Monthly Archives: April 2018

Can poor oral health cause falls in the elderly?

Source: www.medicalnewsbulletin.com
Author: Viola Lanier PhD, MSc

There is some research that indicates that, however unlikely it seems, poor oral health may contribute to the risk of falls. This question recently led researchers in Japan to investigate if poor oral health could in fact be associated with incident falls in the elderly.

As the baby boomer population ages, incidental falls have increasingly become a major public health concern around the world. In England, 28-35% of those over 65 years of age experienced a fall in 2016, while in Japan falls and fractures accounted for 12.2% of senior citizens requiring long-term care. Though hip fractures and light bruises are the most common outcomes, the most unfortunate incident can cause death. Therefore, identifying risk factors that can be modified may serve as an intervention for reducing falls in the elderly.

Examining oral health conditions and comparing incidental falls was important for researchers from the Graduate School of Dentistry at Kanagawa Dental University in Japan because the association between the two has been controversial in the research community. One study determined an association between a decrease in occlusal function and postural instability, whereas, a different study showed that occlusal disharmony is a risk factor for a decrease in balance function. Interestingly, a recent study that investigated 4,425 older community dwellers who had less than 19 teeth and lacked dentures, had a higher frequency of falls.

The JAGES Project Longitudinal Study
For this research study, panel data was used from the Japan Gerontological Evaluation Study, which was conducted between 2010 and 2013. Questionnaires were completed by 19,995 males and 20,858 females over 65 years old who did not have a history of falls during the previous year. The researchers then used a multilevel logistic regression model to determine the association between poor health in 2010 and multiple incident falls in 2013. The results were recently published in the journal PLoS ONE.

For both sexes, poor oral function, including difficulty eating tough foods and choking, was associated with incident falls. However, females who had between 10 and 19 teeth and lacked dentures were significantly associated with incident falls; compared with those who had more than 20 teeth. Additionally, those who had fewer than nine teeth, with or without dentures, experienced a higher likelihood of falls.

Adding interesting results to the research community, these findings suggest that poor oral health, having fewer teeth, and not using dentures are predictors of incident falls. These falls, essentially caused by dry mouth, choking, and difficulty eating tough foods, agree with some of the previous finding’s and thus, may help to reduce controversial views about this topic. Though this area needs further investigation to determine whether improving oral health can reduce the risk of falls in the elderly, basic screening test that assess oral health may contribute to the reduction of incidental falls in the frail older adults.

April, 2018|Oral Cancer News|

With oral cancer on the rise, dentists can play an important role

Source: http://exclusive.multibriefs.com
Author: Tammy Adams

Today’s dental professionals routinely see and deal with many issues and conditions that were not so common just a few short decades ago. For example, there has been a marked increase in the incidence of oral cancer in the United States, sparking the need for regular oral cancer screening as part of a preventive dental checkup. This additional screening is now routinely performed in many dental practices across the nation.

The American Cancer Society estimates that around 50,000 Americans are infected with oral cancer each year. In past generations, oral cancer was mostly linked to smoking, alcohol use or a combination of the two. But even as smoking rates have fallen, oral cancer rates have risen (especially in men), and researchers have concluded that this is likely caused by the human papillomavirus (HPV), a sexually transmitted disease.

Early diagnosis makes a difference
Oral cancer is often only discovered when the cancer has metastasized to another location, most commonly the lymph nodes of the neck. Prognosis at this stage of discovery is significantly worse than when it is caught in a localized intraoral area.

According to the Oral Cancer Foundation, the best way to screen for HPV-related oral and oropharyngeal cancer is through a visual and tactile exam given by a medical or dental professional, who will also perform an oral history taking to ask about signs and symptoms that cover things that are not visible.

Most of the symptoms of a developing HPV-positive infection are discovered by asking questions, using a test, a light or other device.

ADA supports dental industry with this growing challenge
In 2017, a panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs published a clinical practice guideline called the “Evidence-Based Clinical Practice Guideline for the Evaluation of Potentially Malignant Disorders in the Oral Cavity.”

