Oral Cancer News

How often should you see a dentist?

Source: www.bbc.com
Author: staff


Margie Taylor says seeing a dentist once a year – or even once every two years – is enough for many patients. Some dentists argue this could make it harder for them to spot diseases such as mouth cancer. And they say it could see the wealthy paying for private dental care – while the poor have less access to a dentist.

Ms Taylor met representatives of the British Dental Association (BDA) in Stirling on Wednesday afternoon to discuss their concerns.

What is the Scottish government proposing?
The Scottish government published its Oral Health Improvement Plan earlier this year, which says NHS dental services should focus on preventing oral health disease, meeting the needs of the ageing population, and reducing oral health inequalities between Scotland’s rich and poor.

The document says there is no clinical evidence that all patients need basic check-ups every six months – regardless of their oral health – as is currently the case. It quotes National Institute for Health and Care Excellence (NICE) guidelines, which state that “patients who have repeatedly demonstrated that they can maintain oral health and who are not considered to be at risk of or from oral disease may be extended over time up to an interval of 24 months.”

Risk assessment
Under the new system outlined by the government plans, an Oral Health Risk Assessment (OHRA) would be introduced for every patient – with the frequency of check-ups determined by their overall score.

This may mean that people will no longer have to attend every six months if they have good oral health and a healthy lifestyle. But patients who have poorer oral health and higher risk factors are likely to be seen more frequently.

The improvement plan also says that the traditional theory that the scale and polish procedure prevents gum disease has been thrown into considerable doubt in recent years. Instead, it says that “the most effective option for routine care is adequate oral hygiene by the patient themselves”.

What does Ms Taylor say about the plans?
The chief dental officer told BBC Scotland that medical evidence suggests many people can leave two years between basic check-ups without any problem. But she stressed that it was important to be realistic – and that it was not reasonable to expect people who are accustomed to having two check-ups a year to suddenly start seeing a dentist just once every two years.

She said: “At the moment, quite a lot of people come yearly and that’s fine for patients who are not at risk and who know how to look after their mouth and who have got a healthy diet.

“But it will be absolutely dependent on the risk as assessed by their own dentist, and there is no suggestion that everybody is to move to two-yearly checkups.

“And in fact we may want to see some patients more often than six months”.

Ms Taylor also insisted there was no intention to take NHS money from dentists in wealthier areas and giving it to those in poorer areas.

She added: “What we are talking about is making sure people in the poorer areas are able to get treatment”.

Ms Taylor stressed that everybody who needs a scale and polish – such as those suffering from periodontal disease – will still get one. But she conceded that the government had “more communicating to do” on the changes, which she said were about “evolution and not revolution”.

What do dentists say?
Ahead of their meeting with Ms Taylor, BDA Scotland released the results of a survey which it said suggested many of its members had “deep concerns” over the Oral Health Improvement Plan.

According to the survey:

  • Nearly two thirds of NHS dentists (62%) who responded had a “negative” or “very negative’ impression of the overall plan.
  • Three quarters had concerns about financial viability, and how the plan will be funded.
  • Almost 70% of respondents viewed the proposals to reduce the frequency of dental checks negatively.
  • About 80% had concerns about the proposed reduction in scale and polish treatments.

The BDA’s chairman in Scotland, Robert Donald, said: “Talk from government on prevention and tackling health inequalities is long overdue, but will remain warm words until they are backed up with needed investment.

“Vulnerable older patients deserve oral health care tailored to their needs, but this plan fails to spell out how it can be provided safely and effectively, or how it will be paid for. Sadly while officials have sketched out the big issues, they have skimped on the detail.”

Meanwhile, dentist John Davidson, who runs a practice in Edinburgh, told BBC Scotland that oral cancer is on the increase in Scotland and “the more often we see patients, the more likely we are to pick that up”.

He added: “We feel it is important that patients are seen more regularly, and it may get to the stage where patients pay themselves to come in and have their routine examinations and scale and polishes done.

“For a lot of patients it will not make a lot of difference for them (financially), but there are patients who just cannot afford to do that”.

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The rise of HPV-related cancers in men

Source: www.tmc.edu
Author: Alexandra Becker

Scott Courville admired his full beard and round belly in the mirror: He was ready for the upcoming holiday season. It was November 2015 and Courville, who plays Santa Claus in Lafayette, Louisiana, was too excited about his favorite time of year to worry much about the pain developing in his jaw.

By February, though, the ache had worsened and was accompanied by new symptoms: white spots on his right tonsil, difficulty swallowing and lumps in his throat. He finally made his way to a walk-in clinic where he was diagnosed with tonsillitis and prescribed antibiotics.

“They sent me home and said, ‘In two weeks everything should clear up,’” Courville recalled.

But his symptoms only worsened. Courville made an appointment with a local ear, nose and throat (ENT) specialist who also diagnosed Courville with tonsillitis. The doctor prescribed more antibiotics and steroids, but two weeks later there were no improvements. Courville was referred to a dentist—“In case they see something we don’t”—but that, too, was a dead end.

Courville’s dentist insisted he return to his ENT, where he ultimately had a CT scan that revealed a mass in his throat. That was June 6, 2016. Two days later, Courville underwent a biopsy. When he awoke from the surgery, his doctor was standing over him.

Courville always gets choked up retelling this part of his story.

“The hardest part for me is always remembering when the doctor said, ‘I’m sorry, but you’ve got cancer.’”

Courville was referred to The University of Texas MD Anderson Cancer Center, where doctors confirmed that he had squamous cell carcinoma of the right tonsil. But there was more: Courville learned that his cancer had been caused by the human papillomavirus—HPV.

11 million men
Courville’s story is becoming increasingly common, with the annual incidence of HPV-related cancers of the throat, tonsils and the base of the tongue in men in the United States now outnumbering cases of cervical cancer in women, according to the U.S. Centers for Disease Control and Prevention (CDC). A 2017 research paper authored by scientists at Baylor College of Medicine and The University of Texas Health Science Center at Houston School of Public Health, among others, found the overall prevalence of oral HPV in men in the U.S. to be upwards of 11 million—much higher than previously believed.

“This has implications, because pretty much everyone is exposed to HPV,” said Andrew Sikora, M.D., Ph.D., one of the authors of the paper and vice chair for research and co-director of the Head and Neck Cancer Program at Baylor College of Medicine. “When we’re talking about the prevalence of oral HPV infection, we’re talking about that infection persisting inside the tonsils or on the base of the tongue of these men, and I think that’s what sets you up for cancer later in life—it may happen decades after you were exposed to HPV.”

