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Background: The increase in the use of oral cancer drugs implies that nurses take on new roles for which education and support to patients and family members become fundamental for promoting therapeutic adherence., Objective: To describe the patients' and nurses' perceptions on the effectiveness of the educational process in oral cancer treatment., Methods: A mixed method with a convergent design was used. Data were collected using a questionnaire (structured according to the Multinational Association of Supportive Care in Cancer Teaching Tool for Patients Receiving Oral Agents for Cancer guidelines) and semistructured interviews with patients. Focus groups were used with the nurses. Quantitative data were analyzed with SPSS 22.0 (IBM SPSS 22.0, Armonk, New York). Qualitative data were analyzed using semantic analysis., Results: One hundred forty-two questionnaires were analyzed. Patients were usually informed by physicians and nurses (81%), alone (33%) or in the presence of an informal carer (29.6%). Language comprehension was high, with a significant difference between those 70 years or older (P = .04) and those younger than 70 years. From the interviews (n = 16), 3 themes were identified: emotions during communication, feeling reassured by the presence of family members and nurses, feeling welcomed and an active part of the educational process. Three themes were identified from the focus groups (n = 4): prerequisites for an effective therapeutic education, nurses' skills, and educational process barriers., Conclusions: Overall, patients were satisfied with the education received. They perceived nurses as people who can help them understand the information they have received and manage their treatment and adverse effects., Implications for Practice: This study highlighted some important points for an effective educational process: having a nurse to refer to, technical relationship competences, joint visits with physicians, and being available by phone., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Perioperative oral care is effective for the prevention and reduction of complications following surgery. However, oral cancer patients' oral health is often poor. During hospitalization, oral cancer patients frequently receive oral care from ward nurses as well as professional oral care from dental hygienists. Maintenance of good oral hygiene in these patients ideally requires cooperation between nurses and dental hygienists. Consequently, communication tools used to share information about the status of patients' oral health are needed. One such tool is the Oral Assessment Guide (OAG). However, the inter-rater reliability of the OAG has not been consistently reported; therefore, we examined this between nurses and dental hygienists., Methods: Participants comprised 76 patients hospitalized for oral cancer treatment. After surgery, a nurse and a dental hygienist performed oral assessments using the OAG. Comparative statistical analyses were conducted to examine differences and consistencies in the scores of nurses and dental hygienists., Results: Although almost all patients' oral health status was poor, none were given the worst score in the mucous membrane or gingiva categories. Further, the tongue, saliva, mucous membrane, gingiva, and teeth/denture categories had low κ coefficients, indicating poor nurse-dental hygienist inter-rater reliability. In contrast, the κ coefficients and agreement rates for voice and swallowing were high. Dental hygienists' scores were significantly higher for the tongue, gingiva, and teeth/denture categories than were nurses' scores., Conclusions: This study showed low nurse-dental hygienist inter-rater reliability for the OAG and highlighted the difficulties in objectively assessing patients' symptoms and oral health conditions. Therefore, rather than only relying on an objective assessment of symptoms by a clinician, assessments should also include patients' subjective reporting of symptoms. OAG will likely be used until a new assessment tool is developed. Objective assessment training and/or user manual development may be required to improve the reliability of OAG. The present training of one lesson a year is insufficient, and efforts should be made to improve this to get more reliable outcomes.

Family caregivers face multiple challenges when caring for patients with oral cancer at home. Understanding the difficulties they face may assist health professionals to better organise and provide support for family caregivers of oral cancer patients. The aim of this study was to describe the caregivers' primary tasks and the difficulties they encounter when caring for a family member with oral cancer. This qualitative study included a purposeful sample of 22 primary family caregivers ranging in age from 25 to 71 years old. The researchers used face-to-face, semi-structured and tape-recorded interviews to collect data and employed qualitative content analysis to elicit caregiving-related themes. Six task-related themes and associated challenges were identified. These included managing the patient's nutritional issues, investigating and making decisions about patient care, managing sudden and unpredictable changes in the patient's condition, managing emotional distress, adjusting their attitudes towards patient care, and seeking resources. Family caregivers handle such essential tasks when they care for patients in home settings and they face specific challenges related to them. This study identified several challenges related to each task. From the outset, healthcare providers should actively offer caregiving information and strategies. Health professionals can incorporate strategies for supporting caregivers' ability to carry out these tasks into their treatment model and can help caregivers manage difficulties that can impede them from doing so., (© 2018 John Wiley & Sons Ltd.)

