Exploring oral health care for patients undergoing head and neck cancer therapy: A case study in eThekwini District, KwaZulu-Natal. Results show that head and neck cancer patients reported limited access to professional oral health care.
INTRODUCTION
- Introduction
- Problem Statement
- Purpose of the study
- Research Questions
- Aim and Objectives of the study
- Chapter Outline (Format of the the dissertation)
- Summary
Thus, oral health planning for patients with head and neck cancer will be patient-based. What are the oral health practices of persons undergoing therapy for head and neck cancer.
LITERATURE REVIEW
Introduction
Worldwide, head and neck cancer is the sixth most common cancer (Tanaka, Tanaka, & Tanaka, 2011; Joshi et al., 2014). Literature shows that head and neck cancer is male predominated (Joshi et al., 2014).
Contextual setting: Describing KwaZulu-Natal
Poverty is particularly prevalent in rural areas of KZN (KwaZulu-Natal Department of Health, 2016, p. 18). Extreme poverty was experienced by 28%, while absolute poverty was present in 29% of the total KZN population in the year 2012 (KwaZulu-Natal Department of Health, 2016, p. 18).
KwaZulu-Natal cancer crisis
The poverty figure for KwaZulu-Natal is estimated to be 7.7% and the poverty intensity is 42.5% (Statistics South Africa, 2016). The lowest absolute poverty level is found in Ethekwini and UmGungundlovu while the highest absolute poverty level is in Harry Gwala, Zululand, Umzinyathi and Umkhanyakude districts (KwaZulu-Natal Department of Health, 2016, p. 18).
Challenges facing health care
The long waiting period claimed the lives of several hundred cancer patients in KZN (Ndaliso, 2017a). The high burden of all these diseases therefore places an unequal demand on the South African health system (KwaZulu-Natal Department of Health, 2016).
Scope of oral health care and education
Challenges in equitable oral health care distribution
Similarly, oral health care has always been inadequate in the province (Dookie, Singh and Myburgh, 2017). However, the pattern of oral health service delivery within rural areas is also uneven across the province (Dookie, Singh, & Myburgh, 2017).
Package of care and policy planning
In addition, the reduction in the ratio of extraction to filling, which has been fluctuating since 2005, was also prepared in the KwaZulu-Natal Oral Health Plan (Dookie, Singh and Myburgh, 2017). A study by Singh et al also reported that persuasive strategies for oral health have been proposed and exist on paper in the South African health care system, but are not fully translated into action, so there is a lack of meaningful content. (Singh, Myburgh and Lalloo, 2010).
Philosophy of health promotion
- Ottawa Charter
- Jakarta Declaration
- Bangkok Charter
It provides guidance to the goals and concepts of health promotion in public health (Flynn, 2015). The principles established in the charter are fundamental to health promotion activities (McPhail-Bell, Fredericks and Brough, 2013).
Oral health promotion strategies in head and neck cancer
- Toothbrushing and fluoride toothpaste
- Fluoride rinses
- Custom made fluoride trays
- Fluoride gels, varnishes and lacquers
- Interdental aids
- Water fluoridation
- Diet instructions
The buffering effect and composition of proteins are altered, creating mucoid acidic fluid (Papas et al., 2008). Following a diet specifically designed for patients with head and neck cancer is important to correct weight loss and metabolic stress (Colasanto et al., 2005).
Health promotion settings
- Hospitals and clinics
- Hospices and homes
Maintaining and promoting oral cancer care is a critical determinant of improving overall health and well-being in holistic settings (Simons, 2016). Another study from England has shown the importance of integrating oral care care for cancer patients who suffer from oral problems due to the cancer itself or the side effects of cancer therapy (Simons, 2016).