That lag time, coupled with an absence of symptoms, is part of the reason HPV-related oropharyngeal cancers, also referred to as head and neck cancers, are increasing.

“What makes this cancer interesting is that it’s one of the only cancers in the body that we’re actually seeing more cases of year over year,” explained Ron J. Karni, M.D., who serves as chief of the division of Head and Neck Surgical Oncology at McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center. “In the U.S., we can expect a certain number of breast cancer cases and lung cancer cases every year, but this is actually starting to look a bit like an epidemic in that we are seeing more every year. It’s alarming.”

Holy grail
HPV is the most common sexually transmitted disease in the U.S., with an estimated 79 million individuals infected. According to the CDC, HPV is so common that most people who are sexually active will get the virus at some point in their lives if they do not get the HPV vaccine.

The virus is spread through vaginal, anal and oral sexual activity, and often exhibits no signs or symptoms. In many cases, HPV is cleared by the immune system and does not cause health problems, but it can also persist and show up decades later alongside conditions such as genital warts and cancer—including cervical cancer, anal cancer and oropharyngeal cancers. For reasons not well understood, oropharyngeal cancers predominately affect men.

Currently, there is no annual screening test for men to determine whether they have the virus. Women, on the other hand, are advised to get regular pap smears.

The Papanicolaou test, commonly known as the pap smear, involves collecting cells from inside a woman’s cervix to detect pre-cancerous changes. It is performed during a woman’s annual exam and has been widely credited for detecting early signs of HPV-related cervical cancer and saving countless lives. No such screening test has been successfully developed for oropharyngeal cancer—another reason cited for its steady rise.

“We’re at a huge disadvantage,” said Sikora, who, in addition to his research, treats patients at the Michael E. DeBakey VA Medical Center in Houston. “The pap smear, in terms of global health impact, is probably one of the best, most cost-effective things ever invented in terms of just the sheer number of women who have not had cancers because of it. We have nothing like that for men.”

Sikora explained that anatomy is, in part, to blame. Whereas the cervix is easily sampled, the tonsils are full of “nooks and crannies,” he said, and scientists have yet to develop a reliable technique for obtaining a representative sample of cells inside the throat, tonsils and back of the tongue.

“It’s sort of a holy grail for researchers in the field,” Sikora said. “It would be a game-changer in terms of prevention and early detection of cancer.”

Scientists at MD Anderson, where Courville was treated, may be closing in on some answers. Researchers, including Erich M. Sturgis, M.D., MPH, the Christopher & Susan Damico Chair in Viral Associated Malignancies, are currently conducting a clinical trial for an antibody test that could be used to screen for HPV-related throat cancer.

The HOUSTON study, an acronym for “HPV-related Oropharyngeal and Uncommon Cancers Screening Trial of Men,” is looking to recruit 5,000 men ages 50 to 64 years to provide blood and saliva samples for serologic HPV testing and oral HPV testing, respectively. If a subject is found to have a positive antibody test, he will be asked to participate in a second phase of the study, which includes an intensive screening program run through MD Anderson’s oral pre-cancer clinic.

“A researcher at Arizona State University, Dr. Karen Anderson, developed a serologic test that predicts extremely well the risk for HPV-related oropharyngeal cancer,” Sturgis explained. “We have been able to show that serum antibodies to HPV early proteins, which are rare in the general population, are markers for oropharyngeal cancer. Specifically, we found that those who had antibodies to certain HPV antigens have a greater than 450-fold higher risk of oropharyngeal cancer compared with those who do not have the antibodies.”

The hope is that this study will reveal that serological HPV antibody testing is an effective screening tool for HPV-related cancer in men: the equivalent to a pap smear.

A lump in the neck
If and when HPV-related cancer does develop, men often notice a pain in their jaw or throat, trouble swallowing, change or loss of voice that lasts more than a week or two, a sore spot on the tongue and, most often, a lump in the neck.

“There’s often a very small, primary tumor, which is the tumor that is in the tongue or in the tonsil, and it travels early to the lymph nodes,” Sikora explained. “Depending on what your neck looks like, lymph nodes can get pretty big before they become noticeable. But a lump in the neck is by far the most common symptom, and unfortunately it’s often detected much later than we would like.”

Even more troubling, many individuals who have these symptoms are commonly misdiagnosed and handed antibiotics, as in Courville’s case.

“The most important message I can convey is that if you have a lump in your neck, go see an ear, nose and throat doctor,” Karni said, emphasizing the importance of an informed diagnosis and specialized care.

Treatment for oropharyngeal cancers varies depending on the case and often involves a multidisciplinary team of clinicians, as well as some form of combined modality therapy such as radiation and chemotherapy. In the future, Sturgis sees novel therapies, including immunotherapy options, changing the landscape of treatment protocols.

Karni hopes UTHealth’s dedicated HPV-related throat cancer program will carry patients through the entire arc of treatment by offering minimally invasive robotic surgery for qualifying cases, as well as annual community-wide screening clinics, rehabilitation therapists, and numerous other specialists.

“We want to think about cancer the way Target thinks about shopping or the way the best airlines think about flying,” Karni said. “We designed a program that is patient-centered. We asked, ‘What does the patient need on their fourth week of radiation? What do they need on their third month post-radiation? How can we get that into one clinic space?’ It’s a large team and it’s all centered around this one disease.”

47th in the nation
In 2006, an HPV vaccine named Gardasil hit the market. It was originally intended to prevent HPV in females and, ultimately, HPV-related cervical cancer. But as scientists learned more about HPV—first that males could be carriers and later that it causes cancer in men, as well—public health professionals and clinicians unanimously recommended the vaccine to everyone. The CDC recommends all young women through the age of 26 and all young men through age 21 receive two doses for the vaccine to be effective.

And it is. A recent report published in May by Cochrane, a global independent network of clinical researchers and health care professionals, concluded that the HPV vaccine protects against cervical cancer in young women, especially when they are vaccinated between the ages of 15 and 26.

Which begs the question: Will the vaccine protect young men against the development of oropharyngeal cancers?

“There is a lot more data on cervical cancer in women and the vaccine than there is on head and neck cancer in men and the vaccine, but what data exists suggests that it is going to be a very effective intervention,” Sikora said.

Yet despite scientific evidence that prophylactic HPV vaccination of children and young adults will drastically reduce HPV-related cancers, vaccination rates in the U.S. remain alarmingly low—and Texas ranks 47th. Even more, several generations did not have the vaccine available to them and are currently at risk for HPV-related cancer.

As Karni said, it is alarming.

