cancer is a debilitating disease with high morbidity and mortality. Depending on the site and extent of the involvement of the cancer and the type of treatment modality, these patients can develop pain, trismus, xerostomia, dysphagia, and taste disturbances, compromising them socially and nutritionally. The aim of the study was to evaluate malnutrition and quality of life in patients treated for oral and oropharyngeal cancer. Methodology. A cross-sectional study was conducted which included 97 patients treated for oral and oropharyngeal cancer. The quality of life of the selected patients was assessed by using a validated European Organization for the Research and Treatment of Cancer's Quality of Life Questionnaire, Head and Neck and Mandibular Function Impairment Questionnaire. Pre- and posttreatment weight of the patients were assessed, and weight loss of ≥10% of pretreatment weight was considered as malnutrition. The chi-square test was used to correlate the symptoms with the quality of life. A paired t test was used to assess the differences in weight before and after treatment, and a p value of <0.005 was considered as significant. RESULTS: The most commonly reported symptoms were xerostomia (93.81%), pain (81.44%), and dysphagia (76.3%). A total of 40.2% of the individuals in the study had malnutrition. Malnutrition was comparatively lower in the group who had nutritional supplements. CONCLUSION: The quality of life in patients treated for oral and oropharyngeal cancer deteriorates immediately after the treatment; however, it significantly improves over time.

Oral Psychosomatic Disorders in Family Caregivers of Oral Squamous Cell Carcinoma Patients.

OBJECTIVE: To investigate the oral psychosomatic disorders (PSDs) in family caregivers (FCs) of oral cancer (OC) patients and to evaluate the correlation between these oral PSDs to severity of depression anxiety and stress. METHODS: A total of 50 participants were included each in first degree relative (FDR), second degree relative (SDR) and control group. All the participants completed DASS-21 questionnaire and were subjected to thorough clinical history and oral examination. RESULTS: All the FCs reported statistically significant higher mean levels of depression, anxiety and stress compared to controls (p˂0.001). A significantly greater number of FCs (40.00%) reported oral PSDs than control group (12.00%). Most prevalent oral PSD in FCs was aphthous stomatitis followed by oral lichen planus, bruxism, burning mouth syndrome and myofascial pain dysfunction syndrome. Moreover, there was a preponderance of these diseases in FDR (60.86%) compared to SDR (26.08%). FCs with moderate to very severe depression, anxiety and stress showed higher prevalence of these oral PSDs compared to the ones with mild depression, anxiety and stress. CONCLUSION: The observations of higher prevalence of oral PSDs in FCs with psychological alterations can enhance healthcare professionals' awareness to better understand FCs' oral healthcare needs.
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Oral health-related quality of life in oral cancer patients: systematic review and meta-analysis.

Aim: The purpose of this meta-analysis was to evaluate the impact of oral health on quality of life in oral cancer patients (OCPs). Methods: PubMed, Scopus and Web of Science databases were searched for publications on oral health-related quality of life (OHRQoL) in OCP and the information was extracted according to the PRISMA guidelines. A random effect model was used to obtain the pooled standard mean differences of Oral Health Impact Profile (OHIP)-14 questionnaire responses in meta-analysis. Results: total of 12 research papers were analyzed and revealed poor OHRQoL in OCPs (standard mean difference: 2.53; 95% CI: 1.55-3.50; p < 0.00001) compared with healthy individuals due to the effects of oncotherapy. Moreover, OHRQoL deteriorated with combinations of different treatment modalities. Conclusion: Oral health and oncotherapy can affect the quality of life in OCPs.

Fulfillment of patients' information needs during oral cancer treatment and its association with posttherapeutic quality of life.

