Supportive Care in Cancer

, Volume 11, Issue 7, pp 435–441 | Cite as

Barriers and strategies in implementation of oral care standards for cancer patients

Review Article


Oral complications of cancer therapy include mucositis, oral pain, poor oral intake, infection, bleeding, and difficulty communicating. Use of oral care standards can help manage these problems, but their systematic implementation is relatively rare. The purpose of this paper is to discuss barriers to implementing oral care standards, and to make suggestions for how such standards might be implemented in clinical settings. These purposes are accomplished through a review of relevant literature from various health-care disciplines, and discussion of one institution's implementation of an oral care standard for leukemia and bone marrow/stem cell transplant patients. Key principles underlying this successful institutional effort were recognition of the medical necessity of oral care, collaboration among health-care disciplines, and use of evidence-based practice wherever possible.


Oral care standards Oral hygiene Cancer treatment Mucositis Stomatitis Barriers 


  1. 1.
    Adams R (1996) Qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards. J Adv Nurs 24:552–560PubMedGoogle Scholar
  2. 2.
    Armstrong TS (1994) Stomatitis in the bone marrow transplant patient: an overview and proposed oral care protocol. Cancer Nurs 17:403–410PubMedGoogle Scholar
  3. 3.
    Barker GJ (1999) Current practices in the oral management of the patient undergoing chemotherapy or bone marrow transplantation. Support Care Cancer 7:17–20CrossRefPubMedGoogle Scholar
  4. 4.
    Beck SL (1992) Prevention and management of oral complications in the cancer patient. Curr Iss Cancer Nurs Pract 1:1–12Google Scholar
  5. 5.
    Bellm LA, Cunningham G, Durnell L, Eilers J, Epstein JB, Fleming T, Fuchs HJ, Haskins MN, Horowitz MM, Martin PJ, McGuire DB, Mullane K, Oster G (2002) Defining clinical meaningful outcomes in the evaluation of new treatments for oral mucositis: Oral Mucositis Patient Provider Advisory Board. Cancer Invest 20:793–800CrossRefPubMedGoogle Scholar
  6. 6.
    Borowski B, Benhamou E, Pico JL, Lapanche A, Margainaud JP, Hayat M (1994) Prevention of oral mucositis in patients treated with high-dose chemotherapy and bone marrow transplantation: a randomized controlled trial comparing two protocols of dental care. Eur J Cancer Oral Oncol 30B:93–97Google Scholar
  7. 7.
    Clarkson JE, Worthington HV, Eden OB (2000) Prevention of oral mucositis or oral candidiasis for patients with cancer receiving chemotherapy (excluding head and neck cancer) (Cochrane Review), issue 1. In: The Cochrane Library, OxfordGoogle Scholar
  8. 8.
    Coleman S (1995) An overview of the oral complications of adult patients with malignant haematological conditions who have undergone radiotherapy or chemotherapy. J Adv Nurs 22:1085–1091PubMedGoogle Scholar
  9. 9.
    Dando SJ (1995) Cancer patients and health care professionals perceptions of the need for oral health education. Br Dental Nurs J 54:18–19Google Scholar
  10. 10.
    Dollar BM, Lawson GC (1994) Protocol for nursing assessment and management of stomatitis. Home Healthcare Nurs 12:25–27Google Scholar
  11. 11.
    Eilers J, Berger A, Petersen M (1988) Development, testing and application of the oral assessment guide. Oncol Nurs Forum 15:325–330PubMedGoogle Scholar
  12. 12.
    Ezzone S, Jolly D, Replogle K, Kapoor N, Tutschka PJ (1993) Survey of oral hygiene regimens among bone marrow transplant centers. Oncol Nurs Forum 20:1375–1381PubMedGoogle Scholar
  13. 13.
    Fulton JS, Middleton GJ, McPhail JT (2002) Management of oral complications. Semin Oncol Nurs 18:28–35PubMedGoogle Scholar
  14. 14.
    Holmes S (1991) The oral complications of specific anticancer therapy. Int J Nurs Stud 28:343–360PubMedGoogle Scholar
  15. 15.
    Jansma J, Vissink A, Spijkervet FK, Roodenburg JL, Panders AK, Vermey A, Szabo BG, Gravenmade EJ (1992) Protocol for the prevention and treatment of oral sequelae resulting from head and neck radiation therapy. Cancer 70:2171–2180PubMedGoogle Scholar