“Because the median age of oropharynx cancer related to HPV is about 55 and, in some studies, 60, and because the vaccine does not seem to work in individuals who have already been exposed, the benefits of vaccination on HPV-related cancer will not be realized for several decades,” Sturgis said. “Even if we vaccinate 100 percent of our boys and girls tomorrow, we have a whole generation or two who are at risk for this cancer and cannot do anything about it.”

Courville endured six rounds of chemotherapy and 33 daily rounds of radiation to treat his cancer. He lost a year of his life, 100 pounds, his taste buds and salivary glands, and can no longer grow his full beard— but his therapy was successful. He has now made it his life’s mission to inform the public about the importance of the vaccine as well as ongoing advocacy and research surrounding HPV-related cancers.

“If you can educate the public and educate the parents, they will vaccinate their kids,” Courville said. “And if we can vaccinate this generation, we could eliminate these types of cancers.”

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Ask the Dentist: Cancer patients should be aware how radiotherapy can affect saliva

Source: www.irishnews.com
Author: Lucy Stock

SALIVA – we normally give little thought to our spit but we definitely notice when it’s not there. Every day in the UK 31 people are diagnosed with a head and neck cancer. With increasing numbers of people undergoing radiotherapy for head and neck cancers there are more people living with the side-effects of not having enough saliva.

Dry mouth, termed xerostomia, is common after radiotherapy. It’s not only extremely uncomfortable, it makes speaking and swallowing more difficult and alters how things taste. Food can taste saltier, metallic; you can lose your sense of taste totally; and perhaps even worse, foods can taste foul, like sour milk.

Not being able to chew and swallow easily can reduce how much you eat and how well you eat, leading to weight loss and poor nourishment.

Saliva performs numerous jobs. It starts digestion by breaking down food and flushes food particles from between the teeth. Crucially, saliva contains minerals such as calcium and phosphate that keep teeth strong. So no saliva means that teeth decay rapidly and extensively. Even voice quality can change.

Without enough saliva, bacteria and other organisms in the mouth take the opportunity to grow uncontrollably. Nasty sores and mouth infections, including yeast thrush infections, are run-of-the-mill.

Luckily a dry mouth is usually a temporary nuisance that clears up in about two to eight weeks but it can take six months or longer for the salivary glands to start producing saliva again after radiotherapy ends.

In a 2017 study, out of several treatments tested, the drug pilocarpine gave the most significant improvement in dry mouth following radiotherapy. However, you may experience a side effect, albeit short lived, from this medication and it can take a couple of months to work.

Artificial salivas are available as lozenges, sprays and gels, the downside being that their benefits last only a few hours. The Biotene range is specially designed to help relieve dry mouths and includes toothpastes, mouthwashes and gels to give comfort and protect the teeth.

You can buy small atomiser spray bottles from most chemists and fill them with water or fluoride mouthwash. If you cannot swallow, your nurse or doctor can give you a nebuliser to moisten your mouth and throat. Always visit your dentist before cancer treatments to maximise the health of your mouth.

Relieve a dry mouth by:

  • Sipping water often
  • Avoiding drinks with caffeine which dry out the mouth
  • Chewing sugarless gum
  • Avoiding spicy or salty foods, which may cause pain
  • Avoiding tobacco or alcohol
  • Using a humidifier at night.
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Nivolumab Plus Stereotactic Body Radiotherapy Fails To Improve Outcomes in Head and Neck Cancer

Source: https://www.cancertherapyadvisor.com

 

CHICAGO—Although the addition of stereotactic body radiation therapy (SBRT) to nivolumab did not increase toxicity, it did not lead to any improvement in response rates or survival outcomes among patients with metastatic head and neck squamous cell carcinoma (HNSCC), according to an oral presentation at the American Society of Clinical Oncology 2018 Annual Meeting on Friday, June 1.

Researchers sought to determine whether or not SBRT to a single lesion plus nivolumab would improve abscopal responses (tumor regression in non-irradiated lesions) and other outcomes among this patient population.

In this phase 2 interventional study (ClinicalTrials.gov Identifier: NCT02684253), researchers randomly assigned 53 patients with metastatic HNSCC to receive nivolumab alone every 2 weeks or with SBRT between the first and second doses of nivolumab. The 2 study arms did not have any significant differences in terms of age, EBV/HPV viral status, primary site, or median lines of previous chemotherapy. The median follow-up was 12.8 months.

Results showed that the overall response rate (ORR) was 26.9% (95% CI, 13.7-46.1) compared with 22.2% (95% CI, 10.6-40.8) in the nivolumab alone arm and nivolumab plus SBRT arm, respectively (P = .94). Patients receiving nivolumab alone did not have an evaluable median duration of response (DOR) compared with 9.3 months (95% CI, 55.2-not reached [NR]) among patients in the SBRT arm.

The 1-year overall survival rate was 64% (95% CI, 47-88) in the nivolumab alone arm compared with 53% (95% CI, 36-79) in the nivolumab plus SBRT arm (P = .79); median progression-free survival (PFS) was 1.9 months (95% CI, 1.78-NR) compared with 2.4 months (95% CI; 1.0-11.4) with nivolumab plus SBRT (P = .8).

Treatment-related grade 3 and worse adverse effects were reported in 15% of patients who received nivolumab alone and in 11% of patients who received SBRT plus nivolumab (P = .96).

The authors concluded that “While safe, the addition of SBRT to nivolumab in M1 HNSCC failed to improve ORR, PFS, or OS. This is the first randomized evaluation of the abscopal response in any tumor histology.”

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June, 2018|Oral Cancer News|

History of the Anti-Vaccine Movement – When Did the Anti-Vaccine Movement Really Start?

February 8th, 2018
By: Vincent Iannelli, MD
Source: https://www.verywellfamily.com

It is likely a surprise to many people that there has always been an anti-vaccine movement. It isn’t something new that was created by Jenny McCarthy and Bob Sears.

18th Century Anti-Vaccine Movement

In fact, the anti-vaccine movement essentially predates the first vaccine.

Edward Jenner’s first experiments with a smallpox vaccine began in 1796.

Even before that, variolation as a technique to prevent smallpox was practiced for centuries in many parts of the world, including Africa, China, India, and the Ottoman Empire.

In fact, Onesimus, his African slave, taught Cotton Mather about the technique in 1706.

Lady Mary Wortley Montagu introduced inoculation to England, having learned about the practice in Turkey. As she encouraged others to inoculate and protect their children against smallpox, including the Royal Family, there was much debate. It is said that “Pro-inoculators tended to write in the cool and factual tones encouraged by the Royal Society, with frequent appeals to reason, the modern progress of science and the courtesy subsisting among gentlemen. Anti-inoculators purposely wrote like demagogues, using heated tones and lurid scare stories to promote paranoia.”

