Skip to main content

Advertisement

SpringerLink
Log in

The Implementation of an Integrated Oral Care Protocol for Pediatric Cancer Patients: a Qualitative Study

  • Published:
Journal of Cancer Education Aims and scope Submit manuscript

Abstract

Aim

In this study, we evaluated the impact of an integrated oral care protocol for pediatric patients undergoing antineoplastic treatment from the perspective of the multidisciplinary team, oral healthcare team, and caregivers.

Subject and Methods

This was a qualitative study carried out in the pediatric sector of a reference cancer hospital in Brazil. Focus group and individual semi-structured interview techniques were used, and the data were analyzed by the Discourse of the Collective Subject (DCS) method.

Results

A total of 44 professionals involved in providing care to children and adolescents with cancer and 38 caregivers were interviewed. All interviewees perceived an improvement in the patients’ oral health condition. Health professionals reported a reduction in the occurrence and severity of oral mucositis (OM). Communicating with the medical team and understanding the importance of oral care to the patient’s systemic condition were the greatest difficulties reported by the oral healthcare team.

Conclusion

This implementation project contributed to establishing a complete multidisciplinary team to assist pediatric patients in all their needs during antineoplastic treatment. The integrated oral care protocol further contributed to reducing the occurrence and severity of OM by increasing its surveillance and diagnostic efficiency, which, altogether, improved the patients’ quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Academy of Pediatric Dentistry (2018) Dental management of pediatric patients receiving immunosuppressive therapy and/or radiation therapy. Pediatr Dent 40(6):392–400

    Google Scholar 

  2. Hong CH, daFonseca M (2008) Considerations in the pediatric population with cancer. Dent Clin North Am 52(1):155–81. ix. https://doi.org/10.1016/j.cden.2007.10.001

    Article  PubMed  Google Scholar 

  3. Allen G, Logan R, Revesz T, Keefe D, Gue S (2018) The prevalence and investigation of risk factors of oral mucositis in a pediatric oncology inpatient population; a prospective Study. J Pediatr Hematol Oncol 40(1):15–21. https://doi.org/10.1097/MPH.0000000000000970

    Article  PubMed  Google Scholar 

  4. Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, McGuire DB, Migliorati C, Nicolatou-Galitis O, Peterson DE, Raber-Durlacher JE, Sonis ST, Elad S, Mucositis guidelines leadership group of the multinational association of supportive care in Cancer and International Society of Oral Oncology (MASCC/ISOO) (2014) MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 120(10):1453–61 (Erratum in: Cancer. 2015 Apr 15;121(8):1339)

    Article  PubMed  Google Scholar 

  5. Jensen SB, Pedersen AM, Vissink A, Andersen E, Brown CG, Davies AN, Dutilh J, Fulton JS, Jankovic L, Lopes NN, Mello AL, Muniz LV, Murdoch-Kinch CA, Nair RG, Napeñas JJ, Nogueira-Rodrigues A, Saunders D, Stirling B, von Bültzingslöwen I, Weikel DS, Elting LS, Spijkervet FK, Brennan MT, Salivary gland hypofunction/xerostomia section; Oral Care Study Group; Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO) (2010) a systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer 18(8):1061–79. https://doi.org/10.1007/s00520-010-0837-6

    Article  CAS  PubMed  Google Scholar 

  6. Ribeiro ILA, de Castro RD, Costa RC, Damascena LCL, de Lucena NNN, Maracajá PMB, Dos Santos FG, de Medeiros Serpa EB, Sousa SA, Valença AMG (2021) Integrated oral care contributes positively to the course of treatment of oncopediatric patients. Eur J Pediatr 180(9):2757–2764. https://doi.org/10.1007/s00431-021-04024-z

    Article  PubMed  Google Scholar 

  7. Liaw SN, Sullivan A, Joselow M, Duncan J, Wolfe J (2016) Impact of an interprofessional training program in pediatric palliative care on interprofessional competencies and career development of former fellows (S780). J Pain Symptom Manage 51(2):451–452