The goal of this guideline is to inform dentists, orthodontists and other dental professionals about triage tools for evaluating lesions, including potentially malignant disorders, in the oral cavity. If you’re a dentist or an orthodontist, the ADA offers the following considerations concerning the diagnosis of oral and oropharyngeal cancers:

  • Clinicians should obtain an updated medical, social and dental history as well as perform an intraoral and extraoral conventional visual and tactile examination in all adult patients.
  • For patients with suspicious lesions, clinicians should immediately perform a biopsy of the lesion or refer the patient to a specialist.
  • Salivary and light-based tools are not recommended for evaluating lesions for malignancy.

If you are a dental professional and want to learn more about the dental industry’s role in addressing the rising occurrence of oral cancer, visit the ADA’s Oral and Oropharyngeal Cancer page.

April, 2018|Oral Cancer News|

Positioning during cancer radiation may be key to heart risks

Source: health.usnews.com
Author: Mary Elizabeth Dallas, HealthDay Reporter

If you have lung or throat cancer, exactly how you are positioned during your radiation treatments may alter your chances of beating the disease.

New research suggests that even tiny shifts can mean the radiation may harm organs around tumors in the chest, most notably the heart.

“We already know that using imaging can help us to target cancers much more precisely and make radiotherapy treatment more effective,” said researcher Corinne Johnson, a Ph.D. student at the Manchester Cancer Research Center in England.

“This study examines how small differences in how a patient is lying can affect survival, even when an imaging protocol is used,” Johnson explained. “It tells us that even very small remaining errors can have a major impact on patients’ survival chances, particularly when tumors are close to a vital organ like the heart.”

When cancer specialists prepare to perform radiation therapy, they scan the patient’s body to determine the exact position and size of the tumor, the researchers explained. Before every treatment that follows, more images are used to ensure that the patient and the tumor are in the same position.

For the study, the researchers recruited 780 patients undergoing radiation therapy for non-small cell lung cancer. For each treatment, patients were positioned on the machines and an image was taken to ensure they were lying within 5 millimeters (mm) of their original position.

The researchers used the images to assess how precisely the radiation was delivered, and to determine if it shifted closer or farther away from the heart.

The patients whose radiation shifted slightly towards their heart were 30 percent more likely to die than those who experienced a similar shift away from their heart, the investigators found.

When the analysis was repeated with 177 throat cancer patients, the researchers noted an even larger difference — about 50 percent — even after they took other factors, such as the patients’ ages, into account.

The findings were scheduled for presentation Sunday at the European Society for Radiotherapy and Oncology (ESTRO) annual meeting, in Barcelona, Spain. Research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

“By imaging patients more frequently and by reducing the threshold on the accuracy of their position, we can help lower the dose of radiation that reaches the heart and avoid unnecessary damage,” Johnson said in a news release from the meeting.

April, 2018|Oral Cancer News|

What’s the link between HPV and head and neck cancer?

Source: blogs.bcm.edu
Author: Dr. Michael Scheurer

As a molecular epidemiologist, I’ve been conducting research on human papillomavirus (HPV)-related cancers since my dissertation work in 2003. While working with the clinical faculty here at Baylor College of Medicine, I’ve heard many questions lately about the possibility of the HPV vaccine “helping treat” head and neck cancer (HNC).

It’s important to know the link between HPV and HNC because patients with HPV-positive tumors often have better survival rates than those with HPV-negative tumors. Check out these frequently asked questions to learn more about HPV and HNC.

What is HPV?

  • HPV is a sexually transmitted infection that can infect the oral cavity, tonsils, back of throat, anus, and genitals.
  • There are many types of HPV. Some types can cause cancer and other types can cause warts.
  • HPV infection is very common in the U.S. with more than 50 percent of adults being infected at some point in their lifetime.
  • There is no treatment for HPV infection.
  • For some people, their HPV infection naturally clears while others develop cancer after many years.

What is oropharyngeal cancer?

  • Oropharyngeal cancer occurs in the tonsils and back of throat.
  • In the U.S., HPV now causes most oropharyngeal cancers.
  • Most doctors would recommend that oropharyngeal cancers be tested for HPV.
  • Smoking and alcohol use can also increase risk of developing oropharyngeal cancer.

How did I get HPV infection in my mouth or throat?