Were those the first vaccine debates?

19th Century Anti-Vaccine Movement

Eventually, Edward Jenner’s smallpox vaccine replaced variolation.

Even though this was much safer than the previous practice and smallpox was still a big killer, there were still those who objected.

Much of the resistance may have come because getting the smallpox vaccine in the UK in the 19th century was compulsory—you had to vaccinate your children or you would be fined, and the fines were cumulative.

The Anti-Vaccination League was created shortly after the passage of the Vaccination Act of 1853.

Another group, the Anti-Compulsory Vaccination League, was founded after the passage of the Vaccination Act of 1867, which raised the age requirements for getting the smallpox vaccine from 3 months to 14 years old.

There were anti-vaccination leagues in the United States, too.

That they actually called them “anti-vaccine” is one of the only big differences between these groups and the modern anti-vaccine movement.

Anti-vaccine groups in the 19th Century typically:

  • said that vaccines would make you sick
  • blamed medical despotism, “a hard, materialistic, infidel thing” for creating the vaccination acts
  • warned about poisonous chemicals in vaccines, namely carbolic acid in the smallpox vaccine
  • said that Jenner’s smallpox vaccine didn’t work
  • pushed alternative medical practices, including herbalists, homeopaths, and hydropaths, etc.
  • used their own literature to scare people away from vaccines

They even had some celebrities join the anti-vaccine movement, including George Barnard Shaw, who also believed in homeopathy and eugenics.

20th Century Anti-Vaccine Movement

Anti-vaccine groups didn’t change much in the 19th and early 20th Century.

That’s perhaps not too surprising, as after Jenner’s smallpox vaccine, it would be almost 100 years before another vaccine was developed—Louis Pasteur’s vaccine against rabies in 1885.

And it was more than 50 years before the American Academy of Pediatricsformally approved the use of a pertussis vaccine (1943).

Over the next few decades, the other vital vaccines that we know today were developed, including the DPT vaccine, polio vaccines, and MMR, etc.

Of course, the anti-vaccine movement was alive and well during this time, using all of the same tactics.

In 1973, John Wilson and M. Kulenkampff reported on 50 children seen over 11 years at the Hospital for Sick Children in London. He reported on a clustering of neurological complications in the first 24 hours of the kids getting their DPT shot, even though his team didn’t actually see the children for months or years later.

In 1974, they reported the findings of 36 of these children in the Archives of Diseases in Childhood.

As with a later report by Wakefield, media coverage of this small study led to fear of vaccines and lower immunization rates. John Wilson even appeared on “This Week,” a prime-time TV show in the UK. The consequences were not unexpected. In addition to a large outbreak in England, with at least 100,000 cases and 36 deaths, there were pertussis outbreaks and deaths in Japan, Sweden, and Wales after this study. Pertussis deaths in the UK were likely underreported, though, and some experts think that the actual number of childhood deaths was closer to 600.

While many people think that Lea Thompson’s “DPT: Vaccine Roulette” in 1982 helped create the modern anti-vaccine movement, it should be clear that others had a hand.

This was also the time that Dr. Robert Mendelsohn, a self-proclaimed “medical heretic” and one of the first anti-vaccine pediatricians, became infamous for writing “The Medical Time Bomb of Immunization Against Disease” and making the rounds on the talk shows of the day. Mendelsohn also was against adding fluoride to water and “coronary bypass surgery, licensing of nutritionists, and screening examinations to detect breast cancer.”

Lea Thompson’s show did prompt Barbara Loe Fisher and a few other parents to form the group Dissatisfied Parents Together (DPT). And from there we got her book, “A Shot in the Dark,” that had such a great influence on Dr. Bob Sears, and the eventual formation of the National Vaccine Information Center.

And since excerpts of “DPT: Vaccine Roulette” even ran nationally on the Today Show, it likely influenced a lot more people.

Next came accusations that the DPT vaccine caused SIDS. And that the hepatitis B vaccine causes SIDS. Barbara Loe Fisher was in the middle of many of these accusations, even testifying before Congress.

And while she was certainly not the first anti-vaccine celebrity, this was the time (1990) when Lisa Bonet of The Cosby Show fame went on The Donahue Show and said that vaccines could “introduce alien microorganisms into our children’s blood and the long-term effects which could be trivial or they could be quite hazardous – and they could just be allergies or asthma or sleep disorders or they could be cancer, leukemia, multiple sclerosis, sudden infant death syndrome. It’s very scary and it’s very serious, and I think because I felt wrong doing it…that’s why I didn’t do it. You know we have to think twice. You know why are our kids getting these diseases?”

A few years later, in 1994, the first deaf Miss America was crowned, with her mother blaming the DPT vaccine for her child’s deafness. Like many other vaccine-injury stories, Heather Whitestone’s story wasn’t what it seemed. Her pediatrician quickly came forward and set the record straight—she was deaf because of a life-threatening case of Hib meningitis and the subsequent treatment with an ototoxic antibiotic. It took several days for the media to run the corrected story, though.

Born in 1973, it would be another 15 years before the first Hib vaccine was approved and began to be routinely given to children. The DPT vaccine, which has never been shown to cause hearing problems, had nothing to do with Heather Whitestone’s deafness. It certainly didn’t stop anti-vaccine groups from using her initial story and the media coverage to scare parents about vaccines, though.

This is about the same time that Katie Couric did a segment on the NBC News show Now with Tom Brokaw and Katie Couric about DPT “hot lots.”

But of course, things didn’t really get moving in the modern anti-vaccine movement until the 1998 press conference for Andrew Wakefield’s study, when he said that “that is my feeling, that the risk of this particular syndrome developing is related to the combined vaccine, the MMR, rather than the single vaccines.”

ABC’s 20/20 even got in on the anti-vaccine misinformation, raising “serious new questions about a vaccine most children are forced to get” in their 1999 episode “Who’s Calling the Shots?”

The media didn’t take as big an interest in the fact that:

  • a series of lawsuits in England which were brought against the manufacturers of the DPT vaccines claiming they caused children to develop seizures and brain damage all found that the DPT vaccines did not cause vaccine injuries
  • a 1991 IOM report which concluded that the evidence doesn’t indicate a causal relationship between DPT and SIDS and there was insufficient evidence to suggest a causal relationship between DPT and chronic neurological damage and many other disorders
  • many cases of alleged vaccine encephalopathy secondary to the DPT vaccine were in fact caused by Dravet syndrome

It should even be considered “media malpractice” that they didn’t correct all of the misinformation in the Vaccine Roulette piece.