    Article  Google Scholar 

  8. Gandhi K, Datta G, Ahuja S, Saxena T, Datta AG (2017) Prevalence of oral complications occurring in a population of pediatric cancer patients receiving chemotherapy. Int J Clin Pediatr Dent 10(2):166

    Article  PubMed  PubMed Central  Google Scholar 

  9. Murshid EZ, Azizalrahman TA, AlJohar AJ (2017) Oral mucositis in leukemic Saudi children following chemotherapy. Saudi J Dent Res 8(1):79–85

    Article  Google Scholar 

  10. Velten DB, Zandonade E, Miotto MHMB (2017) Prevalence of oral manifestations in children and adolescents with cancer submitted to chemotherapy. BMC Oral Health 17(1):49

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hong CH, Hu S, Haverman T et al (2018) A systematic review of dental disease management in cancer patients. Support Care Cancer 26(1):155–174

    Article  PubMed  Google Scholar 

  12. Ribeiro ILA, Limeira RRT, Castro RD, Bonan PRF, Valença AMG (2017) Oral mucositis in pediatric patients in treatment for acute lymphoblastic leukemia. Int J Environ Res Public Health 14(12):1468

    Article  PubMed  PubMed Central  Google Scholar 

  13. Huang BS, Wu SC, Lin CY, Fan KH, Chang JT, Chen SC (2008) The effectiveness of a saline mouth rise regimen and education programme on radiation-induced oral mucositis and quality of life in oral cavity cancer patients: a randomized controlled trial. Eur J Cancer Care. https://doi.org/10.1111/ecc.12819

    Article  Google Scholar 

  14. Carneiro TV, Ribeiro ILA, Alves CV, Bonan PRF, Lima-Neto EA, Valença AMG (2017) Factors associated with health-related quality of life among children with cancer from the standpoint of patients and caregivers. J Public Health 25(4):371–377

    Article  Google Scholar 

  15. McGrady ME, Peugh JL, Brown GA, Pai AL (2017) Spending on hospital care and pediatric psychology service use among adolescents and young adults with cancer. J Pediatr Psychol 42(9):1065–1074

    Article  PubMed  PubMed Central  Google Scholar 

  16. Xie J, Ding S, He S, Duan Y, Yi K, Zhou J (2017) A Prevalence study of psychosocial distress in adolescents and young adults with cancer. Cancer Nurs 40(3):217–223

    Article  PubMed  Google Scholar 

  17. Riley P, Glenny AM, Worthington HV, Littlewood A, Clarkson JE (2015) McCabe MG (2015) Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy. Cochrane Database Syst Rev 12:CD011552. https://doi.org/10.1002/14651858.CD011552.pub2

    Article  Google Scholar 

  18. Widjaja NA et al (2020) Efficacy oral glutamine to prevent oral mucositis and reduce hospital costs during chemotherapy in children with acute lymphoblastic leukemia. Asian Pac J Cancer Prev 21(7):2117–2121

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Fried JL, Maxey HL, Battani K, Gurenlian JR, Byrd TO, Brunick A (2017) Preparing the future dental hygiene workforce: knowledge, skills, and reform. J Dent Educ 81(9):eS45–eS52

    Article  PubMed  Google Scholar 

  20. Kahn JM, Athale UH, Clavell LA, Cole PD, Leclerc JM, Laverdiere C, Silverman LB (2017) How variable is our delivery of information? Approaches to patient education about oral chemotherapy in the pediatric oncology clinic. J Pediatr Health Care 31(1):e1–e6

    Article  PubMed  Google Scholar 

  21. Mitchell JK, May R, Riggs B (2017) Oral Health Care for Nurse Educator, Part 2: The school year: 6 years old to young adult. Teach Learn Nurs 12(2):165–169

    Article  Google Scholar 

  22. World Health Organization (2011) Implementation research for the control of infectious diseases of poverty: strengthening the evidence base for the access and delivery of new and improved tools, strategies and interventions. TDR/WHO, Geneva, p 154f