Oral health promotion in cancer
- Life style and socio-economic risk factor intervention through educational
- Education and training of oral health promoters
- Self examination of oral cavity
- Early screening and recognition of factors which delay diagnosis
- Incorporating head and neck malignancy as a CPD topic
The campaign against oral cancer carried out by Brazil also proved to be very useful and had a positive impact on the oral health of the population (Martins et al., 2012). Therefore, updates in professional education related to head and neck malignancies are essential to improve treatment outcomes (Hertrampf et al., 2009).
Palliative approach to promote health
Palliative care is based on the relief of suffering from cancer pain with the aim of accepting life as it is and viewing death as the law of nature (World Health Organization, 2003). In addition to psychological upliftment and counseling, palliative care is also based on compliance with medication to relieve pain (World Health Organization, 2003).
Risk factors of head and neck cancer
- Chemical and environmental factors
- Biological Factors
- Diet
Herpes simplex virus (HSV), also known as human herpes virus (HHV), is associated with several malignancies, including that of the head and neck (McLemore et al., 2010). The syphilitic lesion on the lip can give rise to squamous cell carcinoma in the oral cavity (Strieder et al., 2015).
Oral health assessment and management
Head and neck cancer patients very often present with poor oral health (Critchlow, Morgan and Leung, 2014). Oral health is vital to overall well-being in head and neck cancer (Pateman et al., 2015).
Impact of head and neck cancer therapies oral health
- Surgery
- Radiotherapy
- Chemotherapy
Socioeconomic impact of head and cancer
In a study conducted in Denmark, 45,149 out of 236,993 cancer participants suffered unemployment after active treatment (Carlsen et al., 2008). The socio-economic status and level of education are factors that can be linked to the risk of unemployment (Carlsen et al., 2008).
Perception of self esteem and body image
A low socioeconomic status is also related to non-adherence to treatment and disadvantaged quality of life and well-being (O'Brien et al., 2017). The literature states that 20% to 50% of cancer patients in general have low self-esteem (Kobayashi et al., 2008).
Summary
However, patients with cancer of the head and neck region are more exposed to body image and self-esteem issues than patients with cancer in other regions, due to the easily observable or observable nature of the head and neck region (Kobayashi et al., 2008; Nayak, Pai and George, 2016). It is also reported that patients with head and neck cancer experience greater isolation, worsening relationships with their partners, and experience more psychological distress and depression compared to other cancers (Gamba et al., 1992; Kobayashi et al., 2008) .
STUDY DESIGN AND METHODOLOGY
Introduction
Study design
Study site
Sample population
Selection of research participants (patients) for the questionnaire phase
- Inclusion criteria
- Exclusion criteria
Sampling framework
- Sampling technique
- Sample size
Data collection tools for the questionnaire phase
Interview schedules
- Interview schedule for patient interviewees
- Interview schedule for Ethekwini oral health district coordinator
Data collection process
Data analysis
- Data analysis for the quantitative phase
- Data analysis for the qualitative phase
Ethical considerations
- Ethical clearance and permission to conduct study
- Confidentiality, beneficence and data storage
- Scientific validity and reliability in the quantitative data
- Rigour and trustworthiness in the qualitative data
- Respect for participants, participant information sheet and informed consent
Budget required and work plan
Dissemination of results
Summary
MANUSCRIPT PRESENTATION
Reduction in sugar intake frequency is one of the foundations of oral health promotion (Solhi et al., 2010). Radiotherapy is one of the treatment methods used in head and neck cancer to destroy malignant cells (Beech et al., 2014).
Self-reported oral health status: Perspectives of patients undergoing therapy for
Head and neck cancer (HNC) is a complex disease that extends from the base of the skull to the clavicle, and consists of different subsites, namely pharynx (including hypopharynx, nasopharynx and oropharynx), larynx, paranasal sinuses and nasal cavity, small and major salivary glands, oral cavity (including lip, alveolar ridge, buccal mucosa, gingiva, oral tongue, retromolar trigone and oral floor), ear, skin and neck. The study population consisted of 235 patients undergoing treatment for cancer of the head and neck.
