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120 rev port estomatol med dent cir maxilofac. 2019;60(3):118-124

oral complications, as well as increase the comfort and qual- trate the changes felt and observed during and after CT. The
ity of life of these patients before, during and after CT. 6 Mann-Whitney and the Kruskal-Wallis tests were used to ver-
At the time of this study, the authors found some studies ifying potential associations between the number of oral man-
about CT-related oral complications and symptoms in pediat- ifestations and the cycles and duration of CT, the frequency of
ric populations. 3,12,13 However, studies about the prevalence of dental appointments and the quality of life. Changes in qual-
CT oral manifestations in adult populations, as well as the ity of life were assessed using a sign rank test.
patient’s associated experience, were scarce. There were also
some CT studies associated with other oncology therapies, like
radiotherapy. 14 Results
This study aimed to investigate oral manifestations and
symptoms during CT in a sample of onco-hematology pa- The final sample consisted of 49 patients treated in an outpa-
tients, and whether oral health routines influence the patient’s tient hospital, with a mean age of 53.6 years (±19.2 [18-84]).
experience of oral manifestations and symptoms. The majority of patients were male (53.1%), had primary edu-
cation or less (53.1%) and had intermediate professional qual-
ifications (57.1%).
Material and Methods The most observed oncologic pathology was lymphoma
(67.3%), followed by leukemia (26.5%); there were a few cases
This observational study was conducted in November and of myeloma (4.1%). At the time, 48 (98%) patients had been
December 2017 in an adult population submitted to CT at the doing CT for more than three months (53.1%). In all cases,
Francisco Gentil Portuguese Institute of Oncology – Lisbon chemotherapeutic agents were delivered intravenously.
Center (Instituto Português de Oncologia Francisco Gentil de The number of CT cycles varied between one (14.3%) and
Lisboa – IPOFGL). Patients were recruited from the outpatient six or more (34.6%), with almost two-thirds of patients having
clinic of two departments, which gave permission: Hematolo- had less than six cycles (65.3%). Besides CT, 11 (22.4%) patients
gy Department and Myeloma Clinic (Serviço de Hematologia had also had radiotherapy and/or surgery in locations other
e Clínica de Mieloma). To be eligible to participate, patients than the head and neck. Additionally, all patients were under
could not have conditions that affect the logic, such as de- other medications besides CT for other systemic conditions, of
mentia or other incapacities that would impede them from which cardiovascular drugs were the most frequent (60.7%).
answering the questionnaire with consciousness and respon- Metabolic and digestive system drugs were the second most
sibility. Patients that had been submitted to major oral sur- frequent drugs (57.1%). Some patients were also under antibi-
gery and/or head and neck radiotherapy were also excluded otics and nervous system drugs (14.3% and 10.7%, respectively).
because these could compromise the interpretation of CT ef- All patients brushed their teeth daily, with 91.8% of the
fects independently. patients doing it at least twice a day. Interdental means of
For data collection, a questionnaire based on the literature plaque removal were used by a quarter (26.5%) of the sample,
and the European Organization for Research and Treatment of with dental floss being the most used (18.4%). Mouth rinses
Cancer Quality of Life Questionnaire – Head and Neck module were commonly used by 71.4% of the patients.
(EORTC QLQ–H&N35) was used. The questionnaire had three Almost 70% of patients received instructions on daily oral
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sections. The first was about the oncologic pathology (diagno- hygiene, and the most frequent instruction was rinsing (67.3%)
sis, location of the pathology, treatment modality and medi- with a non-alcoholic solution (69.4%). Diet recommendations
cation). The second section was about daily oral hygiene rou- were less frequently reported (24.5%), and a soft diet (75%) was
tine before and after CT. The last section was the self-reported the most common recommendation. No patient reported be-
changes in the oral cavity during CT as well as the oral ing recommended a cold diet, a non-spicy diet, an acid diet or
health-related quality of life. Lastly, the participant’s sociode- tobacco and alcohol avoidance.
mographic data were also recorded. An oral examination was Eighteen patients (36.7%) made changes to their oral hy-
performed to evaluate the decayed, missing and filled teeth giene routine, and, for 94.4% of those, the change was to in-
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(DMFT) index, the simplified oral hygiene index (OHI-s), tensify toothbrushing or rinsing frequencies. One patient
and the presence/absence of oral changes (hyperplasia, reces- (2.0%) reported that he started brushing less often. Regarding
sions, mobility, mucositis, xerostomia, ulcers/sores, infection, diet, 14.3% of the patients did not make any change during CT.
sensibility, halitosis, loss of appetite, Candidiasis and alike, Most patients (89.8%) felt changes in their oral cavity
white/red lesions, herpes, dysgeusia, gingival changes, mouth during CT. The most common change was xerostomia (71.7%),
soreness, tooth pain, difficulty in speech and feeding, and tem- followed by dysgeusia (47.8%), dental hypersensitivity (39.1%)
poromandibular joint pain). The questionnaire and the oral and mouth ulcers and loss of appetite (30.4%). Pain and func-
examination took part during one session of CT treatment in tion difficulties were reported by 13 patients (26.5%), and
an outpatient hospital of IPOFGL. mouth soreness (15.2%), TMJ pain (12.2%), difficulties in speech
The Council of Research, the Ethics Commission and the (12.2%), difficulties in feeding (10.2%) and tooth pain (8.2%)
Administration Board of IPOFG approved the study protocol were also mentioned. In the intraoral examination, gingival
(Ref UIC/1099). Each potential participant was invited, and changes (inflammation, hemorrhage, and hyperplasia) were
signed informed consent was obtained. Data were analyzed the most common oral manifestation (77.6%), followed by den-
using the software Statistical Package for the Social Sciences tal caries (42.6%) and halitosis (24.5%). Mucositis was observed
®
(SPSS , version 25). Descriptive statistics were used to illus- in nine patients (18.4%) (Table 1).