PURPOSE: Surgical therapy for oral cancer can lead to severe physical and psychological disorders that negatively impact patient quality of life (QoL). This study aimed to evaluate the relationship between fulfillment of patients' information needs during oral cancer treatment and patients' perception of posttherapeutic disorders influencing QoL. METHODS: A retrospective analysis of 1359 patients who were surgically treated for oral cancer using questionnaires administered during the multicenter rehabilitation study by the German-Austrian-Swiss Cooperative Group on Tumors of the Maxillofacial Region (DÖSAK). Patients and medical practitioners completed questionnaires following cancer treatment. RESULTS: Approximately 37% of patients felt inadequately informed about possible physical and psychological consequences of surgery. In contrast, only 16% of patients felt they were given inadequate information about the operative procedure and possible complications, and with regard to tumor diagnosis and cancer disease, only 15% of patients. Significant correlations were found between lacking information and increased perception of posttherapeutic disorders, whereas correlations with tumor-specific and operation-related parameters were markedly lower. The patients with superior QoL after treatment stated more frequently, nearly independent of individual patient characteristics, that the information that they were given prior to therapy was adequate. Information concerning possible physical and psychological consequences of an operation, however, was frequently stated to be inadequate, independent of QoL. CONCLUSION: Patients whose information needs concerning the diagnosis and treatment of oral cancer are adequately fulfilled may benefit in terms of their therapeutic outcome, experiencing less perception of posttherapeutic physical and psychological disorders and a superior QoL.

Depression and related factors after oral oncological treatment: a 5-year prospective cohort study.

PURPOSES: Being diagnosed with oral cancer is a life-threatening life event. It often induces social, emotional and psychological consequences and may cause depressive disorders. The primary aim of this study was to identify and quantify the personal and clinical characteristics involved in depression for patients who have been treated for oral cavity malignancies, with a 5-year follow-up period after treatment. The secondary aim of this study was to identify the clinical factors that increase a patient's risk of experiencing depression 5 years after treatment. METHODS: Patients with primary oral cancer were assessed for up to 5 years after primary treatment. A mixed-model analysis was performed, with depression measured by the Center for Epidemiologic Studies Depression Scale as outcome measure. RESULTS: A total of 141 patients were included in the study. Factors associated with depression were gender, tumour location and having an emotion-oriented coping style. The occurrence of depression within 5 years after treatment could be reliably predicted by a patient's gender, the location of their tumour and the extent to which they had an emotion-oriented coping style. CONCLUSIONS: This study revealed that being female, having a maxillary tumour and having an emotion-oriented coping style are associated with higher levels of depressive symptoms in patients treated for oral cancer up to 5 years post-treatment. A substantial proportion of the patients with oral cancer experienced high levels of depression both before and after their treatment, suggesting that adequate diagnostics and care are needed to try to prevent severe depression in these patients.

Câncer bucal: voz e qualidade de vida pós mutilação / Oral cancer: voice and quality of life after mutilation / Cáncer oral: voz y calidad de vida después de la mutilación

Objetivo: investigar o impacto da deformidade bucal oncológica na comunicação oral e na qualidade de vida de adultos e idosos. Métodos: estudo observacional descritivo, transversal, com abordagem mista. Amostra de 41 pacientes, submetidos à cirurgia para retirada do câncer bucal, resultando em mutilação e inteligibilidade verbal. Instrumentos: Questionário sociodemográfico; Índice de Desvantagem Vocal; Questionário Qualidade de Vida da Universidade de Washington; Roteiro Semiestruturado para análise no software Iramuteq®.Resultado: a mutilação predominou em região de palato. Avaliação vocal mostrou o sexo masculino com pior qualidade de vida, expressivamente escala Social, enquanto, o feminino, escala Física. A análise lexical mostrou necessidades, frustrações e expectativas. Conclusão: o estudo revelou a vergonha, o medo, o isolamento social e, ao mesmo tempo, a esperança de voltar a, pelo menos, poder falar e ser compreendido pelas outras pessoas através do uso da prótese