  • The most likely route of exposure is by oral sex, although other routes may exist.
  • Performing oral sex and having many oral sex partners can increase your chances of oral HPV infection.
  • HPV is not transmitted casually by kissing on the cheek or sharing a drink with someone.
  • We do not know for sure if HPV is transmitted by open-mouth or “French” kissing.

What does it mean as a HNC patient if I have HPV in my tumor?

  • Many studies have shown that oropharyngeal cancer patients with HPV in their tumor have a better outcome than people without HPV.
  • These patients tend to respond better to both chemotherapy and radiation treatment for HNC. Appropriately selected patients also have excellent outcomes after surgery.

Is the HPV vaccine for me?

  • The HPV vaccines work by preventing people from getting new HPV infections.
  • These vaccines do not treat HPV infection or the cancers that HPV cause.
  • The vaccines are currently recommended for people ages nine to 26 years old.
April, 2018|Oral Cancer News|

Early phase clinical trial shows promise for advanced head and neck cancer

Source: www.fredhutch.org
Author: Rachel Tompa / Fred Hutch News Service

For many survivors of head and neck cancer, the disease — and its treatment — leave a lifelong, unmistakable mark. Surgeries to remove tumors in the mouth, neck or throat often leave patients with disfiguring scars and difficulty speaking or swallowing. Some may not even be able to perform these tasks at all.

Carla Stone participated in a clinical trial run by Fred Hutch’s Dr. Eduardo Méndez for her advanced head and neck cancer. The experimental approach shrank her tumor down to nothing, sparing her what is typically a disfiguring surgery.
Photo by Robert Hood / Fred Hutch News Service

When you look at Carla Stone, you might not guess that she was diagnosed with stage 4 head and neck cancer just two years ago. The only visible sign of her disease and treatment — and you have to know what you are looking for — is the tiny dot tattooed on her chest, the marker for the radiation she received to her throat.

Stone, a 66-year-old bookkeeper from Monroe, Washington, had ongoing symptoms for nearly two years before her doctors finally detected the tumor that had been growing on the base of her tongue. Her primary care physician dismissed the lump in her neck she found in 2014, Stone said, and a series of doctors kept giving her different antibiotics for the chronic sore throat she developed in early 2016.

Eventually, when the antibiotics didn’t work, Stone sought out an ear, nose and throat specialist, or ENT. This doctor didn’t dismiss the lump.

When Stone’s CT scan results came back, the ENT said, “’I went to a lecture last week by a doctor at Fred Hutch about this new treatment he has,’” Stone recounted. “’I want you to call him as soon as you get out of here.’”

That doctor was the late physician-scientist Dr. Eduardo Méndez, an expert on head and neck cancer at Fred Hutchinson Cancer Research Center. And that “new treatment” was a recently launched early-phase clinical trial testing a new cancer drug that Méndez hoped could shrink advanced head and neck tumors to the point where surgeries for his patients wouldn’t be nearly so disfiguring.

Reducing surgery’s side effects
“Part of Eddie’s desire in designing this study was to take patients who would otherwise require a very large, very deforming surgery that could leave them with minimal function at the end of their treatment and see what we could do, not only to boost their chances of being cured, but to leave them with the best functional outcome at the end,” said Dr. Cristina Rodriguez, a clinical research colleague of Méndez and fellow oncologist at Seattle Cancer Care Alliance, the Hutch’s clinical care partner.

Méndez became Stone’s oncologist and she became the seventh participant enrolled in his clinical trial.

“I said, ‘OK, I want to try it,’ because I’m a gambler,” she said. “So let’s have at it.”

For Stone, the gamble paid off. The drug, AZD1775, in combination with two chemotherapies, shrunk her tumor to the point that it was undetectable, she said. She had a minimally invasive surgery to remove some of her lymph nodes and a course of radiation to her throat after that, but there was no sign of the original tumor.

The 30 days she spent taking the experimental drug and undergoing chemotherapy were no picnic, Stone said. She had pretty severe gastrointestinal side effects. But she could also tell that the treatment was doing something.

“My sore throat was gone in about two weeks, which was amazing to me,” she said.

A promising first step
Méndez’s research team published the results of that clinical trial last month in the journal Clinical Cancer Research. Including Stone, 10 people with advanced head and neck cancer were treated with the experimental drug combination. All the participants were either ineligible for surgery or, like Stone, their tumors were such that surgery would have been significantly disfiguring.