21st Century Anti-Vaccine Movement

The anti-vaccine groups in the 21st Century aren’t that much different from their 19th Century counterparts. They still:

  • say that vaccines will make you sick
  • blame Big Pharma
  • warn about poisonous chemicals and toxins in vaccines, although they continue to shift which chemicals they worry about, moving from thimerosal to formaldehyde and aluminum, etc.
  • say that Jenner’s smallpox vaccine didn’t work and neither do any of the other ones
  • push alternative medical practices, including herbalists, homeopaths, chiropractic, naturopaths, and other holistic providers
  • use their own literature to scare people away from vaccines

One difference is that instead of a few people writing pamphlets with their anti-vaccine ideas, like they did in Boston in 1721, now anyone can reach a lot more people by starting their own website or blog, posting in message boards, writing a book, or getting on TV, etc.

Another is that even more than the late 20th Century, we saw a great rise in the media scaring parents about vaccines in the last 10 or 15 years, including:

  • Jenny McCarthy on Larry King Live
  • Holly Pete on Larry King Live
  • Jenny McCarthy on Oprah in 2007
  • Jenny McCarthy in Time magazine in 2009
  • Matt Lauer interviewing Andrew Wakefield on Dateline in 2009
  • Katie Couric and HPV in 2013
  • Barbara Loe Fisher discussing “Forced Vaccinations” on Lou Dobbs in 2009
  • Matt Lauer and his hour-long Dateline episode, A Dose of Controversy, with Andrew Wakefield himself
  • Robert DeNiro on the Today Show in 2016

This is also the time when we saw the rise of the celebrity anti-vaccine spokesperson and the pandering pediatricians.

And we should have seen them coming. We were less than a week into the year 2000 when Cindy Crawford appeared on Good Morning America with her celebrity pediatrician, Dr. Jay Gordon.

But what’s really different today? Although the great majority of people still vaccinate their kids, clusters of intentionally unvaccinated children are certainly on the rise. And it is these clusters of unvaccinated kids and adults that are leading to a rise in outbreaks of vaccine-preventable diseases that are getting harder to control.

One thing that may be different now is that more people have grasped on to the Natural is the new Medicine movement. From amber necklaces and essential oils to sports magnets and homeopathic “medicines” on pharmacy shelves, these things go hand in hand with the modern anti-vaccine movement.

In addition to pandering pediatricians who push non-standard, parent-selected, delayed protection vaccine schedules, we now have more and more chiropractors, naturopaths, holistic pediatricians, and integrative pediatricians who might advise a parent to skip vaccines altogether. And with Dr. Oz on TV pushing a lot of these types of holistic remedies on TV every day, it probably does seem like an OK thing to do.

Big natural remedy websites that also push everything from organic food to medical conspiracy theories also provide a lot of fodder for anti-vaccine folks. Many others push fear about chemicals, so it isn’t surprising that it would be easy to scare parents about vaccines.

But still, it is important to keep in mind that these things have not become mainstream, it is just that the anti-vaccine movement has become a big business. From selling vitamins, supplements, e-books, e-courses, and holistic treatments to pushing for new laws ensuring that kids can stay intentionally unvaccinated and unprotected, they are the very vocal minority.

Of course, that doesn’t make them right.

Get Educated. Get Vaccinated. Stop the Outbreaks.

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May, 2018|Oral Cancer News|

Plasma-laser combo method for treating cancer is minimally invasive

Source: www.bioopticsworld.com
Author: Lee Dubay, Associate Editor, BioOptics World

Knowing that chemotherapy, radiation, and surgery can be expensive, weaken the immune system, and not work well for all cancer patients, a team of researchers at Purdue University (West Lafayette, IN) has developed a minimally invasive technique that may help doctors better explore and treat cancerous cells, tissues, and tumors without affecting nearby healthy cells.

The method, called PLASMAT (Plasma Technologies for a Healthier Tomorrow), combines cold atmospheric plasma (CAP) with electroporation and/or photoporation to kill cancerous cells without harming nearby healthy ones. The method has proven effective in the laboratory against several types of cancerous cells and cancer lines, including types of breast cancer, mouth/cervical cancer, and prostate cancer.

CAP, a near room-temperature ionized gas, is used to introduce active oxygen or nitrogen species into the cancerous cells, tissues, or tumors. An electric field or a laser is used to open the membranes of the cells for introduction of the species. This introduction leads to apoptosis (killing) of cancer cells once a critical level of reactive species is reached. Nearby healthy cells are either unaffected or minimally affected to a point they are able to easily restore themselves to a normal level.

 


“Using these three techniques in a combined method has been shown to be 70% to 90% more effective in killing cancerous cells than other treatments,” says Prasoon Diwakar, a postdoctoral research associate in the Purdue School of Nuclear Engineering, who developed PLASMAT along with Ahmed Hassanein, the Paul L. Wattelet Distinguished Professor of Nuclear Engineering.

Diwakar says PLASMAT does not introduce chemicals into the body during treatment and is significantly less expensive than chemotherapy or radiation. The technique is also more mobile than traditional cancer treatments because the required equipment is small and easily accessible in most medical settings.

“Our method is easy to integrate with existing method technologies,” Diwakar says. “PLASMAT can be combined with nanomedicines for further effective cancer treatment.”

A patent application has been filed by the Purdue Office of Technology Commercialization, and the method is available for licensing.

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When Is Insurance Not Really Insurance? When You Need Pricey Dental Care.

May 21, 2018
By: David Tuller
Source: https://khn.org

I’m 61 years old and a San Francisco homeowner with an academic position at the University of California-Berkeley, which provides me with comprehensive health insurance. Yet, to afford the more than $50,000 in out-of-pocket expenses required for the restorative dental work I’ve needed in the past 20 years, I’ve had to rely on handouts — from my mom.

This was how I learned all about the Great Divide between medicine and dentistry — especially in how treatment is paid for, or mostly not paid for, by insurers. Many Americans with serious dental illness find out the same way: sticker shock.

For millions of Americans — blessed in some measure with good genes and good luck — dental insurance works pretty well, and they don’t think much about it. But people like me learn the hard way that dental insurance isn’t insurance at all — not in the sense of providing significant protection against unexpected or unaffordable costs. My dental coverage from UC-Berkeley, where I have been on the public health and journalism faculties, tops out at $1,500 a year — and that’s considered a decent plan.