Background: Oral antiproliferative therapies have become increasingly important in the treatment of tumors. To ensure patient safety, medical care is focused on adherence and side effects., Objectives: To meet increased personnel and time requirements, delegation of tasks to nonmedical specialists (NMS) may be a solution; however, presently, little is known about the options in Germany., Method: At least 3,300 members of the German Society for Hematology and Medical Oncology (DGHO), 580 members of the Professional Association of Office-Based Hematologists and Oncologists in Germany (BNHO), and 1,500 members of the Conference on Oncology Nursing and Pediatric Nursing (KOK) were contacted via a web-based survey. The survey focused on the feasibility of oncology nurse consultation as an additional consulting service for patients undergoing oral tumor therapy., Results: In total, 255 (physicians) and 206 (NMS) questionnaires were evaluable; 90.9% of the physicians were hematologists/oncologists, 87.8% advocated oncology nurse consultation, 34.1% had previously implemented/scheduled such consultations, 58.3% of the NMS were nursing staff, 46.1% had advanced training in oral tumor therapy, 94.2% were interested in further qualifications, 37.8% worked at facilities with established/planned nurse consultations, and 62.1% personally conducted/preferred conducting consultations., Conclusions: Throughout Germany, there seems to exist a group of qualified NMS who are motivated to provide care to patients undergoing oral tumor therapy. Particular physicians actively support these nurse consultations. Extensive implementation of delegation concepts in standard care of patients undergoing oral tumor therapy is not yet underway., (© 2019 S. Karger AG, Basel.)

Symptom burden and poor adherence to oral anticancer agents remain significant clinical problems. This study examined feasibility, preliminary efficacy, and satisfaction with ADHERE, a nurse practitioner intervention that promotes symptom management and adherence among patients prescribed oral agents. The intervention group (which received one semistructured, face-to-face session followed by three weekly telephone sessions using motivational interviewing, brief cognitive-behavioral therapy, and a toolkit to promote self-management) had significantly lower symptom severity postintervention. Self-reported adherence was high and did not differ by group. Patients reported being highly satisfied with the ADHERE intervention.
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Purpose: The purpose of this article is to identify medication-related considerations for clinical nurse specialist practice by presenting a case report detailing the complexities of medication management, unresolved medication discrepancies, and reconciliation across care transitions., Background: Care transitions are a vulnerable time for medication-related problems to occur. Unresolved medication discrepancies can lead to adverse drug events and other poor health outcomes, including hospital readmissions and increased healthcare costs. Reconciling medication discrepancies during care transitions has been identified as a national patient safety goal to prevent medication-related problems. Clinical nurse specialists are uniquely qualified to lead and manage efforts to mitigate these problems during care transitions., Case Presentation: A 72-year-old male patient diagnosed with oral cancer underwent 8 weeks of chemotherapy and radiation treatments. Throughout these 8 weeks, the patient was seen by 4 providers and admitted to the hospital for neutropenia. As a result, a total of 19 new medications were prescribed and 5 medications were discontinued. Medication reconciliation was completed at each visit and at admission and discharge at the hospital. At discharge, the patient's medication regimen was complex, with 38 separate doses of 17 different medications per 24-hour period. Understanding and organizing the daily medication regimen were a consistent challenge for the patient during his illness., Discussion: This case highlights the complexities of medication regimens and opportunities to improve medication management and reconciliation across care transitions. This case underscores the need for and importance of quality patient-provider communication, assessing and managing medication regimen complexity, evaluating medications against the American Geriatrics Society Beers Criteria, evaluating potential drug-drug or drug-food interactions, and recognizing at-risk behaviors that may lead to medication discrepancies and errors at care transitions. Potential opportunities where clinical nurse specialists could intervene to promote safe and effective medication management across care transitions are presented., Conclusion/implications: Clinical nurse specialists have the unique ability to make key contributions and influence medication management and reconciliation across care transitions to promote medication effectiveness and safety.

