Oral Candida Lesions and Candida tropicalis: Potential Prognostic Markers in End-of-Life Cancer Patients

Purpose. To evaluate the distribution of oral candidosis lesions and Candida species as prognostic indicators in palliative care patients with end-of-life cancer. Methods. We consecutively included palliative care patients and diagnosed oral candidosis in them using microbiological techniques. Samples were collected from the buccal mucosa using cotton swabs and inoculated onto CHROMagar culture plates. The extent of oral lesions was classified using Kodsi's grade, ranging from no extent (no pseudomembrane) to grade 1 and ≥ grade 2. We assessed the association between oral candidosis and overall survival using multivariate Cox proportional hazards models adjusted for clinically relevant factors. Results. We included 142 patients (median age 77 years; 52.8% female), and the prevalence of oral candidosis was 76.1%. The most common Candida species identified was Candida albicans (C. albicans) (80.6%). Extensive oral candidosis lesions were classified as no extent, grade 1 (28.7%) or ≥ grade 2 (14.8%). During the observation period, multivariate Cox proportional hazards models revealed that the existence of oral lesions ≥ grade 2 (adjusted hazard ratio [aHR] = 2.04; 95% confidence interval [CI]:1.18–3.54; p = 0.011) and the presence of Candida tropicalis (C. tropicalis) (aHR = 2.38; 95% CI:1.03–5.55; p = 0.044) were predictive factors. Conclusion. The severity of oral candidosis lesions and presence of Candida species, particularly C. tropicalis, might be prognostic indicators in patients with end-of-life cancer. These findings may help deliver prognosis-based oral care to such patients, improving their quality of life and mortality.