Dental policies are more like prepayment plans for a basic level of care. They generally provide full coverage for routine preventive services and charge a small copay for fillings. But coverage is reduced as treatment intensifies. Major work like a crown or a bridge is often covered only at 50 percent; implants generally aren’t covered at all.

In many other countries, medical and dental care likewise are segregated systems. The difference is that prices for major procedures in the U.S. are so high they can be out of reach even for middle-class patients. Some people resort to so-called dental tourism, seeking care in countries like Mexico and Spain. Others obtain reduced-cost care in the U.S. from dental schools or line up for free care at occasional pop-up clinics.

Underlying this “insurance” system in the U.S. is a broader, unstated premise that dental treatment is somehow optional, even a luxury. From a coverage standpoint, it’s as though the mouth is walled off from the rest of the body.

My humbling situation is not about failing to brush or floss, not about cosmetics. My two lower front teeth collapsed just before my 40th birthday. It turned out that, despite regular dental care, I had developed an advanced case of periodontitis — a chronic inflammatory condition in which pockets of bacteria become infected and gradually destroy gum and bone tissue. Almost half of Americans 30 and older suffer from mild to severe forms of it.

My diagnosis was followed by extractions, titanium implants in my jaw, installation of porcelain teeth on the implants, bone grafts, a series of gum surgeries — and that was just the beginning. I’ve since had five more implants, more gum and bone grafts and many, many new crowns installed.

At least I’ve been able to get care. The situation is much worse for people with lower incomes and no family support. Although Medicaid, the state-federal insurer for poor and disabled people, covers children’s dental services, states decide themselves on whether to offer benefits for adults. And many dentists won’t accept patients on Medicaid, child or adult, because they consider the reimbursement rates too low.

The program typically pays as little as half of what they get from patients with private insurance. For example, as Kaiser Health News reported in 2016, Medicaid in Colorado pays $87 for a filling on a back tooth and $435 for a crown, compared with the $150 and $800 that private patients typically pay.

“It’s really a labor of love to do it,” said Dana Lubet, a recently retired dentist in Madison, Wis., who estimated Medicaid paid only a third of his costs. Accepting too many, he said, “could easily kill your practice.”

A few years ago, while in his mid-50s, Nick DiGeronimo, a facility maintenance worker at a New Jersey sports center, obtained private insurance coverage through the Affordable Care Act, hoping to get treatment for progressive tooth decay.

He needed two implants but, to his dismay, the plan did not cover them. To pay the $10,500 bill, he had to take out loans. “Dental insurance is basically useless,” said DiGeronimo. “It’s a sham, a waste of money, and another case of the haves versus the have-nots.”

As for older Americans, many lose employer-based dental coverage when they retire even as they suffer from increasing dental problems. Among those 65 and older, 70 percent have some form of periodontal disease, according to the Centers for Disease Control and Prevention. Yet basic Medicare plans do not include dental coverage, although options exist for seniors to purchase it.

Overall, in 2015, almost 35 percent of American adults of working age did not have dental insurance. By contrast, only about 12 percent of American adults under 65 did not have medical insurance in 2016. That lack of coverage and treatment can diminish economic and social opportunities — for instance, it can be costly at work or in a job interview not to smile because of unsightly or missing teeth.

Eventually, poor prevention and treatment can become a medical problem — leading to serious, and occasionally deadly, health consequences. In an infamous 2007 case — described by Mary Otto in her book “Teeth: The Story of Beauty, Inequality and the Struggle for Oral Health in America” — Deamonte Driver, a 12-year-old boy in Maryland, died after a tooth infection spread to his brain. The family’s Medicaid coverage had lapsed.

Research has demonstrated links between periodontal infections and chronic conditions like diabetes and cardiovascular disease. Studies have found associations between periodontitis and adverse pregnancy outcomes, such as premature labor and low birth weight. Tooth problems also hinder chewing and eating, affecting nutritional status.

The split between the medical and dental professions, however, has deep roots in history and tradition. For centuries, extracting teeth fell to tradesfolk like barbers and blacksmiths — doctors didn’t concern themselves with such bloody surgeries.

In the U.S., the long-standing rift between doctors and dentists was institutionalized in 1840, when the University of Maryland refused to add training in dentistry and oral surgery to its medical school curriculum — leading to the creation of the world’s first dental school.

Dentists have in some ways benefited from the separation — largely escaping the corporate consolidation of American medicine, with many making good livings in smaller practices. Patients often willingly pay out-of-pocket, at least to a point.

Some people deliberately forgo dental coverage, considering it less urgent than having insurance against medical catastrophes. “You might not get a job as hostess at the restaurant, but by the same token people that have a lot of missing teeth live to tell the tales,” Lubet said.

With fluoridation and advances in treatment, many Americans have come to take the health of their teeth for granted and shifted their attention to more cosmetic concerns. And the dental field has profited from the business.

In my experience, which includes extensive travel in other countries, Americans often seem disoriented or even horrified when confronted with imperfect dentition. During my period of intense dental care here, I hated wearing temporaries and often braved the public with missing front teeth. I found myself routinely reassuring people that, yes, I knew about the gap, and yes, I was having it dealt with.

Meanwhile, the bold line between what is covered or what is not often strikes patients as nonsensical.

Last fall, Lewis Nightingale, 68, a retired art director in San Francisco, needed surgery to deal with a benign tumor in the bone near his upper right teeth. The oral surgeon and the ear, nose and throat doctor consulted and agreed the former was best suited to handle the operation, although either one was qualified to do it.

Nightingale’s Medicare plan would have covered a procedure performed by the ear, nose and throat doctor, he said. But it did not cover the surgery in this case because it was done by an oral surgeon — a dental specialist. Nightingale had no dental insurance, so he was stuck with the $3,000 bill.

If only his tumor had placed itself just a few inches away, he thought.

“I said, what if I had nose cancer, or throat cancer?” Nightingale said. “To separate out dental problems from anything else seems arbitrary. I have great medical insurance, so why isn’t my medical insurance covering it?”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

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May, 2018|Oral Cancer News|

Eight-time GRAMMY® winner Ziggy Marley partners with the Oral Cancer Foundation

Source: ww.prnewswire.com
Author: press release

The Oral Cancer Foundation has a new relationship with eight-time GRAMMY® winner, Emmy winner, humanitarian, singer, songwriter and producer, Ziggy Marley. Mr. Marley has generously offered to allow CharityBuzz to auction off three (3) VIP events for two (2) on his REBELLION RISES TOUR. The winner(s) will enjoy this highly anticipated tour that only a select few get to experience up close and personal, meeting Mr. Marley. After the concert at a tour city of the winners choosing, a photo opportunity will be provided during their meet & greet with Ziggy Marley himself. The tour starts in America and travels to several European cities. Raising funds for the oral cancer issue via OCF, this auction will help support awareness campaigns, research, early discovery initiatives, and outreach that will help save lives. The auction begins today; May 20, 2018. Available tour dates are here: https://bit.ly/2dZPCcR (Dates may be subject to change).

