Oral health and chemotherapy act as cofactors in malnutrition in the elderly with other cancers than head and neck malignancies

  • Nada El Osta
  • Lana El Osta
  • Claire Lassauzay
  • Marwan Ghosn
  • Stephanie Tubert-Jeannin
  • Martine Hennequin
Original Article



This study explores whether the chemotherapy regimen has a role in inducing oral health problems and malnutrition in elderly patients with other cancers than head and neck malignancies.

Material and methods

An observational cross-sectional study was designed to compare the relationships between oral health and nutritional status between four groups of elderly differing in cancer or chemotherapy regimen. Data were collected using a questionnaire including the Mini-Nutritional Assessment (MNA), the Geriatric Oral Health Assessment Index (GOHAI) and questions about perception of xerostomia. The oral examinations recorded the number of functional dental units (PFU) and the presence of oral lesions.


The sample comprised 46 patients receiving chemotherapy, 48 patients on a non-chemotherapy regimen, 45 persons in complete remission not under treatment and 53 non-cancer patients. Oral health perception was significantly worse in chemotherapy patients. They reported limiting the kinds of food they consumed, the discomfort felt when eating and took medications for oral pain. Oral lesions were frequent in chemotherapy participants. Nutritional status was related to the cancer treatment regimen (OR = 4.17; p value = 0.017), the presence of oral lesions (OR = 4.51; p value = 0.003), perception of xerostomia (OR = 3.54; p value = 0.012), the number of PFU (OR = 2.51; p value = 0.046) and GOHAI score (OR = 1.617; p value = 0.019).


The presence of oral lesions and the chemotherapeutic regimen were highly associated with nutritional status in older patients with cancer.

Clinical relevance

Dental professionals should be asked to intervene preventively and per-therapy to optimise oral health status in elderly patients with other cancers than head and neck malignancies.


Cancer Oral health Nutrition status Elderly Chemotherapy 



The authors would like to thank Professor Paul Riordan (Write2Publish; and Accent Europe for corrections of the English manuscript. We would like to thank Professor Negib Geahchan for his supportive involvement in the study.