Oral health promotion for patients undergoing therapy for head and neck
Support for oral health promotion is important for patients undergoing head and neck cancer therapy. This was a descriptive case study using qualitative data to explore head and neck cancer patients' perspectives on oral health care.
Knowledge and practices of oral health care
Barriers to accessing oral health care - The present socioeconomic landscape . 116
There is also inequality in the province, with urban areas being more privileged in terms of oral health services compared to rural areas, which make up 54%. This inequitable distribution is due to staff shortages and lack of access to oral health services (Brindle et al., 2000; Ramphoma, 2016).
Support for oral health care
This statement is in line with the literature reporting that dentists may be the first to diagnose head and neck cancerous lesions and are also important in changing lifestyles such as alcohol and smoking (Mol, 2010; Samim et al., 2016 ). 1. Is there any institutional support for oral health promotion activities for head and neck cancer patients?
Perceived Opportunities
Access to a dental hygienist “If there is a problem, the dentist usually refers you to a dental hygienist” (P2). This patient had swelling of the nose and an abnormality of the jaw and this could be a reason for the dentist to refer him.
Present precautions outdoors
Comprehensive explanation “The doctor explained the benefits as well as the complications and directed me to others” (P9). Self-reflection “That's why I sometimes get stressed, I don't smoke, I don't drink, why I get cancer every time I go to church, so why bad things happen in my life” (P10).
Shortcomings identified in service delivery at district level
This approach is supported by the South African Oral Health Promotion Framework (Molete, Daly and Hlungwani, 2013). The oral health status of pre-treatment head and neck cancer patients.', British Dental Journal, 216(1), p.
CONCLUSION AND RECOMMENDATIONS
Introduction
Most participants acknowledged the importance of oral health in relation to overall health. The findings and recommendations represent the collective participation and input of head and neck cancer patients and the district oral health coordinator.
Significance of the study findings
More research is needed to further explore the barriers and opportunities for improving oral health care in this population. Oral health care is not included in general health care in terms of lifestyle risk factors.
Study limitations
Insufficient budget allocations and manpower are responsible for the lack of effective oral health promotion activities. The general well-being and oral health status (in terms of pain, dysphagia, xerostomia, sticky saliva and trismus) of patients with head and neck cancer are subjective and dictated by the stage of the cancer and the type of treatment.
Recommendations
Further research is needed to identify further mechanisms that may improve the oral health-related quality of life in people with head and neck cancer. There is an urgent need to review provincial oral health policies to ensure that specific oral health promotion activities are planned and implemented for people with head and neck cancer.
Conclusion
A Multidimensional Analysis of Body Image Concerns Among Newly Diagnosed Patients with Oral Cavity Cancer', Head and Neck, 32(3), s. 2015) 'Empowering people to be sunder: public health nutrition through the Ottawa Charter', The Proceedings of the Nutrition Society, 74(3), s. En kvalitativ undersøgelse af oplevelsen af oral cancer blandt taiwanske mænd', International Journal of Nursing Practice, 15(4), s. 2016).'Epidemiology, etiology, and diagnosis of nasopharyngeal carcinoma '. The mediating role of dysfunctional attitudes and rummination', Body Image, 20, s. 2017) 'Apoptotic Capacity and Risk of Squamous Cell Carcinoma of the Head and Neck', Eur J Cancsr, 72, pp.
Quality of life of patients with head and neck cancer', Brazilian Journal of Otorhinolaryngology, 79(1), pp.
BREC ethical clearance letter
BREC Approval for amendment of title
Approval letter from KZN Department of Health
Support letter from CEO of hospital
User agreement form
Questionnaires used in the study
Interview schedule for oral health district coordinator
Interview schedule for patient interviewees
Letter requesting permission to conduct interview of oral health district
Letter requesting permission to CEO of hospital to conduct study
Letter requesting permission of the HOD of Oncology
Participant information sheet and consent form-English version
Participant information sheet and consent form-IsiZulu version
Research Ethics Certificates
Language Clearance Certificate