Objective: to investigate the impact of oral cancer deformity on oral communication and the quality of life of adults and the elderly. Methods: descriptive, cross-sectional observational study with a mixed approach. Sample of 41 patients undergoing surgery to remove oral cancer, resulting in mutilation and verbal intelligibility. Instruments: Sociodemographic questionnaire; Voice Handicap Index; University of Washington Quality of Life Questionnaire; Semi-structured script for analysis in the Iramuteq® software. Result: mutilation predominated in the palate region. Vocal assessment showed the male sex with worse quality of life, significantly on the Social scale, while the female, Physical scale. Lexical analysis showed needs, frustrations and expectations. Conclusion:the study revealed shame, fear, social isolation and, at the same time, the hope of returning to at least being able to talk and be understood by other people through the use of the prosthesis

Objetivo: investigar el impacto de la deformidad del cáncer oral en la comunicación oral y la calidad de vida de adultos y ancianos. Métodos: estudio observacional descriptivo, transversal con enfoque mixto. Muestra de 41 pacientes sometidos a cirugía para extirpar el cáncer oral, lo que resulta en mutilación e inteligibilidad verbal. Instrumentos: cuestionario sociodemográfico; Índice de discapacidad de voz; Cuestionario de calidad de vida de la Universidad de Washington; Guión semiestructurado para análisis en el software Iramuteq®. Resultado: la mutilación predominó en la región del paladar. La evaluación vocal mostró el sexo masculino con peor calidad de vida, significativamente en la escala social, mientras que la hembra, la escala física. El análisis léxico mostró necesidades, frustraciones y expectativas. Conclusión: el estudio reveló vergüenza, miedo, aislamiento social y, al mismo tiempo, la esperanza de volver al menos a poder hablar y ser entendido por otras personas mediante el uso de la prótesis

Supportive care for oral cancer survivors in COVID-19 lockdown.

OBJECTIVE: Availability and accessibility to routine health care services for cancer patients were a cause of concern during the COVID-19 pandemic, which induced stringent enforcement of lockdown and social distancing in Sri Lanka. Oral cancer patients who have undergone surgery recently encountered problems such as pain, difficulty in swallowing. However, accessing routine treatment and obtaining medication emerged as the most pressing concerns among them. Therefore, we aimed to provide supportive care for affected oral cancer patients. METHODS: A rapid situational analysis was conducted among 25-randomly selected oral cancer patients of an ongoing interventional study aimed at improving life situation of oral cancer patients. RESULTS: Over-the-phone supportive care tailored to the needs of oral cancer patients, provided by a health professional, deemed a simple but helpful intervention. CONCLUSIONS: Facilitating patients to navigate the health care system to ensure that they can continue in receiving timely treatment was the most critical aspect of the intervention. Interventions tailored to patients' needs could offer better supportive care for cancer patients in COVID-19 pandemic scenario.

Development of depression in patients with oral cavity cancer: a systematic review.

BACKGROUND: The incidence of oral cancer is approximately 300,000 patients annually. A cancer diagnosis and treatment affect both physical and mental issues. OBJECTIVES: The aim of this systematic review was to examine the development of depression in patients who have been treated for oral squamous cell carcinoma (OSCC). MATERIAL AND METHODS: PubMed and EMBASE were systematically searched for studies addressing depression among patients treated for OSCC and published within the past ten years. RESULTS: We identified three studies comprising 528 patients (range: 75-349), primarily men (66-83%), treated for OSCC from Europe and India. Tumour stage, treatment modality, and scales used to evaluate depressive symptoms varied in the studies. The European studies showed that 28% of the patients experienced depressive symptoms on the Hospital Anxiety and Depression Scale (HADS) and a mean of 8.0 on depression in the Brief Symptom Inventory (BSI). The Indian study showed a significant increase (p Value < .001) from moderate to severe depressive symptoms on the Depression, Anxiety, and Stress Scale-21 (DASS-21).Conclusion and Significance: This systematic review showed that OSCC patients are at risk of developing depressive symptoms after treatment, though severity of symptoms varied. This knowledge could preferably be implemented in future follow-up regimes.

Psychometric evaluation of Azeri version of the head and neck cancer specific quality of life questionnaire (EORTC QLQ-H&N43).