Objective: The aim of this study was to identify factors associated with unmet supportive care needs in family caregivers of patients with oral cancer after surgery., Methods: In a cross-sectional study, we recruited patient-family caregiver dyads from the otolaryngology head and neck surgery wards of a medical center in northern Taiwan. Patients were assessed using a set of structured questionnaires to measure symptom distress, sleep quality, and depression. Social support and supportive care needs of family caregivers were measured., Results: Of the 102 dyads surveyed, needs for supportive care in information domain and healthcare professional/healthcare services domain were highest. Patients with more severe symptoms and family caregivers who received less social support from family were associated with greater overall unmet supportive care needs., Conclusions: Family caregivers report the need for more information and healthcare services after a family member has had oral surgery. Caregiving training programs should be developed for caregivers on the basis of meeting reported needs., (Copyright © 2014 John Wiley & Sons, Ltd.)

Most terminally ill people express a preference for dying at home. Within established models of palliative care, achieving death at home is a particular challenge for homeless people. This paper describes a quality-improvement project undertaken by a community-based palliative care service in Melbourne, Australia, to understand homeless people's palliative care needs and the challenges that workers face. Six semi-structured interviews with workers in hospital and community-based settings were undertaken and a case study documented. The results were used to initiate discussion about how policy and protocols for the community-based palliative care service might serve this population more effectively. The findings confirmed that homeless people have complex psychosocial and medical needs. They may be periodically uncontactable or living in unsafe settings, experience isolation from social support networks, and have issues of compliance with treatment protocols exacerbated by mental health problems and/or substance abuse. Service providers had particular challenges in meeting the palliative care needs of homeless people. A flexible, compassionate, and coordinated response is required, and more work is needed to explore how the needs of this particular group can be met.

Oral cancer occurs in a range of anatomical sites within the oral cavity and pharynx. Although oral cancer is relatively rare in the UK, it can have a significant effect on individuals, with treatment being associated with eating, drinking, speaking and breathing difficulties. Treatment may also result in alterations to body image and functionality, which can lead to depression. Therefore, nurses need to have knowledge of associated risk factors, treatment and nursing care to improve patient outcomes and enhance quality of life.

Although the overall incidence of head, neck, and oral cancer has been decreasing, oral and neck cancer caused by the human papillomavirus (HPV) has risen. This article discusses statistics, risk factors, causes, pathophysiology, treatments, and the home healthcare and hospice nursing implications for these patients. A real-life patient's journey through neck cancer caused by HPV is presented.

Purpose: Oral squamous cell carcinoma and its treatment are associated with facial disfigurement and functional inabilities that may lead to malnutrition or under nourishment. This study assessed the incidence of food restrictions in patients undergoing treatment for oral and oropharyngeal cancer., Method: We interviewed 120 patients in two hospitals in São Paulo, Brazil, using a structured food frequency questionnaire comprising the most commonly consumed foods in Brazil. This questionnaire was applied twice; the first time to inform dietary patterns prior to the diagnosis of cancer and the second time to assess recent modifications of diet that were associated with the disease and its treatment. Hospital files provided information on clinical status. Multivariate Poisson regression models assessed covariates with prognostic value., Results: One third of patients suffered major food restrictions (i.e., they reduced substantially the intake of more than 50% of the most commonly consumed food items before the diagnosis); 39% suffered a less severe condition (they could not eat less than 50% of the most commonly consumed food items before the diagnosis, and they needed changes in food preparation). Larger tumour size (adjusted incidence ratio IR = 1.45), posterior location (IR = 1.33), radiotherapy (IR = 1.84), loss of tongue mobility (IR = 1.36) and loss of teeth (IR = 1.25) in the surgery were associated significantly with the study outcome., Conclusion: This study identified clinical predictors of food restrictions in patients undergoing treatment for oral and oropharyngeal cancer. This knowledge may contribute to improve patient care and management, and to develop interventions aimed at preventing nutritional depletion of these patients., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Despite the fact that South African men are among the group having the highest risk of developing oral cancer there is currently no population-based primary and secondary prevention services for oral cancer in South Africa. This study aimed to develop an intervention focusing on the prevention and detection of oral cancer and pilot test the intervention in a semi-urban resource-poor community in Tshwane. The intervention was assessed in terms of screening uptake, knowledge and awareness of oral cancer and perception of the educational material developed for the intervention. Statistics were used to calculate screening uptake while a pre- and post-intervention design was used to determine knowledge and awareness and perception of the educational material. Sampling was purposive and all people reporting for oral screening were recruited for the study. The sample totalled 65 (n= 65) and the participation rate was 100%. Notwithstanding a favourable report on the flyer as motivator to take up oral screening the number of people especially those in the high-risk group who reported for screening was disappointing. However, the strategy used to improve knowledge and awareness was successful. Ways to improve screening uptake should be explored and tested to improve the current intervention., (© 2011 Blackwell Publishing Ltd.)

