Disputas Ragnhild Monsen

Tittel på avhandling: Oral Health in Advanced Cancer - Assessment and management of oral symptoms and fungal infection in adult patients with advanced cancer

Tid og sted: 7. juni kl. 13:15 Auditoriet i Kreftsenteret (bygg 11), Ullevål Sykehus

Prøveforelesningen avholdes samme sted kl. 10:15

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Engelsk sammendrag:

Oral symptom and problems are highly prevalent in patient with advanced cancer, and xerostomia is reported in 84% of the cases. Between 30% - 50% of the patients develop oral infections, which most common infection is oral candidiasis. Despite the symptoms negative impact on quality of life, oral symptoms and problems are not systematically assessed or treated in palliative care. The evidence supporting the effectiveness of mouth rinses in alleviating oral discomfort is limited. Additionally, knowledge of oral fungal species and their susceptibility to antifungal agents are spares. The overall aim of this thesis was to investigate oral symptoms and problems in patients with limited life expectancy receiving inpatient palliative care due to advanced cancer.

In study 1 we performed an interventions study where we investigated the effect of a mouth rinse based on the herb Salvia Officinalis (SO) compared to standard care using normal saline in 88 patients with advanced cancer. Both groups showed statistically significant improvement in their overall oral symptoms and SO was as effective as standard care.

In study 2 we conducted a microbiological analysis of oral swab tests from 45 patients taken during study 1. Seven different Candida species were detected, and nine patients had mixed infection. The susceptibility to antifungal agents was high.

In Study 3, we observed the symptom dry mouth in two different versions of a symptom assessment questionnaire. The symptom dry mouth was included in one version, while in a revised version, patients were required to report dry mouth as an “Other problem”. Dry mouth was the third most reported symptom when prompted in a symptom list, whereas the symptom was significantly less reported in the revised version.

This thesis highlights the presence of oral symptoms and problems in patients with advanced cancer and has shown that SO mouth rinse was as good as normal saline in an oral care procedure. Furthermore, there is a diversity of Candida species and mixed oral infections occurs. Finally, systematic assessment is crucial to identify the present of different oral symptoms.