Grammy winning artist Ziggy Marley partners with the Oral Cancer Foundation to raise awareness of the disease, and funds for its many missions to reduce impact of oral cancers. (PRNewsfoto/Oral Cancer Foundation)

Reggae icon Ziggy Marley will release his seventh full-length solo studio album, Rebellion Rises, on May 18th through Tuff Gong Worldwide. Fully written, recorded and produced by Marley, this passionate and indelible new collection of music encourages people to stand together in activism through love.

Ziggy Marley has released many albums to much critical acclaim. His early immersion in music came at age ten when he sat in on recording sessions with his father, Bob Marley. As front man to Ziggy Marley & The Melody Makers, the group has released ten live and studio albums, three of which became GRAMMY-winners with such chart-topping hits as “Look Who’s Dancing,” “Tomorrow People,” and “Tumbling Down.” Then, in an effort to pursue his own creative endeavors, 2003 saw the launch of Ziggy’s solo career with the release of Dragonfly (RCA Records). His second solo effort, Love Is My Religion (Tuff Gong Worldwide), won a GRAMMY in 2006 for Best Reggae Album, as did the subsequent release of Family Time (Tuff Gong Worldwide) in 2009 for Best Children’s Album. 2011’s Wild and Free was also nominated for Best Reggae Album, the same year in which Ziggy debuted his first-ever graphic novel, Marijuanaman. In addition to his music, Marley established the U.R.G.E. (Unlimited Resources Giving Enlightenment) organization to help children in poverty.

You can go directly to the auction item and start bidding at the following link: https://www.charitybuzz.com/catalog_items/meet-ziggy-marley-with-2-vip-tickets-to-his-rebellion-1527300

About the Oral Cancer Foundation
While the financial support for the many missions OCF engages in is important, our view of this amazing opportunity is focused elsewhere. The foundation represents a deadly disease that in the US too many people have not even heard of until it directly impacts their lives. That lack of visibility, that lack of the disease having a significant voice, has far reaching implications. The most obvious is that without national awareness, the knowledge of avoidable risk factors that might bring you to it does not exist. Further, absent a well-established national screening program, the early discovery of pre-cancers, and early stage disease does not currently take place often. This means poorer long-term outcomes, a much higher morbidity from the treatments patients must undergo to cope with an advanced stage disease, and a high 5-year death rate.

While OCF may be the largest of the oral cancer charities and within that group have the greatest reach, we still are small when compared to charities that represent larger incidence cancers whose names are household words. These large charities impact hundreds of thousands each year in the US alone, and take in tens, if not hundreds of millions of dollars a year in donations to advance their agendas and serve the populations they represent. We do not have those assets to work with, but we can develop strategic partners that help us in other ways. OCF’s thoughts are on what this relationship means to that paradigm. We may be at a tipping point in the disease if we can raise the awareness of it. When people with this much visibility become associated with a problem, it cascades into CHANGE.

We hope all of you who read this, especially those who have had this disease touch their lives, will Share on FaceBook, Tweet, and post on Instagram about this relationship, the auctions, and spread the word; so that this opportunity of increased visibility for oral cancer, and a change from late to early discovery and diagnosis can be realized.

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An AI oncologist to help cancer patients worldwide

Source: www.sciencedaily.com
Author: staff, University of Texas at Austin, Texas Advanced Computing Center

Comparison between predicted ground-truth clinical target volume (CTV1) (blue) and physician manual contours (red) for four oropharyngeal cancer patients. The primary and nodal gross tumor volume is included (green). From left to right, we illustrate a case from each site and nodal status (base of tongue node-negative, tonsil node-negative, base of tongue node-positive, and tonsil node-positive).
Credit: Carlos E. Cardenas, MD Anderson Cancer Center

Before performing radiation therapy, radiation oncologists first carefully review medical images of a patient to identify the gross tumor volume — the observable portion of the disease. They then design patient-specific clinical target volumes that include surrounding tissues, since these regions can hide cancerous cells and provide pathways for metastasis.

Known as contouring, this process establishes how much radiation a patient will receive and how it will be delivered. In the case of head and neck cancer, this is a particularly sensitive task due to the presence of vulnerable tissues in the vicinity.

Though it may sound straightforward, contouring clinical target volumes is quite subjective. A recent study from Utrecht University found wide variability in how trained physicians contoured the same patient’s computed tomography (CT) scan, leading some doctors to suggest high-risk clinical target volumes eight times larger than their colleagues.

This inter-physician variability is a problem for patients, who may be over- or under-dosed based on the doctor they work with. It is also a problem for determining best practices, so standards of care can emerge.

Recently, Carlos Cardenas, a graduate research assistant and PhD candidate at The University of Texas MD Anderson Cancer Center in Houston, Texas, and a team of researchers at MD Anderson, working under the supervision of Laurence Court with support from the National Institutes of Health, developed a new method for automating the contouring of high-risk clinical target volumes using artificial intelligence and deep neural networks.

They report their results in the June 2018 issue of the International Journal of Radiation Oncology*Biology*Physics.

Cardenas’ work focuses on translating a physician’s decision-making process into a computer program. “We have a lot of clinical data and radiation therapy treatment plan data at MD Anderson,” he said. “If we think about the problem in a smart way, we can replicate the patterns that our physicians are using to treat specific types of tumors.”

In their study, they analyzed data from 52 oropharyngeal cancer patients who had been treated at MD Anderson between January 2006 to August 2010, and had previously had their gross tumor volumes and clinical tumor volumes contoured for their radiation therapy treatment.

Cardenas spent a lot of time observing the radiation oncology team at MD Anderson, which has one of the few teams of head and neck subspecialist oncologists in the world, trying to determine how they define the targets.

“For high-risk target volumes, a lot of times radiation oncologists use the existing gross tumor disease and apply a non-uniform distance margin based on the shape of the tumor and its adjacent tissues,” Cardenas said. “We started by investigating this first, using simple distance vectors.”

Cardenas began the project in 2015 and had quickly accumulated an unwieldy amount of data to analyze. He turned to deep learning as a way of mining that data and uncovering the unwritten rules guiding the experts’ decisions.

