Supportive Care in Cancer

, Volume 18, Issue 8, pp 1023–1031

A systematic review of orofacial pain in patients receiving cancer therapy

  • Joel B. Epstein
  • Catherine Hong
  • Richard M. Logan
  • Andrei Barasch
  • Sharon M. Gordon
  • Lorree Oberlee-Edwards
  • Deborah McGuire
  • Joel J. Napenas
  • Linda S. Elting
  • Fred K. L. Spijkervet
  • Michael T. Brennan
Review Article

Abstract

Purpose

We present the findings of a structured systematic review of the literature assessing orofacial pain induced by malignant disease and/or its therapy (excluding mucositis). This evaluation of the literature published after the 1989 NIH Development Consensus conference on the oral complications of cancer therapies is an effort to assess the prevalence of pain, quality of life and economic impact, and management strategies for cancer therapy-induced orofacial pain.

Methods

A systematic medical literature search was conducted with assistance from a research librarian in MEDLINE/PubMed and EMBASE databases for articles published between January 1, 1990 and December 31, 2008. Each study was independently assessed by two reviewers with expertise in the field of oral oncology.

Results

Thirty-nine studies assessed pain in the head and neck region. The measure was commonly embedded in quality of life studies. Most of these studies described pain in head and neck cancer (HNC) patients, which therefore became the focus of the report.

Pain is common in patients with HNC and is reported by approximately half of patients prior to cancer therapy, 81% during therapy, 70% at the end of therapy, and by 36% at 6 months after treatment. Pain is experienced beyond the 6-month period by approximately one third of patients and is typically more severe than pre-treatment cancer-induced pain.

Conclusions

This systematic review identified the presence of pain before cancer therapy, likely attributable to the cancer; an increase in pain during therapy and the common persistence of pain following cancer treatment. Continuing research should use validated tools to prospectively assess orofacial pain, its causes and pathophysiology, and its effect on quality of life and economic impact. Clinical trials of pain management in this setting are also warranted.

