Oral hygiene care and the management of oral symptoms in patients with cancer in palliative care: a mixed methods systematic review.

Abstract

Objective: The objective of this review was to examine the effectiveness of oral hygiene care for the management of oral symptoms in patients with cancer receiving specialist palliative care and the patients' experience of oral symptoms and oral hygiene care.

Introduction: Oral symptoms, such as xerostomia, mouth pain, or dysgeusia, are highly prevalent in patients with cancer receiving specialist palliative care. These symptoms negatively affect patients' quality of life. Oral hygiene care can assist in the management of oral symptoms. This care could be improved with a more systematic approach, adequate guidelines, and training to properly integrate it into the care provided by specialist palliative care teams.

Eligibility criteria: This review considered quantitative, qualitative, and mixed methods studies on oral hygiene care for the management of oral symptoms in adult patients with cancer, aged 18 years or older, diagnosed with any type of cancer, receiving specialist palliative care. For the quantitative component, eligible studies measured the effectiveness of oral hygiene care, of any frequency or duration, using any valid method, for the management of oral symptoms; oral hygiene care interventions were compared with standard care, another experimental care, or no comparison. For the qualitative component, eligible studies explored participants' experiences of oral symptoms and the provision of oral hygiene care. Specialist palliative care was provided in several settings, including palliative care units, inpatient hospice, home palliative care teams, or day care centers.

Methods: The search was conducted in PubMed (NLM), CINAHL Complete (EBSCOhost), Cochrane Central Register of Controlled Trial, Dentistry and Oral Sciences Source (EBSCOhost), and MedicLatina (EBSCOhost). Sources of unpublished studies and gray literature searched included Networked Digital Library of Theses and Dissertations and Repositórios Científicos de Acesso Aberto de Portugal. Studies in English, Portuguese, and Spanish from 2000 to October 2023 were considered. Methodological quality was assessed and data were extracted by 2 reviewers. Synthesis and integration followed the JBI convergent segregated approach for mixed methods reviews. Meta-analysis of quantitative studies was not possible and findings were reported narratively. Meta-aggregation was used to pool findings of qualitative studies.

Results: Six studies (2 randomized controlled trials, 2 quasi-experimental studies, and 2 qualitative studies) were included, involving 451 participants. Studies that had a methodological quality of 75% or higher, based on affirmative answers in the respective critical assessment tool, were included in the review. Evidence indicated that oral hygiene care may be effective for the management of oral symptoms. Patients reported a reduction in oral symptoms, such as xerostomia, accompanied by a reduction of oral mucositis and retention of oral debris. One synthesized finding indicated that patients with cancer receiving specialist palliative care may experience oral symptoms that have detrimental effects on their physical and psychosocial well-being. Oral care may be performed by the patients themselves or by others, but is not seen as a priority by some patients. The integrated evidence supports that oral symptoms affect oral functions and that oral hygiene care may help manage several oral symptoms; however, due to the limited evidence, further integration was not possible.

Conclusions: Patients with cancer receiving specialist palliative care experience a wide variety of oral symptoms that affect oral functions, psychosocial well-being, and quality of life. Although more robust evidence is needed, the available evidence indicates that regular oral hygiene care may help manage oral symptoms.

Supplemental digital content: Translations of the review abstract are available in Spanish http://links.lww.com/SRX/A105 and Portuguese http://links.lww.com/SRX/A106 .