    Google Scholar 

  23. Tremblay D, Prady C, Bilodeau K et al (2017) Optimizing clinical and organizational practice in cancer survivor transitions between specialized oncology and primary care teams: a realist evaluation of multiple case studies. BMC Health Serv Res 17(1):834

    Article  PubMed  PubMed Central  Google Scholar 

  24. Elad S, Raber-Durlacher JE, Brennan MT et al (2015) Basic oral care for hematology–oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT). Support Care Cancer 23(1):223–236

    Article  PubMed  Google Scholar 

  25. Curra M, Gabriel AF, Ferreira MBC, Martins MAT, Brunetto AT, Gregianin LJ, Martins MD (2021) Incidence and risk factors for oral mucositis in pediatric patients receiving chemotherapy. Support Care Cancer 29(11):6243–6251. https://doi.org/10.1007/s00520-021-06199-5

    Article  PubMed  Google Scholar 

  26. Ribeiro I, de Andrade Lima Neto E, Valença AM (2019) chemotherapy in pediatric oncology patients and the occurrence of oral mucositis. Int J Clin Pediatr Dent 12(4):261–267. https://doi.org/10.5005/jp-journals-10005-1633

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hord J, Feig S, Crouch G, Hale G, Mueller B, Rogers Z, Shearer P, Werner E (2014) Policy statement: standards for pediatric cancer centers. Pediatrics 134(2):410–414

    Article  Google Scholar 

  28. Ritwik P, Chrisentery-Singleton TE (2020) Oral and dental considerations in pediatric cancers. Cancer Metastasis Rev 39(1):43–53. https://doi.org/10.1007/s10555-020-09842-5

    Article  PubMed  Google Scholar 

  29. Frascino AV, Fava M, Cominato L, Odone-Filho V (2018) Review of a three-year study on the dental care of onco-hematological pediatric patients. Clinics (Sao Paulo) 3(73):e721. https://doi.org/10.6061/clinics/2017/e721

    Article  Google Scholar 

  30. Yüce UÖ, Yurtsever S (2017) Effect of education about oral mucositis given to the cancer patients having chemotherapy on life quality. J Cancer Educ 32(1):1–6

    Google Scholar 

  31. He M, Zhang B, Shen N, Wu N, Sun J (2017) A systematic review and meta-analysis of the effect of low-level laser therapy (LLLT) on chemotherapy-induced oral mucositis in pediatric and young patients. Eur J Pediatr 1:7–17

    Google Scholar 

  32. Noronha C, Macdonald ME (2016) Oral health issues and quality of life among pediatric cancer survivors. In: Fitzpatrick TR (ed) Treating vulnerable populations of cancer survivors: a biopsychosocial approach. Springer, Cham, pp 111–125. https://doi.org/10.1007/978-3-319-32364-0_8

  33. Silva VCR, Silveira FMM, Monteiro MGB, Cruz MMD, Júnior ADFC, Godoy GP (2018) Photodynamic therapy for treatment of oral mucositis: Pilot study with pediatric patients undergoing chemotherapy. Photodiagn Photodyn Ther 21(1):115–120

    Article  Google Scholar 

  34. Mazzucchelli TG, Ralph A (2019) Self-regulation approach to training child and family practitioners. Clin Child Fam Psychol Rev 22(1):129–145

    Article  PubMed  Google Scholar 

  35. Oliveira MCQ, Martins BNFL, Santos-Silva AR et al (2020) Dental treatment needs in hospitalized cancer patients: a retrospective cohort study. Support Care Cancer 28(7):3451–3457

    Article  PubMed  Google Scholar 

  36. Devi KS, Allenidekania A (2019) The relationship of oral care practice at home with mucositis incidence in children with acute lymphoblastic leukemia. Compr Child Adolesc Nurs 42(sup1):56–64