Keywords

Cancer therapy Head and neck and orofacial pain 

References

  1. 1.
    Oral complications of cancer therapies: diagnosis, prevention, and treatment (1989) Available from: http://consensus.nih.gov/1989/1989OralComplicationsCancerTherapy073html.htm[cited Apr 17] 7:1–11
  2. 2.
    Brennan MT, Spijkervet FK, Elting LS (2010) Systematic reviews of oral complications from cancer therapies, Oral Care Study Group, MASCC/ISOO: methodology and quality of the literature (in press). Support Care CancerGoogle Scholar
  3. 3.
    Pow EH, McMillan AS, Leung WK, Wong MC, Kwong DL (2003) Salivary gland function and xerostomia in southern Chinese following radiotherapy for nasopharyngeal carcinoma. Clin Oral Investig 7:230–234CrossRefPubMedGoogle Scholar
  4. 4.
    Graff P, Lapeyre M, Desandes E, Ortholan C, Bensadoun RJ, Alfonsi M, Maingon P, Giraud P, Bourhis J, Marchesi V, Mege A, Peiffert D (2007) Impact of intensity-modulated radiotherapy on health-related quality of life for head and neck cancer patients: matched-pair comparison with conventional radiotherapy. Int J Radiat Oncol Biol Phys 67:1309–1317PubMedGoogle Scholar
  5. 5.
    Epstein JB, Robertson M, Emerton S, Phillips N, Stevenson-Moore P (2001) Quality of life and oral function in patients treated with radiation therapy for head and neck cancer. Head Neck 23:389–398CrossRefPubMedGoogle Scholar
  6. 6.
    Epstein JB, Stewart KH (1993) Radiation therapy and pain in patients with head and neck cancer. Eur J Cancer B Oral Oncol 29B:191–199CrossRefPubMedGoogle Scholar
  7. 7.
    Magne N, Marcy PY, Chamorey E, Guardiola E, Pivot X, Schneider M, Demard F, Bensadoun RJ (2001) Concomitant twice-a-day radiotherapy and chemotherapy in unresectable head and neck cancer patients: a long-term quality of life analysis. Head Neck 23:678–682CrossRefPubMedGoogle Scholar
  8. 8.
    Langius A, Bjorvell H, Lind MG (1993) Oral- and pharyngeal-cancer patients' perceived symptoms and health. Cancer Nurs 16:214–221PubMedGoogle Scholar
  9. 9.
    Macquart-Moulin G, Viens P, Palangie T, Bouscary ML, Delozier T, Roche H, Janvier M, Fabbro M, Moatti JP (2000) High-dose sequential chemotherapy with recombinant granulocyte colony-stimulating factor and repeated stem-cell support for inflammatory breast cancer patients: does impact on quality of life jeopardize feasibility and acceptability of treatment? J Clin Oncol 18:754–764PubMedGoogle Scholar
  10. 10.
    Hammerlid E, Bjordal K, hlner-Elmqvist M, Boysen M, Evensen JF, Biorklund A, Jannert M, Kaasa S, Sullivan M, Westin T (2001) A prospective study of quality of life in head and neck cancer patients. Part I: at diagnosis. Laryngoscope 111:669–680CrossRefPubMedGoogle Scholar
  11. 11.
    Pow EH, Kwong DL, McMillan AS, Wong MC, Sham JS, Leung LH, Leung WK (2006) Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys 66:981–991PubMedGoogle Scholar
  12. 12.
    Fang FM, Chien CY, Kuo SC, Chiu HC, Wang CJ (2004) Changes in quality of life of head-and-neck cancer patients following postoperative radiotherapy. Acta Oncol 43:571–578CrossRefPubMedGoogle Scholar
  13. 13.
    Duke RL, Campbell BH, Indresano AT, Eaton DJ, Marbella AM, Myers KB, Layde PM (2005) Dental status and quality of life in long-term head and neck cancer survivors. Laryngoscope 115:678–683CrossRefPubMedGoogle Scholar
  14. 14.
    Winter SC, Cassell O, Corbridge RJ, Goodacre T, Cox GJ (2004) Quality of life following resection, free flap reconstruction and postoperative external beam radiotherapy for squamous cell carcinoma of the base of tongue. Clin Otolaryngol Allied Sci 29:274–278CrossRefPubMedGoogle Scholar
  15. 15.
    Ohrn KE, Wahlin YB, Sjoden PO (2001) Oral status during radiotherapy and chemotherapy: a descriptive study of patient experiences and the occurrence of oral complications. Support Care Cancer 9:247–257CrossRefPubMedGoogle Scholar
  16. 16.
    Ethunandan M, Rennie A, Hoffman G, Morey PJ, Brennan PA (2005) Quality of dying in head and neck cancer patients: a retrospective analysis of potential indicators of care. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 100:147–152CrossRefPubMedGoogle Scholar
  17. 17.
    McCarthy GM, Skillings JR (1992) Orofacial complications of chemotherapy for breast cancer. Oral Surg Oral Med Oral Pathol 74:172–178CrossRefPubMedGoogle Scholar
  18. 18.
