title: Prevalence of oral mucositis, dry mouth, and dysphagia in advanced cancer patients.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy. terapiadeldolore@lamaddalenanet.it.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Mercadante
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy. federica.aielli@univaq.it.|"L'Aquila per la Vita" Home Care Unit, L'Aquila, Italy. federica.aielli@univaq.it.
authors.forename: Federica
authors.initials: F
authors.lastname: Aielli
authors.affiliation: Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy. claudio.adile@hotmail.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Adile
authors.affiliation: Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy. patriziaferrera@inwind.it.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Ferrera
authors.affiliation: Faro Foundation, Turin, Palermo, Italy. Alessandro.valle@tin.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Valle
authors.affiliation: Home Care Program, Asp 6, Genoa, Italy. Flavio.Fusco@asl3.liguria.it.
authors.forename: Flavio
authors.initials: F
authors.lastname: Fusco
authors.affiliation: Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy. amandacaruselli@virgilio.it.|Home Care Program, SAMO, Palermo, Italy. amandacaruselli@virgilio.it.
authors.forename: Amanda
authors.initials: A
authors.lastname: Caruselli
authors.affiliation: Division of Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, Home Care Service of the Rome Section of the Italian Association Against Leukemias (RomAIL), Rome, Italy. cartoni@bce.uniroma1.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cartoni
authors.affiliation: Palliative Care Unit, Istituti Clinici di Perfezionamento Hospital, Milan, Italy. massimo.pizzuto@icp.mi.it.
authors.forename: Pizzuto
authors.initials: P
authors.lastname: Massimo
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila, L'Aquila, Italy. francesco.masedu@cc.univaq.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Masedu
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila, L'Aquila, Italy. marco.valenti@cc.univaq.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Valenti
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy. porzio@sctf.it.|"L'Aquila per la Vita" Home Care Unit, L'Aquila, Italy. porzio@sctf.it.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Porzio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000453:epidemiology* / Q000628:therapy; D009369:Neoplasms / Q000453:epidemiology*; D010166:Palliative Care; D015995:Prevalence; D011788:Quality of Life; D013280:Stomatitis / Q000453:epidemiology* / Q000628:therapy; D014987:Xerostomia / Q000453:epidemiology* / Q000628:therapy
keywords: Advanced cancer; Dry mouth; Dysphagia; Mucositis; Oral symptoms; Palliative care; Supportive care
references.citation: Support Care Cancer. 2015 Mar;23(3):881-8
references.pmid: 25322971
references.citation: BMJ. 2011 Aug 25;343:d4920
references.pmid: 21868477
references.citation: Palliat Med. 2006 Sep;20(6):617-22
references.pmid: 17060255
references.citation: J Am Dent Assoc. 2014 Aug;145(8):867-73
references.pmid: 25082939
references.citation: Support Care Cancer. 2012 Mar;20(3):531-7
references.pmid: 21336528
references.citation: Radiother Oncol. 2003 Mar;66(3):253-62
references.pmid: 12742264
references.citation: J Pain Symptom Manage. 1999 Nov;18(5):338-46
references.pmid: 10584457
references.citation: J Support Oncol. 2004 Nov-Dec;2(6 Suppl 3):3-8
references.pmid: 15605918
references.citation: J Pain Symptom Manage. 2000 Aug;20(2):104-12
references.pmid: 10989248
references.citation: Int J Palliat Nurs. 2010 Sep;16(9):439-44
references.pmid: 20871498
references.citation: Oral Oncol. 2014 Sep;50(9):877-83
references.pmid: 25017804
references.citation: Support Care Cancer. 2000 May;8(3):175-9
references.pmid: 10789956
references.citation: J Cell Mol Med. 2013 Nov;17(11):1371-84
references.pmid: 24251854
references.citation: Support Care Cancer. 2014 Mar;22(3):803-10
references.pmid: 24232310
references.citation: J Clin Oncol. 2005 Sep 1;23(25):6240-8
references.pmid: 16135490
references.citation: Dysphagia. 2015 Apr;30(2):145-51
references.pmid: 25533181
references.citation: Oncologist. 2014 Jun;19(6):681-7
references.pmid: 24760709
references.citation: JAMA. 2008 Apr 16;299(15):1818-25
references.pmid: 18413876
references.citation: J Natl Cancer Inst Monogr. 2001;(29):45-51
references.pmid: 11694566
references.citation: Support Care Cancer. 2000 Sep;8(5):372-6
references.pmid: 10975686
references.citation: J Pain Symptom Manage. 2014 Dec;48(6):1060-9
references.pmid: 24751438
references.citation: Indian J Palliat Care. 2012 May;18(2):98-102
references.pmid: 23093824
references.citation: J Palliat Med. 2014 Oct;17(10):1158-63
references.pmid: 24922117
references.citation: Int J Radiat Oncol Biol Phys. 2007 Jul 15;68(4):1110-20
references.pmid: 17398022
references.citation: Support Care Cancer. 2013 Nov;21(11):3161-3
references.pmid: 23942597
references.citation: BMC Palliat Care. 2008 Sep 23;7:16
references.pmid: 18808724