    Article  PubMed  Google Scholar 

  37. Almendra MR, de Mendonça RMH, dos Santos AS (2020) Adherence to dental treatment reduces oral complications related to cancer treatment in pediatric and adolescent patients. Support Care Cancer 28(2):661–670

    Article  Google Scholar 

Download references

Acknowledgements

We thank the support given by the World Health Organization; Implementation Research Brazil; University of São Paulo – Ribeirão Preto Medical School – Department of Social Medicine; Postgraduate Program of Federal University of Paraíba; Research Group in Odontopediatric and Integrated Clinic and Napoleão Laureano Hospital and to all patients, caregivers, and members of the interprofessional team who contributed to this study and to the implementation research team. We especially thank members of the team of this implementation (Fernando Bellissimo-Rodrigues; Andrea Gadelha da Nóbrega Lins; Ivo Sérgio Correia Borges da Fonseca; Paulo Rogério Ferreti Bonan; Raphael Cavalcante Costa; Lecidamia Cristina Leite Damascena; Nyellisonn Nando Nóbrega de Lucena; Faumana dos Santos Câmara; Eliane Medeiros-Serpa; Yane Laiza da Silva Oliveira; Yolanda Targino Medeiros dos Santos; and Elza Cristina Farias de Araújo).

Funding

The present study received a research grant from the World Health Organization Implementation Research Regional Training Centre for the Americas Region.

Author information

Authors and Affiliations

  1. University of São Paulo, Ribeirão Preto, SP, Brazil

    Isabella Lima Arrais Ribeiro & Maria do Carmo Gullaci Guimarães Caccia-Bava

  2. Federal University of Paraíba, João Pessoa, PB, Brazil

    Maria Eduarda Alves Sampaio, Laís Guedes Alcoforado de Carvalho, Simone Alves Sousa & Ana Maria Gondim Valença

  3. Postgraduate Program in Development and Technological Innovation in Medicines, Federal University of Paraíba, João Pessoa, PB, Brazil

    Rebecca Rhuanny Tolentino Limeira

  4. Postgraduate Program in Dentistry, Federal University of Paraíba, João Pessoa, PB, Brazil

    Fabio Gomes dos Santos & Paula Maria Maracajá Bezerra

Authors
  1. Isabella Lima Arrais Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria do Carmo Gullaci Guimarães Caccia-Bava
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Eduarda Alves Sampaio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rebecca Rhuanny Tolentino Limeira
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laís Guedes Alcoforado de Carvalho
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fabio Gomes dos Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paula Maria Maracajá Bezerra
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Simone Alves Sousa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ana Maria Gondim Valença
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Isabella Lima Arrais Ribeiro and Ana Maria Gondim Valença conceptualized and designed the study, was involved in analysis and interpretation of the data, drafted and revised the paper, and gave approval of the final version. Maria do Carmo Gullaci Guimarães Caccia-Bava conceptualized and designed the study and revised the paper. Maria Eduarda Alves Sampaio, Rebecca Rhuanny Tolentino Limeira, Laís Guedes Alcoforado de Carvalho, Paula Maria Maracajá Bezerra, and Simone Alves Sousa were involved in implementation of this project and wrote the article. Fábio Gomes dos Santos was involved in interpretation of the data and wrote the article.

Corresponding author

Correspondence to Fabio Gomes dos Santos.

Ethics declarations

Ethics Approval

This study was approved by the Ethics Committee on Human Research of the Health Sciences Center, Federal University of Paraiba, under protocol number: CAAE:64249317.3.0000.5188, and conducted according to the ethical principles of the declaration of Helsinki.

Consent to Participate

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

Consent for Publication

Patients signed informed consent regarding publishing their data.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ribeiro, I.L.A., Caccia-Bava, M.d.G.G., Sampaio, M.E.A. et al. The Implementation of an Integrated Oral Care Protocol for Pediatric Cancer Patients: a Qualitative Study. J Canc Educ 38, 940–947 (2023). https://doi.org/10.1007/s13187-022-02210-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13187-022-02210-7

Keywords

Search

Navigation