title: Characteristics and referral of head and neck cancer patients who report chewing and dental issues on the Patient Concerns Inventory.
abstract: BACKGROUND
  Patients experience considerable dental-related difficulties following head and neck cancer (HNC) treatment including problems with chewing, dry mouth, oral hygiene, appearance and self-esteem. These can go unrecognised in busy follow-up clinics. The Patient Concerns Inventory (PCI) is specifically for HNC patients, enabling them to select topics they wish to discuss and members of the multi-professional team they want to see.
  
  
  OBJECTIVE
  The study aimed to identify the clinical characteristics of patients raising dental concerns on the PCI and to explore the outcome of onward referral. Assessments included the PCI and the University of Washington Quality of Life Questionnaire (UW-QOL) version 4, with clinic details collated from hospital and cancer databases.
  
  
  METHODS
  PCI data were obtained from 317 HNC patients between 2007 and 2011. Their mean age was 63 years and 60% were male. Most had oral squamous cell carcinoma and underwent surgery. The median (IQR) time from treatment to first PCI was 13 (4-42) months.
  
  
  RESULTS
  Three comparison groups were identified: patients with significant chewing problems, patients without significant chewing problems who wanted to discuss dental-related concerns and patients without significant chewing problems who did not want to discuss such concerns. Fifty-two percent reported either a significant chewing problem on the UW-QOL or a wish to discuss dental-related concerns. A quarter specifically asked to talk to a dental professional. Clinical characteristics significantly associated with dental issues were stage, primary treatment and free flap reconstruction. Clinic letters were copied to only 10% of general dental practitioners (GDPs).
  
  
  CONCLUSIONS
  Better communication with GDPs is essential.
authors.affiliation: Regional Maxillofacial Unit, University Hospital Aintree, Regional Maxillofacial Unit, Aintree University Hospitals NHS Foundation Trust, Aintree, Liverpool, L9 7AL, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Mahmood
authors.affiliation: Regional Maxillofacial Unit, University Hospital Aintree, Regional Maxillofacial Unit, Aintree University Hospitals NHS Foundation Trust, Aintree, Liverpool, L9 7AL, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Butterworth
authors.affiliation: 1] Regional Maxillofacial Unit, University Hospital Aintree, Regional Maxillofacial Unit, Aintree University Hospitals NHS Foundation Trust, Aintree, Liverpool, L9 7AL, United Kingdom [2] Edge Hill University, Liverpool and Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, St. Helens Road, Ormskirk, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Lowe
authors.affiliation: 1] Regional Maxillofacial Unit, University Hospital Aintree, Regional Maxillofacial Unit, Aintree University Hospitals NHS Foundation Trust, Aintree, Liverpool, L9 7AL, United Kingdom [2] Edge Hill University, Liverpool and Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, St. Helens Road, Ormskirk, United Kingdom.
authors.forename: S N
authors.initials: SN
authors.lastname: Rogers
mesh_terms: D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008409:Mastication; D008875:Middle Aged; D011788:Quality of Life; D012017:Referral and Consultation; D009057:Stomatognathic Diseases / Q000150:complications*