Background: Oral cancer continues to have a relatively low survival rate because most tumors are diagnosed at late stages. Nurse practitioners may be optimally positioned for oral cancer prevention and early detection., Methods: A statewide mail-based survey was conducted among 448 Florida nurse practitioners. Logistic regression was conducted to assess the independent relationships between nurse practitioners' attitudes and their practices in oral cancer prevention and early detection., Results: Nurse practitioners' oral cancer practice behaviors were significantly affected by their attitudes., Conclusions: Effective strategies should be implemented to enhance positive attitudes about oral cancer early detection among Florida nurse practitioners.

Purpose/objectives: To assess the knowledge of oral cancer risk factors among African Americans., Design: Descriptive; guided by the Patient/Provider/System Theoretical Model for cancer screening., Setting: Community-based primary care center in a southern state., Sample: 141 African Americans. The majority was female, had a 12th grade education, and had an income less than 10,000 dollars; 25% were smokers., Methods: Participants were asked to identify whether each of 15 factors (i.e., seven risk factors and eight nonrisk factors) increased risk for oral cancer. One point was added for each correct response; therefore, scores could range from 0-15 points. Demographic data were collected., Main Research Variables: Knowledge of and misconceptions about oral cancer., Findings: Only six participants correctly identified all of the risk factors. The majority recognized tobacco but was not as aware of the effects of the sun, alcohol, and diet. Many erroneously identified factors such as hot beverages, poor oral hygiene, spicy foods, dentures, and mouthwash as risk factors. Those with higher incomes and those who visited their dentists in the prior year had more knowledge of risk factors. No differences were found in knowledge based on age, gender, education, or smoking status., Conclusions: Some patients are less likely to routinely visit a dentist and are less knowledgeable about the risk factors for oral cancer. Many of these risk factors are modifiable; therefore, patients need to be aware of the risks and have access to effective strategies to reduce risk., Implications for Nursing: Assess risk factors, teach risk reduction, and correct misinformation. Refer patients to dental professionals. Develop community outreach to African American men at barbershops and fraternal organizations.

This study reports on experience acquired during the care of patients who could not participate in surgery, chemotherapy or radiation therapy because of the extent of the primary, recurrent or metastatic tumour, or because of the deterioration of the general condition or (in the event of recurrence), intervention with a curative aim could not be performed for the mentioned reasons. In these cases, improvement or preservation of the quality of life is the fundamental goal to be achieved at all times, for these patients must receive the best possible supportive treatment for the remainder of their lives, Unfortunately, the quaranteeing of this often tends to become mainly a financial question rather than a professional one. The medical staff has very little chance to influence the financial aspects, and must therefore do everything possible to ensure the highest possible level of care during hospitalization. Attention is drawn to the significant roles to be played by the family, the family doctor, the various home-care services and the hospice.

Knowledge of the etiology and pathophysiology of, and risk factors contributing to oral cavity cancer facilitates patient assessment and diagnosis. If untreated, oral cavity cancer can be disabling and potentially fatal. Even when treated, using the modalities discussed in this article, the patient experiences significant changes in body image and quality of life. The patient's physical and psychosocial needs must be identified pre-operatively and assessed throughout the post-operative period. By providing programs as described at the Toronto General Hospital utilizing a coordinated multidisciplinary team approach that encourages, supports, and nurtures patients and their significant others, an optimum quality of life may be established for this population. From the outset, patient education describing oral cancer and the course of treatment to follow, may contribute to the preservation and/or early return of optimum quality of life. Increased public knowledge and awareness of oral cavity cancer regarding risk factors and their potential effects may contribute to healthier life styles.