Nine of the 10 participants had a partial or complete response to the drug, seven of whom were able to go on to a successful surgery. The 10th patient’s cancer progressed in the middle of the experimental treatment and died soon after.

Méndez himself passed away from another cancer in January, but he was able to see the results of the trial through, said Fred Hutch head and neck cancer researcher and SCCA oncologist Dr. Laura Chow, senior author on the study.

The Phase 1 study was small and designed to figure out the drug’s safety as well as its most tolerable dose, Chow said. The next step would be a much larger, Phase 2 trial with more patients to nail down whether the experimental combination therapy — AZD1775, made by the pharmaceutical company AstraZeneca, plus two chemotherapies, cisplatin and docetaxel — really works for many patients with this cancer.

But of the nine patients who did respond, the responses were much more dramatic than she and her colleagues had anticipated. Of the nine, several were able to have much less invasive surgeries than usually warranted.

“The interesting thing is it had more of an effect than we expected. People actually had dramatic shrinkage of their cancers to the point that they didn’t have cancer left at time of surgery,” Chow said. “It changed the outcomes more than we thought it would.”

‘When basic science and clinical research come together’
The study was born on Méndez’s own laboratory bench, through a series of preclinical studies spearheaded by Méndez and Fred Hutch colleague Dr. Christopher Kemp.

The research team used a technique termed “functional genomics,” which sifts through hundreds or thousands of genes to find cancer cells’ weak spots. The genes the researchers are looking for are those which, when shut off, kill cancer cells but not healthy cells. Those are promising new targets for drugs that could selectively kill cancer without harming the rest of the patient.

When Méndez and Kemp applied the functional genomics technique to head and neck cancer cells with mutations in a gene known as p53, which is mutated in approximately two-thirds of head and neck cancers, their screen identified a gene known as Wee1 as a potential Achilles heel for these tumor cells. Luckily for the researchers, there was already a drug — AZD1775 — that targets Wee1.

When Méndez and Chow designed the clinical trial, they allowed patients with or without mutations in p53 to join — additional preclinical data from Méndez’s team had found that the drug also seemed to work on cancerous cells without a p53 mutation but where the cancer was triggered by HPV infection, a cancer-linked virus that inactivates p53 in a different way.

Indeed, three of the trial participants who had a good response to the drug did not carry p53 mutations in their tumors but were HPV-positive.

“I think the trial is really a great example for what can happen when basic science research and clinical research come together,” said Rodriguez, who is also one of the study authors. “This turned out to be a successful approach both in the petri dish and in human beings.”

National Institutes of Health, the American Cancer Society, philanthropic donations to Fred Hutch and SCCA, and AstraZeneca funded the clinical trial.

Rachel Tompa, a staff writer at Fred Hutchinson Cancer Research Center, joined Fred Hutch in 2009 as an editor working with infectious disease researchers and has since written about topics ranging from nanotechnology to global health. She has a Ph.D. in molecular biology from the University of California, San Francisco and a certificate in science writing from the University of California, Santa Cruz. Reach her at rtompa@fredhutch.org or follow her on Twitter @Rachel_Tompa.

Note:
1. Original article published in Fred Hutch News. Available here.

April, 2018|Oral Cancer News|

What University of Toronto researchers are doing to help ‘devastating’ swallowing problems

Source: www.utoronto.ca
Author: Jim Oldfield

We swallow about 600 times a day, mostly without thinking about it. But swallowing involves dozens of muscles and nerves in the mouth, throat and esophagus, and for people who struggle with the process, the results can be devastating.

Malnutrition, dehydration and social isolation are common in people with swallowing trouble. So is depression and aspiration of food that leads to pneumonia. Occasionally, swallowing issues cause choking and sudden death. And a recent U.S. study of hospitalized patients with serious illnesses found that more than half said needing a feeding tube to live was a state equal to or worse than death.

Many conditions can cause swallowing problems: stroke, neurodegenerative diseases such as Parkinson’s, and congenital or developmental conditions such as cerebral palsy and cleft palate. People treated for head and neck cancer often develop problems, sometimes years later; and their numbers are growing as cancer survival rates improve. Estimates on the global prevalence of swallowing disorders, which collectively are known as dysphagia, are about eight per cent – almost 600 million people.