    Elting LS, Cooksley C, Chambers M, Cantor SB, Manzullo E, Rubenstein EB (2003) The burdens of cancer therapy. Clinical and economic outcomes of chemotherapy-induced mucositis. Cancer 98:1531–1539CrossRefPubMedGoogle Scholar
  19. 19.
    Keefe DM, Schubert MM, Elting LS, Sonis ST, Epstein JB, Raber-Durlacher JE, Migliorati CA, McGuire DB, Hutchins RD, Peterson DE, Mucositis Study Section of the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology (2007) Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 109:820–31CrossRefPubMedGoogle Scholar
  20. 20.
    Bairati I, Meyer F, Gelinas M, Fortin A, Nabid A, Brochet F, Mercier JP, Tetu B, Harel F, Abdous B, Vigneault E, Vass S, Del VP, Roy J (2005) Randomized trial of antioxidant vitamins to prevent acute adverse effects of radiation therapy in head and neck cancer patients [see comment]. J Clin Oncol 23:5805–5813CrossRefPubMedGoogle Scholar
  21. 21.
    Barber C, Powell R, Ellis A, Hewett J (2007) Comparing pain control and ability to eat and drink with standard therapy vs Gelclair: a preliminary, double centre, randomised controlled trial on patients with radiotherapy-induced oral mucositis. Support Care Cancer 15:427–440CrossRefPubMedGoogle Scholar
  22. 22.
    Epstein JB, Truelove EL, Oien H, Allison C, Le ND, Epstein MS (2001) Oral topical doxepin rinse: analgesic effect in patients with oral mucosal pain due to cancer or cancer therapy. Oral Oncol 37:632–637CrossRefPubMedGoogle Scholar
  23. 23.
    Oguchi M, Shikama N, Sasaki S, Gomi K, Katsuyama Y, Ohta S, Hori M, Takei K, Arakawa K, Sone S (1998) Mucosa-adhesive water-soluble polymer film for treatment of acute radiation-induced oral mucositis. Int J Radiat Oncol Biol Phys 40:1033–1037PubMedGoogle Scholar
  24. 24.
    LeVeque FG, Parzuchowski JB, Farinacci GC, Redding SW, Rodu B, Johnson JT, Ferretti GA, Eisenberg PD, Zimmer MB (1992) Clinical evaluation of MGI 209, an anesthetic, film-forming agent for relief from painful oral ulcers associated with chemotherapy. J Clin Oncol 10:1963–1698PubMedGoogle Scholar
  25. 25.
    Epstein JB, Elad S, Eliav E, Jurevic R, Benoliel R (2007) Orofacial pain in cancer: part II—clinical perspectives and management. J Dent Res 86:506–518CrossRefPubMedGoogle Scholar
  26. 26.
    Benoliel R, Epstein J, Eliav E, Jurevic R, Elad S (2007) Orofacial pain in cancer: part I—mechanisms. J Dent Res 86:491–505CrossRefPubMedGoogle Scholar
  27. 27.
    Stiff PJ, Emmanouilides C, Bensinger WI, Gentile T, Blazar B, Shea TC, Lu J, Isitt J, Cesano A, Spielberger R (2006) Palifermin reduces patient-reported mouth and throat soreness and improves patient functioning in the hematopoietic stem-cell transplantation setting. J Clin Oncol 24:5186–5193CrossRefPubMedGoogle Scholar
  28. 28.
    Fang FM, Tsai WL, Chien CY, Chiu HC, Wang CJ, Chen HC, Hsiung CY (2005) Changing quality of life in patients with advanced head and neck cancer after primary radiotherapy or chemoradiation. Oncology 68:405–413CrossRefPubMedGoogle Scholar
  29. 29.
    Borggreven PA, Verdonck-de LI, Muller MJ, Heiligers ML, de BR, Aaronson NK, Leemans CR (2007) Quality of life and functional status in patients with cancer of the oral cavity and oropharynx: pretreatment values of a prospective study. Eur Arch Otorhinolaryngol 264:651–657CrossRefPubMedGoogle Scholar
  30. 30.
    Kita T, Yokoyama K, Higuchi T, Kinuya S, Taki J, Nakajima K, Michigishi T, Tonami N (2004) Multifactorial analysis on the short-term side effects occurring within 96 hours after radioiodine-131 therapy for differentiated thyroid carcinoma. Ann Nucl Med 18:345–349CrossRefPubMedGoogle Scholar
  31. 31.
    Roh JL, Kim AY, Cho MJ (2005) Xerostomia following radiotherapy of the head and neck affects vocal function. J Clin Oncol 23:3016–3023CrossRefPubMedGoogle Scholar
  32. 32.
    Claus F, Duthoy W, Boterberg T, De Gersem W, Huys J, Vermeersch H, De Neve W (2002) Intensity modulated radiation therapy for oropharyngeal and oral cavity tumors: clinical use and experience. Oral Oncol 38:597–604CrossRefPubMedGoogle Scholar
  33. 33.
    Schwartz DL, Montgomery RB, Yueh B, Donahue M, Anzai Y, Canby R, Buelna R, Anderson L, Boyd C, Hutson J, Keegan K (2005) Phase I and initial phase II results from a trial investigating weekly docetaxel and carboplatin given neoadjuvantly and then concurrently with concomitant boost radiotherapy for locally advanced squamous cell carcinoma of the head and neck. Cancer 103:2534–2543CrossRefPubMedGoogle Scholar
  34. 34.