BACKGROUND: Oral cancer surgery can have a deep effect on the quality of life in the patient both in terms of functional and psychological aspects. This study aimed to translate and validate the European Organization for Research and Treatment of Cancer head and neck cancer specific quality of life questionnaire (EORTC QLQ-H&N43) in Azerbaijan. METHODS: Forward-backward translation was applied in order to translate the EORTC QLQ-H&N43 from English into Azeri. Then, a sample of patients with oral cancer attending a teaching hospital affiliated to Azerbaijan Medical University completed the EORTC QLQ-C30 (the core cancer specific questionnaire), and the EORTC QLQ-H&N43. To evaluate psychometric properties of the QLQ-H&N43, known groups validity, convergent and divergent validity was performed. Internal consistency reliability was examined by estimating the Crornbach's alpha coefficient. RESULTS: Ninety-six patients with confirmed diagnosis of oral cancer were entered into the study. The mean age of patients was 59.6 (SD = 10.7) years and 36 patients (37.5%) diagnosed as having stage IV and 10 patients (10.5%) were metastatic. The results obtained from comparing quality of life scores among these patients showed that the questionnaire was able to differentiate among patients who differed in stage and metastasis lending support to its validity. In addition convergent and divergent validity showed satisfactory results. The internal consistency of the multi-item scales as assessed by the Cronbach's alpha coefficient showed acceptable results (alpha ranging from 0.66 to 0.78). CONCLUSION: The findings suggest that in general the Azeri version of EORTC QLQ-H&N43 has satisfactory internal consistency reliability and validity, but additional psychometric evaluation is needed to draw firm conclusions.

Effects of stigma, hope and social support on quality of life among Chinese patients diagnosed with oral cancer: a cross-sectional study.

BACKGROUND: Improving quality of life (QoL) has been one of the goals of health care for people living with oral cancer. This study aimed to assess QoL and investigate the effects of stigma, hope, and social support on QoL among Chinese oral cancer patients. METHODS: A cross-sectional study was conducted at the Department of Stomatology, Shengjing Hospital of China Medical University and Stomatology Hospital of China Medical University in Liaoning Province, China, between May 2016 and October 2017. A total of 230 oral cancer patients were recruited to complete a questionnaire including the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N), the Social Impact Scale (SIS), the Herth Hope Index (HHI) and the Multidimensional Scale of Perceived Social Support (MSPSS). Univariate one-way ANOVA/t-test, Person's r and hierarchical linear regression analysis were conducted to explore the factors influencing QoL and the relationships between stigma, hope, perceived social support and QoL. RESULTS: The mean QoL score was 90.85 ± 20.15 among the patients with oral cancer. Stigma was negatively related to QoL, explaining 39.3% of the variance. In addition, hope and perceived social support were positively associated with QoL, explaining 8.1% of the variance. CONCLUSION: Overall, Chinese patients with oral cancer suffer from low QoL. Stigma was significantly and negatively associated with QoL, while hope and perceived social support were positively associated with QoL. Oral cancer patients' psychological states should be addressed, and adequate intervention based on positive psychological resources should be provided to improve the QoL of patients with oral cancer.

A Survey of Areca (Betel) Nut Use and Oral Cancer in the Commonwealth of the Northern Mariana Islands.

Areca nut use is a cause of higher rates of oral cavity cancer in the Commonwealth of the Northern Mariana Islands (CNMI). Little is known about patient insights into the risks of areca nut use worldwide. The purpose of this study is to evaluate perceptions of areca nut use and oral cancer among chewers in the CNMI. This is a survey study undertaken at the CNMI's only regional health center-300 adult participants completed a 21-question survey that assessed demographics, chewing behaviors, perceptions of areca nut use and oral cancer, and the willingness to participate in cessation and screening programs. Data was analyzed using chi-squared tests, at a significance value of P < .05. The participant average age was 38, and 41% were male. Almost all (92%) knew that chewing areca nut causes oral cancer, but only 13% correctly identified the actual areca nut as a carcinogen. About half (59%) believed that oral cancer could be treated. Most people (74%) were willing to participate in screening programs for oral cancer. Those who chewed areca nut daily were more likely to be interested in medicated replacement products relative to those who chewed less frequently (P = .048). In conclusion, there are drastic misperceptions about areca nut and oral cancer in the CNMI. Efforts should be made towards promoting awareness of the carcinogenicity of the actual areca nut, and the treatability of oral cancer. Mandated educational warnings should be required with areca nut sales. Further research evaluating substitution methods and screening programs is indicated.

