Haiqin Hu, MMed, Department of Thyroid Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences
Oral cancer is a malignant tumor occurring in the oral cavity. Currently, surgical resection is still the major treatment strategy for oral cancer, but undergoing such treatment may lead to a repertoire of postoperative conditions such as bacterial imbalance, a condition that involves an imbalance of health-promoting and pathogenic bacteria in the gastrointestinal tract. This may have an adverse effect on the prognosis and quality of life of patients after surgery. The perioperative care requirements of oral cancer patients are different from those of patients of other diseases, which demands proficiency of the nurses in their professional practice. At present, there is still a lack of corresponding evidence-based practice of oral care in China. To enhance the quality of life of people with oral cancer, a set of care standards for oral cancer management needs to be developed. To facilitate this, we conducted a review on the evidence-based practice of oral care for oral cancer patients, with the aim to develop, based on the JBI evidence-based health care model, a set of scientific and standardized evidence-based oral care practice program that can guide clinical nursing staff for increasing the efficacy of oral cancer care that they can deliver. This may help provide a more scientific and effective decision-making basis for clinical nursing practice in oral care.
To start off, we first established a research team, consisting of nursing professors, medical specialists in head and neck, clinical psychologist, dietician rehabilitation nurse specialist. The team members conducted a review in order to summarize and evaluate the literature that reports oral care programs currently practiced worldwide. PubMed, Cochrane Library ,Web of Science , the National Comprehensive Cancer Network (NCCN) and the Oncology Nursing Society (ONS) were used in the literature search, using a combination of keywords including oral cancer, oral care and perioperative. In our search, we retrieved four articles for inclusion in this review, including three practice guideline papers and one systematic review paper (Adelstein et al., 2017; Cervenka et al., 2019; Dort et al., 2017; Joo et al., 2019). Upon the retrieval of these articles, we conducted a summary of the evidence presented in these articles, and an evaluation on their suitability in clinical practice. The collected evidence was then summarized narratively in our review, presenting the latest evidence-based practice for perioperative oral care of patients with oral cancer. Recommendations on the care practice were classified into six major themes, including perioperative oral care rehabilitation, behavioral habits, psychology, flap care, nutrition, and pain.
According to the included evidence and the preliminary investigation, the possible obstacles in the implementation of oral care practice were also analyzed. We finally established the final draft of perioperative oral care practice plan for oral cancer patients, including an action plan and a flow chart of this plan (Figure 1).
In order to scientifically and effectively establish an evidence-based practice plan for perioperative oral care for patients with oral cancer, we also carried out a survey among current oral cancer patients. After review of the survey data, we found that current oral care practice does not involve the medical staff to evaluate the oral function of patients before surgery, to guide patients to quit smoking, nor to use skin temperature detectors to monitor the oral flap temperature of patients after surgery.
Overall, our review and survey have highlighted the importance of the evaluation of preoperative and postoperative oral function, nutrition, pain and psychological status among patients, the provision of rehabilitation training to patients, as well as the guidance for them to quit smoking and excessive alcohol consumption.
Adelstein D, Gillison ML, Pfister DG, Spencer S, Adkins D, Brizel DM, Burtness B, Busse PM, Caudell JJ, Cmelak AJ, et al. NCCN Guidelines Insights: Head and Neck Cancers, Version 2.2017. J Natl Compr Canc Netw. 2017; 15(6): 761-770.
Cervenka B, Pipkorn P, Fagan J, Zafereo M, Aswani J, Macharia C, Kundiona I, Mashamba V, Zender C, Moore M. Oral cavity cancer management guidelines for low-resource regions. Head Neck. 2019; 41(3): 799-812.
Dort JC, Farwell DG, Findlay M, Huber GF, Kerr P, Shea-Budgell MA, Simon C, Uppington J, Zygun D, Ljungqvist O, et al. Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction: A Consensus Review and Recommendations From the Enhanced Recovery After Surgery Society. JAMA Otolaryngol Head Neck Surg. 2017; 143(3): 292-303.
Joo YH, Cho JK, Koo BS, Kwon M, Kwon SK, Kwon SY, Kim MS, Kim JK, Kim H, Nam I, et al. Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol. 2019; 12(2): 107-144.
Figure 1. Flowchart of perioperative oral care plan for patients with oral cancer.