  16. 16.
    Kenny SA (1990) Effect of two oral care protocols on the incidence of stomatitis in hematology patients. Cancer Nurs 13:345–353PubMedGoogle Scholar
  17. 17.
    Köstler WJ, Hejna M, Wenzel C, Zielinski CC (2001) Oral mucositis complicating chemotherapy and/or radiotherapy: options for prevention and treatment. CA Cancer J Clin 51:290–315PubMedGoogle Scholar
  18. 18.
    Larson PJ, Miaskowski C, MacPhail L, Dodd MJ, Greenspan D, Dibble S, Paul SM, Ignoffo R (1998) The PRO-SELF Mouth Aware program: an effective approach for reducing chemotherapy-induced mucositis. Cancer Nurs 21:263–268PubMedGoogle Scholar
  19. 19.
    Madeya ML (1996) Oral complications from cancer therapy: part 2—nursing implications for assessment and treatment. Oncol Nurs Forum 23:808–821PubMedGoogle Scholar
  20. 20.
    Majorana A, Schubert MM, Porta F, Ugazio AG, Sapelli PL (2000) Oral complications of pediatric hematopoietic cell transplantation: diagnosis and management. Support Care Cancer 8:353–365CrossRefPubMedGoogle Scholar
  21. 21.
    Miller M, Kearney N (2001) Oral care for patients with cancer: a review of the literature. Cancer Nurs 24:241–254PubMedGoogle Scholar
  22. 22.
    Mueller BA, Millheim ET, Farrington EA, Brusko C, Wiser TH (1995) Mucositis management practices for hospitalized patients: national survey results. J Pain Symptom Manage 10:510–520CrossRefPubMedGoogle Scholar
  23. 23.
    National Institutes of Health (1990) Consensus development conference on oral complications of cancer therapies: diagnosis, prevention, and treatment. NCI Monogr 9:1–184PubMedGoogle Scholar
  24. 24.
    National Oral Health Information Clearinghouse (2000) Oral health, cancer care, and you: fitting the pieces together. US Department of Health and Human Services, National Institutes of Health, Bethesda, MDGoogle Scholar
  25. 25.
    Peterson DE (2000) Oral problems in supportive care: no longer an orphan topic? Support Care Cancer 8:347–348CrossRefPubMedGoogle Scholar
  26. 26.
    Poe SS, Larson E, McGuire D, Krumm S (1994) A national survey of infection prevention practices on bone marrow transplant units. Oncol Nurs Forum 21:1687–1694PubMedGoogle Scholar
  27. 27.
    Raber-Durlacher JE (1999) Current practices for management of oral mucositis in cancer patients. Support Care Cancer 7:71–74CrossRefPubMedGoogle Scholar
  28. 28.
    Sadler GR, Oberle-Edwards L, Faroozi A, Hryniuk WM (2000) Oral sequelae of chemotherapy: an important teaching opportunity for oncology health care providers and their patients. Support Care Cancer 8:209–214CrossRefPubMedGoogle Scholar
  29. 29.
    Sonis ST, Costello KA (1995) A database for mucositis induced by cancer chemotherapy. Eur J Cancer Oral Oncol 31B:258–260Google Scholar
  30. 30.
    Toth BB, Chambers MS, Fleming TJ, Lemon JC, Martin JW (1995) Minimizing oral complications of cancer treatment. Oncology 9:851–858PubMedGoogle Scholar
  31. 31.
    Webster JS, von Hohenleiten C (1995) Development and implementation of an oral pain algorithm in bone marrow transplant patients (abstract). Oncol Nurs Forum 22:383Google Scholar
  32. 32.
    Western Consortium for Nursing Research (1987) Priorities for cancer nursing research: a Canadian replication. Cancer Nurs 10:319–326PubMedGoogle Scholar
  33. 33.
    Whitmyer CC, Waskowski JC, Iffland HA (1997) Radiotherapy and oral sequelae: preventive and management protocols. J Dent Hygiene 71:23–29Google Scholar
  34. 34.
    Yeager KA, Webster J, Crain M, Kasow J, McGuire DB (2000) Implementation of an oral care standard for leukemia and transplant patients. Cancer Nurs 23:40–47PubMedGoogle Scholar
  35. 35.
    Zakrzewska JM, Leeson RMA, Mcliskey M, Vickers M (1997) The development of patient information leaflets. Care of the mouth after radiotherapy. Gerontology 14:48–53Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.University of Pennsylvania School of NursingPhiladelphiaUSA

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