Analysis of the Filipinos' Interest in Searching Online for Oral Cancer.

Objective: This study analyzed the health-seeking behavior of Filipinos using Google Trends tool to quantify relative search volume by term . Oral cancer, mouth cancer, tongue cancer, gum cancer, and lip cancer were used as predetermined search terms. Material and method: Comma-separated values file containing relative search volumes of search trends pertaining to oral cancer from 2009 to 2019 were assessed. Brown-Forsythe one-way ANOVA was used to measure differences with respect to oral cancer across different years and months. Two-way repeated measures ANOVA was applied to detect differences regarding mouth cancer, tongue cancer, gum cancer, and lip cancer across the years. Time series models were fitted and used to forecast search interests. Results: The results revealed that interest in oral cancer was significantly higher in 2019 (43.75±5.5, p<0.05) compared to 2009 (29.0 ± 6.7). In terms of months, searches were higher in February (45.0 ± 6.6) compared to May (24.8 ± 3.4, p=0.015), June (25.3 ± 4.4, p=0.020), and December (26.5 ± 4.0, p=0.038). Search interests for gum cancer and lip cancer remained significantly lower from 2011 to 2019, and tongue cancer from 2016 to 2018 but approximated mouth cancer in 2019. The forecast showed that mouth cancer (31.67%), tongue cancer (23.75%), and lip cancer (3.83%) would fluctuate through time pass, while gum cancer (8%) would remain steady in 2020. Conclusion: Health-seeking behavior through search trends showed an increased interest in oral cancer in 2019 and during February. It was anticipated that search interests would fluctuate in 2020, but at the end of the year would decrease for mouth cancer and tongue cancer, increase for lip cancer, and remain steady for gum cancer.

Conocimientos, Actitudes y prácticas de prevención de riesgo del cáncer bucal en población mayor de 15 años. Panamá. / [Knowledge, attitudes and practices of prevention of oral cancer risk in popul oral cancer risk in population over 15 years old. Panama.

Introducción: El Cáncer Bucal es una enfermedad de importancia en Salud Pública. En Panamá, se desconoce la incidencia y prevalencia de la enfermedad y no se dispone de información por tipo de patología, lesión, localización, ni estudios de conocimientos, ac­ titudes y prácticas, relacionados a los factores de riesgo. Objetivo General: analizar los conocimientos, actitudes y prácticas de prevención de Cáncer Bucal en la población mayor de 15 años. Materiales y Método: estudio descriptivo transversal, realizado en las Regiones Sanitarias de San Miguelito, Metropolitana y Panamá Oeste. Se realizó un muestreo por conveniencia en 42 instalaciones de salud del primer nivel de atención, a la población que acudió al servicio odontológico durante cuatro meses. Se aplicó una encuesta de Conocimiento, Actitudes y Prácticas de prevención de factores de riesgo al cáncer bucal, considerando variables de estilo de vida. Para el análisis estadístico, se utilizaron los programas Epi Info versión 7.2 y XLSTAT 2019 y presentados los datos en medidas paramétricas y no paramétricas. Resultados: se encuestó un total de 3,832 personas mayores de 15 años. La mayor proporción fueron mujeres en edades de 25 y 34 años. En relación al conocimiento, el 81% desconoce los factores de riesgo de cáncer bucal y según la actitud, el 63% no asiste al control odontológico periódicamente. Las prácticas reflejaron hábitos relaciona­ dos al consumo de tabaco y alcohol. Conclusión: La población mayor de 15 años del estudio, desconoce los factores de riesgo del cáncer bucal y manifiesta limitada actitud de práctica preventiva.