But there is good news. Before 1980, most patients with complex dysphagia got feeding tubes; today, clinicians can offer videofluoroscopy and other bedside tests to better assess swallowing problems, and less invasive therapies that emphasize exercise and posture.

And at the University of Toronto, scientists in the department of speech-language pathology and related fields are starting to answer long-standing questions such as how best to give dysphagia screening tests, which interventions work well for specific conditions, and how to create global standards to talk about and address swallowing issues.

Through research, we may be entering a new era in dysphagia care.

Which approach is better?
More than two-thirds of head and neck cancer patients need a feeding tube for several months, after radiotherapy. They typically get therapy from a speech language pathologist before swallowing problems begin or once symptoms arise. Both methods provide benefits, but the extent of the benefits from each approach is unclear.

Professor Rosemary Martino and her colleagues just launched a study that will provide answers. The US$8.5 million PRO-ACTIVE project will enrol 1,000 patients over five years in Toronto and six other cities across North America.

“The stuation now is what we call clinical equipoise,” says Martino, a professor in the department of speech-language pathology who holds a Canada Research Chair in swallowing disorders. “Both treatment approaches work but we don’t know which is better, and so we can’t know where to invest the most resources. We also know the clinical community is mixed in what they offer patients; this study will hopefully resolve those uncertainties once and for all.”

The researchers will track patients who get both proactive and reactive therapy, then measure and compare their ability to eat and swallow along with other health outcomes up to one year after radiotherapy. They will also parse the effects of each approach in different groups of patients and compare the effectiveness of low- and high-intensity proactive interventions. (Low-intensity therapy is pragmatic, with a focus on exercising oral musculature during meal times and some snacks; high-intensity therapy includes additional exercises between meals.)

“Intensity is both a resource and patient burden issue,” says Martino, whose lab is based at U of T and the Krembil Research Institute in University Health Network. “We know patient adherence to exercise therapy is often low, so we need to make sure we don’t overprescribe and raise the risk that they do nothing. And with better evidence, we can let patients know exactly how much better their swallow will be if they comply.”

The study will engage patients and families, clinicians and policy makers at several points, toward ensuring that new findings are practical and available to patients right away. Study researchers will also use new health informatics and quantitative imaging technology to establish the first international database to compare the effectiveness of swallowing interventions relative to radiation targets and doses. The database, housed by Martino and her team at University Health Network, will support trials to further guide therapy and help preserve the swallowing ability of patients.

A quick and effective screening test
Almost 60 per cent of acute stroke patients have some swallowing impairment. Stroke patients with dysphagia are three times more likely to get pneumonia, and for those with severe dysphagia, the risk of pneumonia is 11 times higher.

Globally, there is a pressing need for a quick and reliable bedside screening tool that can tell clinicians if a stroke patient has dysphagia: Early identification of swallowing problems allows for earlier intervention, which reduces the risk for pneumonia, malnutrition and death while speeding patient recovery and limiting health-care costs.

In the early 2000s, Martino’s lab developed a screening test called the Toronto Bedside Swallowing Screening Test (TOR-BSST), a simple one-page tool that only takes 10 minutes to administer and that allows clinicians to determine if a patient has a swallowing problem. In 2009, they published results from a trial of more than 300 stroke patients that showed the test had an accuracy rate of over 90 per cent. It was a practice-changing study.

The lab quickly set up an online training module and began to teach health professionals in Toronto and across Canada and the U.S. how to deliver the test. The tool has now been translated into six languages and is being adopted around the world, most recently in Japan and Brazil. “The TOR-BSST is really a Canadian success story, and we’re now validating this tool in critically ill cardiac patients who have been intubated for one day or more”, says Martino.

Almost 400 clinicians globally have used the TOR-BSST. Martino and her colleagues continue to study new ways of delivering the test and they expect further results later this year.

Why making food easy to swallow is hard
A key treatment for dysphagia is diet-texture modification. Many patients find that soft or liquified foods are easier to swallow, but the best consistency for each patient is highly variable. As well, there is no globally accepted way to name and describe texture-modified foods, which has led to poor communication among patients, caregivers and families, and undermined treatments.