    Schliephake H, Jamil MU (2002) Prospective evaluation of quality of life after oncologic surgery for oral cancer. Int J Oral Maxillofac Surg 31:427–433CrossRefPubMedGoogle Scholar
  35. 35.
    Hainsworth JD, Meluch AA, McClurkan S, Gray JR, Stroup SL, Burris HA III, Yardley DA, Bradof JE, Yost K, Ellis JK, Greco FA (2002) Induction paclitaxel, carboplatin, and infusional 5-FU followed by concurrent radiation therapy and weekly paclitaxel/carboplatin in the treatment of locally advanced head and neck cancer: a phase II trial of the Minnie Pearl Cancer Research Network. Cancer J 8:311–321CrossRefPubMedGoogle Scholar
  36. 36.
    Weymuller EA, Yueh B, Deleyiannis FW, Kuntz AL, Alsarraf R, Coltrera MD (2000) Quality of life in patients with head and neck cancer: lessons learned from 549 prospectively evaluated patients. Arch Otolaryngol Head Neck Surg 126:329–335PubMedGoogle Scholar
  37. 37.
    Derks W, de Leeuw RJ, Hordijk GJ, Winnubst JA (2004) Quality of life in elderly patients with head and neck cancer one year after diagnosis. Head Neck 26:1045–1052CrossRefPubMedGoogle Scholar
  38. 38.
    de Graeff A, de Leeuw JRJ, Ros WJG, Hordijk GJ, Blijham GH, Winnubst JAM (1999) A prospective study on quality of life of patients with cancer of the oral cavity or oropharynx treated with surgery with or without radiotherapy. Oral Oncol 35:27–32CrossRefPubMedGoogle Scholar
  39. 39.
    Rogers SN, Miller RD, Ali K, Minhas AB, Williams HF, Lowe D (2006) Patients' perceived health status following primary surgery for oral and oropharyngeal cancer. Int J Oral Maxillofac Surg 35:913–919CrossRefPubMedGoogle Scholar
  40. 40.
    van Wilgen CP, Dijkstra PU, van der Laan BF, Plukker JT, Roodenburg JL (2004) Shoulder and neck morbidity in quality of life after surgery for head and neck cancer. Head Neck 26:839–844CrossRefPubMedGoogle Scholar
  41. 41.
    Epstein JB, Emerton S, Kolbinson DA, Le ND, Phillips N, Stevenson-Moore P, Osoba D (1999) Quality of life and oral function following radiotherapy for head and neck cancer. Head Neck 21:1–11CrossRefPubMedGoogle Scholar
  42. 42.
    Chaturvedi SK, Shenoy A, Prasad KM, Senthilnathan SM, Premlatha BS (1996) Concerns, coping and quality of life in head and neck cancer patients. Support Care Cancer 4:186–190CrossRefPubMedGoogle Scholar
  43. 43.
    Gellrich NC, Schimming R, Schramm A, Schmalohr D, Bremerich A, Kugler J (2002) Pain, function, and psychologic outcome before, during, and after intraoral tumor resection. J Oral Maxillofac Surg 60:772–777CrossRefPubMedGoogle Scholar
  44. 44.
    Ingram SS, Seo PH, Sloane R, Francis T, Clipp EC, Doyle ME, Montana GS, Cohen HJ (2005) The association between oral health and general health and quality of life in older male cancer patients. J Am Geriatr Soc 53:1504–1509CrossRefPubMedGoogle Scholar
  45. 45.
    Connelly ST, Schmidt BL (2004) Evaluation of pain in patients with oral squamous cell carcinoma. J Pain 5:505–510CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Joel B. Epstein
    • 1
  • Catherine Hong
    • 2
  • Richard M. Logan
    • 3
  • Andrei Barasch
    • 4
  • Sharon M. Gordon
    • 5
  • Lorree Oberlee-Edwards
    • 6
  • Deborah McGuire
    • 7
  • Joel J. Napenas
    • 8
  • Linda S. Elting
    • 9
  • Fred K. L. Spijkervet
    • 10
  • Michael T. Brennan
    • 11
  1. 1.Department Oral Medicine and Diagnostic Sciences, Otolaryngology and Head and Neck Surgery and Cancer Center, MC 838University of IllinoisChicagoUSA
  2. 2.Department of Oral MedicineCarolinas Medical CenterCharlotteUSA
  3. 3.Oral Pathology, School of Dentistry, Faculty of Health SciencesThe University of Adelaide, Consultant Oral Pathologist, Division of Surgical Pathology, SA PathologyAdelaideAustralia
  4. 4.Department of General Dental SciencesUniversity of Alabama at BirminghamBirminghamUSA
  5. 5.University of MarylandBaltimoreUSA
  6. 6.Scripps Center for Dental CareLa JollaUSA
  7. 7.University of Maryland School of Nursing, Program in OncologyUniversity of Maryland Marlene and Stewart Greenebaum Cancer CenterBaltimoreUSA
  8. 8.Department of Oral MedicineCarolinas Medical CenterCharlotteUSA
  9. 9.Department of BiostatisticsThe University of Texas M.D. Anderson Cancer CenterHoustonUSA
  10. 10.Department of Oral & Maxillofacial SurgeryUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
  11. 11.Department of Oral MedicineCarolinas Medical CenterCharlotteUSA

Personalised recommendations