Introduction: Oral Cancer is an importance disease in Public Health. In Panama, the in­ cidence and prevalence of the disease is unknown and there is no information available by type of pathology, injury, location, or studies of knowledge, attitudes and practices re­ lated to risk factors. General Objective: to analyze the knowledge, attitudes and practi­ ces of prevention of Oral Cancer in the population over 15 years old. Materials and Methods: cross­sectional descriptive study, carried out in San Miguelito, Metropolitan and Panamá Oeste Health Regions. Sampling was carried out for convenience in 42 health facilities of the first level of health care, to the population that attended the dental service during four months. A survey of Knowledge, Attitudes and Practices of preven­ tion of risk factors to oral cancer was applied, considering Lifestyle variables. For the statistical analysis, the Epi Info version 7.2 and XLSTAT 2019 programs were used and the data presented in parametric and non­parametric measurements. Results: a total of 3,832 people over 15 years of age were surveyed. The highest propor­ tions were women between the ages of 25 and 34. In relation to knowledge, 81% do not know the risk factors for oral cancer and according to the attitude, 63%, do not attend pe­ riodically to a dental control. The practices reflected habits related to consumption of to­ bacco and alcohol. Conclusion: The population over 15 years old of the study ignores the risk factors of oral cancer and manifests a limited attitude of preventive practice.

The Effect of an Educational Intervention Based on PRECEDE Model on Oral Cancer Prevention Behaviors in Hookah Users.

Educational intervention about oral cancer prevention is essential for all people, especially in hookah users. The aim of this study is investigating the effect of an educational intervention based on PRECEDE model on oral cancer prevention in hookah users living in Fasa, Fars Province, Iran, in 2017-2018. In this quasi-experimental study, 360 hookah users were selected and divided into experimental and control groups (180 subjects for each group). Educational intervention was performed for experimental group in 12 sessions. A questionnaire consisting of items evaluating demographic information and PRECEDE model constructs (knowledge, attitude, self-efficacy, enabling factors, and reinforcing factors) was used to measure oral cancer prevention behaviors and nicotine dependency of subjects before and 6 months after intervention. Obtained data were analyzed by SPSS-22 software through paired t test, independent t test, and chi-square test at significance level of P < 0.05. Six months after intervention, experimental group showed significant increase in knowledge, attitude, self-efficacy, enabling factors, reinforcing factors, oral cancer prevention behaviors, and reduction of nicotine dependency compared with control group. This study showed the efficiency of educational intervention based on PRECEDE model in adoption of oral cancer prevention behaviors and reduction of nicotine dependency of hookah users 6 months after intervention.

Campaign to Increase Awareness of Oral Cancer Risk Factors Among Preadolescents.

Oral squamous cell carcinoma (OSCC) represents one of the most common but scarcely known malignancies worldwide. The etiology of OSCC is strongly related to lifestyle habits and behavior, especially tobacco smoking and alcohol abuse. The mean age of individuals who start smoking and drinking alcohol is decreasing; thus, the aim of our campaign was to test the awareness and increase knowledge of oral cancer and its risk factors among young preadolescents. Six schools with 460 students aged 12-14 years were included in the campaign. A lecture about carcinogenesis and oral cancer was provided. Anonymous questionnaires were submitted to the students before and after the lecture, to test their knowledge, awareness, and understanding. Before the lecture, the students showed very little awareness of oral cancer (26.8%), although almost all of them identified tobacco smoking as a risk factor (92.2%). After the lecture, the students showed a significant understanding of the provided information, thus increasing their awareness. On scales of 1-10, the students rated the appropriateness of the campaign at 8.9 and their overall appreciation at 8.7. Social campaigns, especially among young students, seem to be appreciated and may represent a powerful strategy for increasing knowledge about cancer risk factors, especially when they are highly related to lifestyle habits and behavior.