This work was supported by the Medical Research Council of Saint-Joseph University (grant number: FMD96 – CRENDUnovember2013).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Kido Y (2015) The issue of nutrition in an aging society. J Nutr Sci Vitaminol (Tokyo) 61(Suppl):S176–S177. CrossRefGoogle Scholar
  2. 2.
    N’gom PI, Woda A (2002) Influence of impaired mastication on nutrition. J Prosthet Dent 87:667–673CrossRefPubMedGoogle Scholar
  3. 3.
    Cousson PY, Bessadet M, Nicolas E, Veyrune JL, Lesourd B, Lassauzay C (2012) Nutritional status, dietary intake and oral quality of life in elderly complete denture wearers. Gerodontology 29:e685–e692. CrossRefPubMedGoogle Scholar
  4. 4.
    El Osta N, Hennequin M, Tubert-Jeannin S et al (2014) The pertinence of oral health indicators in nutritional studies in the elderly. Clin Nutr 33:316–321. CrossRefPubMedGoogle Scholar
  5. 5.
    Petersen PE (2009) Global policy for improvement of oral health in the 21st century—implications to oral health research of World Health Assembly 2007, World Health Organization. Community Dent Oral Epidemiol 37:1–8. CrossRefPubMedGoogle Scholar
  6. 6.
    Vainshtein JM, Samuels S, Tao Y, Lyden T, Haxer M, Spector M, Schipper M, Eisbruch A (2016) Impact of xerostomia on dysphagia after chemotherapy-intensity-modulated radiotherapy for oropharyngeal cancer: prospective longitudinal study. Head Neck 38(Suppl 1):E1605–E1612. CrossRefPubMedGoogle Scholar
  7. 7.
    Watters AL, Epstein JB, Agulnik M (2011) Oral complications of targeted cancer therapies: a narrative literature review. Oral Oncol 47:441–448. CrossRefPubMedGoogle Scholar
  8. 8.
    Wilberg P, Hjermstad MJ, Ottesen S, Herlofson BB (2012) Oral health is an important issue in end-of-life cancer care. Support Care Cancer 20:3115–3122. CrossRefPubMedGoogle Scholar
  9. 9.
    Thomaz EBAF, Mouchrek JCE, Silva AQ, Guerra RN, Libério SA, Da Cruz MC, Preira AL (2013) Longitudinal assessment of immunological and oral clinical conditions in patients undergoing anticancer treatment for leukemia. Int J Pediatr Otorhinolaryngol 77:1088–1093. CrossRefPubMedGoogle Scholar
  10. 10.
    Allen G, Logan R, Gue S (2010) Oral manifestations of cancer treatment in children: a review of the literature. Clin J Oncol Nurs 14:481–490. CrossRefPubMedGoogle Scholar
  11. 11.
    Dietrich E, Antoniades K (2012) Molecularly targeted drugs for the treatment of cancer: oral complications and pathophysiology. Hippokratia 16:196–199PubMedPubMedCentralGoogle Scholar
  12. 12.
    Mosel DD, Bauer RL, Lynch DP, Hwang ST (2011) Oral complications in the treatment of cancer patients. Oral Dis 17:550–559. CrossRefPubMedGoogle Scholar
  13. 13.
    Semba SE, Mealey BL, Hallmon WW (1994) Dentistry and the cancer patient: part 2—oral health management of the chemotherapy patient. Compend Newtown Pa 15(1378):1380–1387 quiz 1388Google Scholar
  14. 14.
    Chahine LM, Bijlsma A, Hospers APN, Chemali Z (2007) Dementia and depression among nursing home residents in Lebanon: a pilot study. Int J Geriatr Psychiatry 22:283–285. CrossRefPubMedGoogle Scholar
  15. 15.
    Nasser R, Doumit J (2009) Validity and reliability of the Arabic version of activities of daily living (ADL). BMC Geriatr 9:11. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Vellas B, Villars H, Abellan G et al (2006) Overview of the MNA—its history and challenges. J Nutr Health Aging 10:456–463-465PubMedGoogle Scholar
  17. 17.
    Scully C, Sonis S, Diz PD (2006) Oral mucositis. Oral Dis 12:229–241. CrossRefPubMedGoogle Scholar
  18. 18.
    McGowan D (2008) Chemotherapy-induced oral dysfunction: a literature review. Br J Nurs Mark Allen Publ 17:1422–1426CrossRefGoogle Scholar
  19. 19.
    El Osta N, Tubert-Jeannin S, Hennequin M, Bou Abboud Naaman N, El Osta L, Geahchan N (2012) Comparison of the OHIP-14 and GOHAI as measures of oral health among elderly in Lebanon. Health Qual Life Outcomes 10:131. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Atieh MA (2008) Arabic version of the geriatric oral health assessment index. Gerodontology 25:34–41. CrossRefPubMedGoogle Scholar
  21. 21.
    Daradkeh S, Khader YS (2008) Translation and validation of the Arabic version of the Geriatric Oral Health Assessment Index (GOHAI). J Oral Sci 50:453–459CrossRefPubMedGoogle Scholar
  22. 22.
    Lalla RV, Saunders DP, Peterson DE (2014) Chemotherapy or radiation-induced oral mucositis. Dent Clin N Am 58:341–349. CrossRefPubMedGoogle Scholar
  23. 23.
    Cheng KK-F, Leung SF, Liang RHS, Tai JWM, Yeung RMW, Thompson DR (2010) Severe oral mucositis associated with cancer therapy: impact on oral functional status and quality of life. Support Care Cancer 18:1477–1485. CrossRefPubMedGoogle Scholar
  24. 24.
    Al-Ansari S, Zecha JAEM, Barasch A, De Lange J, Rozema FR, Raber-Durlacher J (2015) Oral mucositis induced by anticancer therapies. Curr Oral Health Rep 2:202–211. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Al-Dakkak I (2011) The association between cancer treatments and oral diseases. Evid Based Dent 12:15–16. CrossRefPubMedGoogle Scholar
  26. 26.
    Epstein JB, Thariat J, Bensadoun RJ, Barasch A, Murphy BA, Kolnick L, Popplewell L, Maghami E (2012) Oral complications of cancer and cancer therapy: from cancer treatment to survivorship. CA Cancer J Clin 62:400–422. CrossRefPubMedGoogle Scholar
  27. 27.
    Hong CHL, Napeñas JJ, Hodgson BD et al (2010) A systematic review of dental disease in patients undergoing cancer therapy. Support Care Cancer 18:1007–1021. CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Jensen SB, Pedersen AML, Vissink A et al (2010) A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer 18:1039–1060. CrossRefPubMedGoogle Scholar
  29. 29.
    Oztürk LK, Emekli-Alturfan E, Kaşikci E, Demir G, Yarat A (2011) Salivary total sialic acid levels increase in breast cancer patients: a preliminary study. Med Chem Shāriqah United Arab Emir 7:443–447Google Scholar
  30. 30.
    Napeñas JJ, Brennan MT, Fox PC (2009) Diagnosis and treatment of xerostomia (dry mouth). Odontology 97:76–83. CrossRefPubMedGoogle Scholar
  31. 31.
    Raber-Durlacher JE, Brennan MT, Verdonck-de Leeuw IM et al (2012) Swallowing dysfunction in cancer patients. Support Care Cancer 20:433–443. CrossRefPubMedGoogle Scholar
  32. 32.
    Sadler GR, Oberle-Edwards L, Farooqi 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

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Nada El Osta
    • 1
    • 2
    • 3
  • Lana El Osta
    • 2
  • Claire Lassauzay
    • 3
    • 4
  • Marwan Ghosn
    • 2
    • 5
  • Stephanie Tubert-Jeannin
    • 3
    • 6
  • Martine Hennequin
    • 3
    • 6
  1. 1.Department of Prosthetic Dentistry, School of DentistrySaint-Joseph UniversityBeirutLebanon
  2. 2.Department of Public Health, School of MedicineSaint-Joseph UniversityBeirutLebanon
  3. 3.University Clermont AuvergneCROC EA 4847, Dental FacultyClermont-FerrandFrance
  4. 4.University of Nice Sophia Antipolis St Jean d’AngélyFrance
  5. 5.Department of Hematology-Oncology, School of MedicineSaint-Joseph UniversityBeirutLebanon
  6. 6.CHU of Clermont-Ferrand, Dental serviceClermont-FerrandFrance

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