In 2013, international experts from several health professions came together to develop a common terminology for texture-modified foods and instructions for simple methods to test food and drink consistency. The group – the International Dysphagia Diet Standardisation Initiative (IDDSI) – published a framework in 2015, and soon after several countries made implementation plans.

New Zealand became the first country to adopt IDDSI in January, and Canada and the U.S. are on track to implement early next year.

“For people with swallowing issues, food and liquid are like medication, and they come with some of the same risks. Getting diet texture wrong can kill,” says Catriona Steele (pictured left), who is a professor in the department of speech-language pathology, an IDDSI board member and a senior scientist at the Toronto Rehabilitation Institute in University Health Network. “Inside the hospital, we don’t treat the kitchen with the same reverence as the pharmacy.”

Steele says the IDDSI framework will bring much more attention to dysphagia diets, but that kitchens and food manufacturers that prepare food for dysphagia patients in Canada have a lot of work to do before roll-out. For example, labels on commercially available products need to change. Moreover, there are still major knowledge gaps regarding which consistencies are best for patients with different conditions.

“Liquid behaves one way in a person with an intact system but may not behave the same in someone with stroke or head and neck cancer,” says Steele, whose lab has studied the physiology of swallowing since 2003. “So clinically, people have been making educated guesses. We’ll collect data for IDDSI on particular measurements in specific conditions to guide clinicians down the road.”

In another project, Steele and colleagues at the University of Waterloo recently looked at nutrition in seniors at 32 long-term care facilities in Canada. The study, called Making the Most of Mealtimes, found that texture-modified foods contribute to malnourishment, in part because people eat less of them and puréeing changes nutrient density.

“People prescribe these liquids with good intentions in terms of safety, but they might be creating a negative cycle that leads to malnutrition,” says Steele, although she points out that researchers are trying to improve the nutrition of these foods through supplements.

Another challenge in seniors and others with dysphagia is the emotional aspect of food.

“We all love to eat, so dietary changes can be very threatening to people. And there are many possible reasons for negative emotions around food,” says Steele. “Early in my career, I worked with Holocaust survivors, for example, and modifying food texture had particularly negative associations for them. So we need to do this carefully and only when justified, and that’s not the standard of care at present.”

A guide to treating the young
Children with swallowing problems can be especially hard to diagnose, in part because the potential reasons for feeding issues are many: feeding aversion secondary to gastrointestinal reflux, sensory issues in autism, problems with muscle weakness or co-ordination in the face or neck, cardiac or respiratory conditions, and lack of appetite from medications, to name a few.

Moreover, many strategies that clinicians use in adults will not work in the pediatric population for developmental reasons. For children with developmental difficulties, swallowing problems are very common and upsetting for families. Up to 80 per cent of these children have some kind of feeding or swallowing impairment.

Treatment for children with developmental challenges is complex, and often demands a team of health professionals that may include a physician, speech language pathologist, developmental paediatrician, occupational therapist, physical therapist, dietitian and nurse.

The clinical feeding and swallowing team at Holland Bloorview Kids Rehabilitation Hospital provides comprehensive expertise to patients with developmental challenges at the hospital. But they also share their knowledge with colleagues at community hospitals, clinics and individual community practitioners, who often face a knowledge gap when trying to address dysphagia in children with developmental issues.

To that end, the swallowing team at Holland Bloorview and the hospital’s Evidence to Care group recently developed a handbook, Optimizing Feeding and Swallowing in Children with Physical and Developmental Disabilities: A Practical Guide for Clinicians. The handbook provides a hierarchical and integrated approach to guide practice, and highlights key considerations clinicians might face.

“There was a lack of clear summaries of the scientific evidence available across disciplines that presented information in an accessible, efficient way for a broad group of community clinicians who may need to care for children with feeding and swallowing impairments,” says Deryk Beal, an assistant professor in U of T’s department of speech-language pathology and clinician scientist at Bloorview Research Institute.

The guide has been a huge success. Viewers have downloaded it more than 4,600 times since it appeared online in June last year, in more than a dozen countries and every Canadian province. The University of Montreal made it required reading for a third-year occupational therapy course, and a survey by Holland Bloorview staff found many users praised the guide for its clarity and relevance to practice.

