Epidemiology
In Australia, healthcare costs for Aboriginal and Torres Strait Islander peoples, including First Nations Australians, are noted to be lower than for other Australians due to lower health-service utilization 9. However, cancer incidence and mortality rates are higher and increasing among First Nations Australians compared to other Australians 12.
Clinical Presentation
The study [PMID:31687949] found that conditions in the oral cavity identified by dentists were more severe than what patients reported, suggesting that oral symptoms might be underrecognized in advanced cancer patients.
Before treatment, patients predominantly experience functional impairments related to chewing and swallowing, highlighting these as critical clinical presentations [PMID:12089691].
Oral symptoms reported in 20 hospice patients included disturbance of taste (26%), dysphagia (37%), soreness (42%), and dryness (58%) [PMID:1831294].
Management
Participants in a Queensland study had a median of five hospital admissions during the end-of-life phase, with 85% in acute care and 15% in palliative care 13. Most admissions were related to cancer or its treatment 13.
The study by Berke et al. ([PMID:19207055]) demonstrates that integrating Part A (inpatient) and Part B (outpatient) Medicare claims data, using a primary or secondary cancer diagnosis within 180 days prior to death, effectively identifies end-of-life cancer cohorts with high accuracy (78.7% attainment). This approach can enhance the precision of palliative care delivery for patients like those with carcinoma of the lower gum nearing end-of-life stages.
The research [PMID:31687949] indicates that oral cavity conditions and pathologies identified during examination are treatable and can potentially enhance the quality of life for incurable cancer patients receiving palliative care.
The study highlights that functional disorders, rather than pain, predominantly affect quality of life post-surgery [PMID:12089691]. It emphasizes the need for intensifying functional reconstruction using microvascular techniques and early physiotherapy implementation.
The study notes that physiotherapy is underutilized post-surgery, with only a small fraction of patients (less than 10%) receiving such interventions, suggesting a gap in current management practices [PMID:12089691].
Among 75% of patients who wore dentures, 71% experienced difficulties with their prostheses [PMID:1831294].
Complications
A larger study reported that 22% of First Nations people had moderate to high levels of unmet supportive care needs, with financial concerns being a major factor 14.
Post-surgical complications include pain in the shoulder region reported by 38.5% of patients and in the neck by 34.9%, underscoring the need for comprehensive pain management strategies [PMID:12089691].
A clinical diagnosis of oral candidiasis was made in 70% of the surveyed hospice patients [PMID:1831294].
Prognosis & Follow-up
In the Queensland study, 78% of participants died in hospital 13, highlighting the critical need for culturally safe and comprehensive EOL care 10.
Berke et al. ([PMID:19207055]) highlight the importance of accurate identification methods for end-of-life cancer patients, suggesting that such methodologies can provide valuable insights into prognosis and necessary follow-up care. For patients with advanced carcinomas like those in the lower gum, these identification techniques can support tailored follow-up plans and palliative care adjustments.
Despite pain being a significant pre-operative concern, the study indicates that functional impairments such as speech intelligibility and mobility issues have a more substantial impact on postoperative quality of life [PMID:12089691].
The high prevalence of oral symptoms, denture problems, and candidiasis clearly affect the quality of remaining life in terminally ill patients [PMID:1831294].
Special Populations
Currently, there is a lack of comprehensive data guiding the design and delivery of optimal and culturally safe EOL care for First Nations Australians diagnosed with cancer 10.
References
1 Berke EM, Smith T, Song Y, Halpern MT, Goodman DC. Cancer care in the United States: identifying end-of-life cohorts. Journal of palliative medicine 2009. link 2 Tebidze N, Chikhladze N, Janberidze E, Margvelashvili V, Jincharadze M, Kordzaia D. PERCEPTION OF ORAL PROBLEMS IN PATIENTS WITH ADVANCED CANCER. Georgian medical news 2019. link 3 Gellrich NC, Schimming R, Schramm A, Schmalohr D, Bremerich A, Kugler J. Pain, function, and psychologic outcome before, during, and after intraoral tumor resection. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2002. link 4 Aldred MJ, Addy M, Bagg J, Finlay I. Oral health in the terminally ill: a cross-sectional pilot survey. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry 1991. link
4 papers cited of 5 indexed.