The deep learning algorithm he developed uses auto-encoders — a form of neural networks that can learn how to represent datasets — to identify and recreate physician contouring patterns.

The model uses the gross tumor volume and distance map information from surrounding anatomic structures as its inputs. It then classifies the data to identify voxels — three-dimensional pixels — that are part of the high-risk clinical target volumes. In oropharyngeal cancer cases, the head and neck are usually treated with different volumes for high, low and intermediate risk. The paper described automating the target for the high-risk areas. Additional forthcoming papers will describe the low and intermediate predictions.

Cardenas and his collaborators tested the method on a subset of cases that had been left out of the training data. They found that their results were comparable to the work of trained oncologists. The predicted contours agreed closely with the ground-truth and could be implemented clinically, with only minor or no changes.

In addition to potentially reducing inter-physician variability and allowing comparisons of outcomes in clinical trials, a tertiary advantage of the method is the speed and efficiency it offers. It takes a radiation oncologist two to four hours to determine clinical target volumes. At MD Anderson, this result is then peer reviewed by additional physicians to minimize the risk of missing the disease.

Using the Maverick supercomputer at the Texas Advanced Computing Center (TACC), they were able to produce clinical target volumes in under a minute. Training the system took the longest amount of time, but for that step too, TACC resources helped speed up the research significantly.

“If we were to do it on our local GPU [graphics processing unit], it would have taken two months,” Cardenas said. “But we were able to parallelize the process and do the optimization on each patient by sending those paths to TACC and that’s where we found a lot of advantages by using the TACC system.”

“In recent years, we have seen an explosion of new projects using deep learning on TACC systems,” said Joe Allen, a Research Associate at TACC. “It is exciting and fulfilling for us to be able to support Carlos’s research, which is so closely tied to real medical care.”

The project is specifically intended to help low-and-middle income countries where expertise in contouring is rarer, although it is likely that the tools will also be useful in the U.S.

Cardenas says such a tool could also greatly benefit clinical trials by allowing one to more easily compare the outcomes of patients treated at two different institutions.

Speaking about the integration of deep learning into cancer care, he said: “I think it’s going to change our field. Some of these recommender systems are getting to be very good and we’re starting to see systems that can make predictions with a higher accuracy than some radiologists can. I hope that the clinical translation of these tools provides physicians with additional information that can lead to better patient treatments.”

Story Source:

Materials provided by University of Texas at Austin, Texas Advanced Computing Center. Note: Content may be edited for style and length.

Journal Reference:

1. Carlos E. Cardenas, Rachel E. McCarroll, Laurence E. Court, Baher A. Elgohari, Hesham Elhalawani, Clifton D. Fuller, Mona J. Kamal, Mohamed A.M. Meheissen, Abdallah S.R. Mohamed, Arvind Rao, Bowman Williams, Andrew Wong, Jinzhong Yang, Michalis Aristophanous. Deep Learning Algorithm for Auto-Delineation of High-Risk Oropharyngeal Clinical Target Volumes With Built-In Dice Similarity Coefficient Parameter Optimization Function. International Journal of Radiation Oncology*Biology*Physics, 2018; 101 (2): 468 DOI: 10.1016/j.ijrobp.2018.01.114

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Supportive care for patients with head and neck cancer

Source: www.oncnursingnews.com
Author: Melissa A. Grier, MSN, APRN, ACNS-BC

Supporting a patient during cancer treatment is a challenge. From symptom management to psychosocial considerations, each patient’s needs vary and must be reevaluated frequently. This is especially true for patients with head and neck cancer.

Head and neck cancers often result in serious quality of life issues. Surgical resection of the affected area can cause disfigurement that not only affects function (eating, drinking, speaking, etc) but also leads to self-image concerns and depression. Radiation therapy and chemotherapy may cause a variety of unpleasant adverse effects, including burns, xerostomia, dental caries, and mucositis. Below are some considerations to help guide nursing care for this patient population.

CALL FOR REINFORCEMENTS
National Comprehensive Cancer Network guidelines recommend early involvement of a dentist, a dietitian, and a speech therapist to help address pre- and posttreatment concerns and preserve quality of life for people with head and neck cancer. The benefits of multidisciplinary collaboration for these complex cases are many but may also result in confusion and information overload for your patient. As the healthcare team provides care, you can help explain the rationale for interventions and assist them with keeping track of recommendations. Additionally, you have a team of experts you can call on when specific issues present themselves during treatment.

KEEP AN EYE OUT
A lot goes on in the life of a patient with head and neck cancer, which means everyday activities like oral and skin care may fall a little lower on their priority list. Performing frequent assessments and assisting with hygiene is vital to preserving and improving quality of life, for example:

  • Help your patients use a handheld mirror to examine their mouth and throat.
  • Ensure that oral care products don’t contain alcohol or other ingredients that can irritate sensitive tissue.
  • Educate your patients about self-care, and guide them toward performing independent dressing changes and surgical site care.
  • Encourage your patients to report any new adverse effects or concerns so they can be addressed promptly.

MEET IN THE MIDDLE
Several factors contribute to malnutrition associated with head and neck cancers. Pain related to mucositis or radiation burns decreases the likelihood that a patient will maintain adequate oral intake. Functional changes following surgery can lead to dysphagia that impairs a patient’s ability to safely receive nutrition and medication by mouth.

To ensure adequate nutrition, many patients with head and neck cancer receive a percutaneous endogastric (PEG) tube prior to beginning treatment. It’s imperative that the patient, the dietitian, and the nursing staff maintain an open line of communication and work together to meet nutritional needs. The patient will likely struggle with losing the ability to taste food and the satisfaction of choosing what they want to eat, so it’s important to allow them to control when they want to receive tube feedings and to follow up frequently to ensure the feedings are being tolerated.

When administering medication via PEG, pay close attention to administration instructions and drug interactions. Extended-release and sustained-release medications should never be crushed and given via PEG. Each medication should be crushed and administered individually, followed by a flush of room-temperature or lukewarm water. If a patient has several medications scheduled at the same time, assess whether administration times can be changed or allow enough time to administer them slowly to avoid patient discomfort related to a high volume of fluid. Lastly, pay attention to whether medication should be administered on a full or empty stomach and coordinate medication administration with tube feedings accordingly.

Although nurses can’t eliminate the hardship that patients will face during treatment for head and neck cancer, we can support them by providing compassionate and thorough care.

Melissa A. Grier, MSN, APRN, ACNS-BC, is a clinical content developer for Carevive Systems, Inc.

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