Clinicians say they use the guide in several ways – as a quick-reference tool when seeing patients, when sharing knowledge with colleagues, and for on-boarding new staff and teaching students. Many users like the guide’s interprofessional focus, which enables them to better understand the perspectives and treatment options that professionals in other fields can bring to cases.

“We know feeding and swallowing is a specialized area of medical care and a lot of people working in the community may not have received specific training in some elements of the care they’re providing,’’ says Andrea Hoffman, an assistant professor in the department of pediatrics and developmental pediatrician at Holland Bloorview. “This handbook helps give them a framework to gather information and determine the important elements of the assessment from a range of disciplines, so they can make the best recommendations and most appropriate referrals to provide optimal care.”

Hoffman and her colleagues recently published two quick-reference handouts based on the guide, and also plan to create client-centred resources for families.

April, 2018|Oral Cancer News|

Woman’s missing jaw regrown by 9 cm after cancer

Source: www.bbc.com
Author: staff

A woman who lost her jaw to cancer has had it regrown from her own skin and bone.

Val Blunden had the bottom of her mouth and chin destroyed by cancer more than two years ago. The 55-year-old was left unable to eat, drink and talk, taking early retirement from her job as a postwoman. Using new treatment, surgeons from Nottingham and Wolverhampton have reconstructed her jaw by “stretching” her own tissue and bone around a frame.

Known as distraction osteogenesis, the process has been around for a number of years but never been used in this way before, Dilip Srinivasan, maxillofacial surgeon at Nottingham University Hospitals Trust, said. A frame built at Queen’s Medical Centre in Nottingham has acted as “scaffolding”, and since an operation in January the jaw has grown 9cm.

It is hoped the final surgery to remove the frame will take place in May.

Ms Blunden, from Wolverhampton, first found a lump underneath her tongue in January 2015 and following diagnosis has had glands, chin, lower lip and part of her tongue removed. After two previous attempts to reconstruct her jaw using skin grafts failed, and with her being unable to use a prosthetic replacement, she hopes the procedure will improve her life.

“Having lived like this for two years I’d begun to accept that this is how life was going to be, but now I’m so much more hopeful for a different future,” she said.

Mr Srinivasan said: “We have been able to achieve this in a few operations before, but we’d never attempted it on a patient missing bone, skin and muscles.

“When there’s no jaw, there’s no shape to follow, and if there’s no shape to follow everything will grow in a straight line.”

April, 2018|Oral Cancer News|

HMB/Arg/Gln does not reduce oral mucositis incidence in head and neck cancer

Source: www.oncologynurseadvisor.com
Author: James Nam, PharmD

The addition of beta-hydroxy-beta-methylbutyrate, arginine, and glutamine (HMB/Arg/Gln) to opioid-based pain control (OBPC) and oral care programs does not effectively prevent chemoradiotherapy (CRT)-induced oral mucositis (OM) in patients with head and neck cancer (HNC), according to a study published in Supportive Care in Cancer.

Chemoradiotherapy with a cisplatin-based chemotherapy regimen is the standard of care for patients with HNC, but is associated with a high incidence of CRT-induced OM. OBPC and oral care programs are insufficient in reducing OM incidence; there is a need for additional interventions to prevent and treat OM.

For this phase 2 study, researchers treated 35 patients with HNC scheduled to receive definitive or postoperative cisplatin-based CRT with oral or percutaneous endoscopic gastrostomy-delivered HMB/Arg/Gln; all patients underwent OBPC and oral care programs.

Results showed that 45.7% (16) of patients developed symptomatic or functional grade 3 or worse OM. Grade 1 or less OM occurred in 51.1% of patients at 2 weeks and in 82.9% of patients at 4 weeks postradiotherapy completion.

Clinical examination, however, revealed that 28.6% (10) of patients developed grade 3 or worse OM, and the incidence of grade 1 or less OM was 80.0% and 100% at 2 weeks and 4 weeks after completing radiotherapy, respectively.

The most frequently reported adverse events included diarrhea and an increase in blood urea nitrogen, but were easily managed with standard care.

Evidence from the study demonstrates that HMB/Arg/Gln does not effectively decrease OM incidence; however, the authors concluded that “the benefit of HMB/Arg/Gln should not be neglected given the findings of clinical examinations and the rapid recovery from severe OM.”