This is the fifth of a six-part series on metastatic spread and natural history of 18 common tumors. Part 1 summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6000 deaths/year in the United States. Bladder and brain cancer were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Parts two, three, and four charted the natural histories, problems, and assessment parameters of advanced cancers of the breast, colon and rectum, esophagus, kidney, liver, and lung; and leukemia, melanoma, and multiple myeloma. Part five provides corresponding information on non-Hodgkin's lymphoma and cancers of the oral cavity (and pharynx) and ovary. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians will be able to anticipate the spread of these cancers and can thus identify problems early in their development so that the problems are more easily managed.

This article provides an introduction to the care of patients following maxillofacial surgery, many of whom undergo the complexities of microvascular flap surgery and need careful nursing assessment in the postoperative period. A brief introduction to this surgery illustrates some of the potential reasons for admission to the intensive care unit. The nursing care is vital to maintain the survival of the flap, the details of which are discussed along with factors which potentially contribute to flap failure. Other considerations such as haemodynamic stability, postoperative complications, the importance of education and other options for postoperative management also form further points for discussion.

Screening for oral cancer is an often overlooked element of annual medical examinations and physical assessments in the elderly. As the elderly population increases, more emphasis will be placed on caring for clients in the home, and oral cancer screening will be provided by nurses. This article outlines the most common types of oral cancer and provides step-by-step instructions of performing an oral cancer screening examination.

Elderly patients with oral cancer present many challenges in the home healthcare setting. Timely detection of disease, appropriate and timely referrals, and the adverse effects of therapies, nutrition, and depression are discussed in this article. Using a case study, the author offers suggestions on the coordination of services of dental, medical, and nursing professionals and management of adverse dental effects.

Epidemic Kaposi's sarcoma, which has consistently been the most prevalent malignancy in people with HIV disease, frequently presents with lesions in the oral cavity. Guidelines for treating oropharyngeal lesions with radiotherapy are ubiquitous in the literature. Treatment indications include pain, dysphagia, and obstruction. Radiotherapy dosage and fractionation differ from that prescribed for non HIV-infected people. Current literature reveals better treatment outcomes for people infected with HIV if treatment is managed by practitioners experienced in HIV care. This article presents a review of the literature and a case study of a HIV-infected patient who experienced severe adverse effects of irradiation.

This paper describes the care of a man following unsuccessful surgery for oral cancer. The authors describe the way in which the patient was involved in decision-making about his care and how this contributed to the maintenance of dignity and self-respect in the months before his death.

Oral cancer is a particularly distressing disease, and treatment can be difficult to cope with. It is more common than is often realized, and may be preventable. This article discusses how nurses may help to reduce the incidence of advanced disease, and briefly explains how the treatment of intraoral cancer is managed in one specialised unit.

The purpose of this study was to describe the perceived eating problems, general symptoms, and general health of a group of oral- and pharyngeal- cancer patients before surgery in order to facilitate nursing care planning. A total of 29 patients (20 men and nine women) participated. Two groups were formed: in group 1, 13 patients participated before and, in group 2, 16 patients participated after the presurgical radiotherapy. Questionnaires were used to collect data. Eating disabilities were evident in both groups. The patients who had had their radiation therapy experienced problems such as bad taste function, mouth dryness, difficulties in chewing, and mouth pain more frequently than those who had not been treated. Only five patients in group 2 ate solid food, compared with 10 in group 1. Shoulder and back pain and feelings of worry and anxiety were perceived as the most frequent general symptoms. Most of the patients perceived their general health as being rather good, but some indicated poor health, several symptoms, poor appetite, and/or severe eating problems. Patients with oral and pharyngeal cancer should be carefully assessed before surgery because of their disparity of symptoms and disabilities so as to identify those who need specific nursing interventions.