Reference
1. Yokota T, Hamauchi S, Yoshida Y, et al. A phase II study of HMB/Arg/Gln against oral mucositis induced by chemoradiotherapy for patients with head and neck cancer [published online April 7, 2018]. Support Care Cancer. doi: 10.1007/s00520-018-4175/4

April, 2018|Oral Cancer News|

The Society for Immunotherapy of Cancer highlights immunotherapy during Oral, Head and Neck Cancer Awareness Week

Source: www.prweb.com
Author: press release

The Society for Immunotherapy of Cancer (SITC) recognizes Oral, Head and Neck Cancer Awareness Week, April 8-15, 2018, in an effort to highlight targeted immunotherapy to treat patients with these types of cancer.

To educate and guide patients, SITC provides informative and engaging online education dedicated to cancer immunotherapy through SITC Cancer Immunotherapy connectED. Two head and neck cancer-specific resources are available on SITC connectED:

Beyond Chemotherapy for Treatment of Head and Neck Cancer: Developed for patients with head and neck cancers and their care partners, the goal of this online class is to learn about treatment options for the newly diagnosed, treatment after chemotherapy, and questions to ask the patient’s healthcare team.

Understanding Cancer Immunotherapy Patient Resource Guide: This guide provides current, medically accurate information on cancer (including head and neck cancers) – intended for patients and caregivers to outline available cancer immunotherapy options, the role of the immune system in this type of cancer treatment and what to expect while undergoing treatment. (free registration required)

Aiming to make cancer immunotherapy a standard of care for cancer patients everywhere, these SITC connectED resources educate and guide patients on immunotherapy treatment options for head and neck cancer. For more information, visit the SITC website at sitcancer.org.

About SITC
Established in 1984, the Society for Immunotherapy of Cancer (SITC) is a nonprofit organization of medical professionals dedicated to improving cancer patient outcomes by advancing the development, science and application of cancer immunotherapy and tumor immunology. SITC is comprised of influential basic and translational scientists, practitioners, health care professionals, government leaders and industry professionals around the globe. Through educational initiatives that foster scientific exchange and collaboration among leaders in the field, SITC aims to one day make the word “cure” a reality for cancer patients everywhere. Learn more about SITC, our educational offerings and other resources at sitcancer.org and follow us on Twitter, LinkedIn, Facebook and YouTube.

April, 2018|Oral Cancer News|

Be your own advocate

Source: www.wvnews.com
Author: Mary McKinley

The importance of dental care goes beyond cavities — it’s also about preventing cancer. The week of April 8 is National Oral, Head and Neck Cancer Awareness Week, and your dentist or dental hygienist may be your first line of defense against oral cancer.

More than 50,000 Americans are expected to be diagnosed with oral or oropharyngeal cancer (cancer of the back of the throat, including the base of the tongue and the tonsils) in 2018, and 350 will be diagnosed in West Virginia alone.

Routine dental exams can detect cancer or pre-cancers during the early stages. If you notice a persistent sore or pain, swelling or changes in your mouth, or red or white patches on the gums, tongue, tonsils or lining of the mouth, visit a doctor or dentist so they can examine your mouth more closely.

Some people diagnosed with oral cancer have no risk factors, so it’s important for everyone to keep those dental appointments.

If you use tobacco, drink alcohol in excess, or have the human papillomavirus (HPV), you have an increased risk for oral cancer. Oral cancer is more common in older adults, particularly men, but oropharyngeal cancer is on the rise in middle-aged, nonsmoking white men between the ages of 35 and 55. The majority of these types of cancer cases are caused by HPV.

Take charge of your health and reduce your risk of oral cancer. If you smoke or chew tobacco, quit now (it’s never too late). Moderate your alcohol consumption to no more than one drink a day for women or two for men.

If you have children, make sure they receive the HPV vaccine, which is recommended for all girls and boys ages 11 and 12; a “catch-up” vaccine is also available for young women up to age 26 and most young men up to age 21.

You can be your own best advocate. Check the inside of your mouth in the mirror each month, and speak up to your dentist or dental hygienist if you notice any changes that concern you.

Ask about cancer screenings when making your dental appointments. And to learn more about cancer prevention, be sure to visit www.preventcancer.org.

April, 2018|Oral Cancer News|