Cancer treatment-induced mucositis describes mucosal injury brought on by cancer treatment in the mouth, pharynx, larynx, esophagus, and other parts of the gastrointestinal tract [1]. Erythema and/or ulceration of the oral mucosa are the symptoms of CT-IOM. It is the dose-limiting toxicity of radiotherapy techniques like hyperfractionated radiotherapy, rapid radiotherapy, and radiotherapy-chemotherapy interventions. Up to 100% of patients receiving high-dose chemotherapy with hematopoietic stem cell transplantation (HSCT) develop CT-IOM [2]. It has been discovered that for patients receiving this treatment, a 1-point rise in the score of oral mucositis. CT-IOM is significantly linked to persistent fever, a higher risk of infection, more days requiring total parenteral nutrition, more use of intravenous narcotic analgesics, total hospital expenses, and a higher risk of death within 100 days [3].
Approximately 200 cGy of radiation for five days a week for 5–7 weeks is administered daily to patients undergoing radiation therapy for malignancy of the maxillofacial region. Nearly all individuals undergoing radiation or chemotherapy will experience CT-IOM to some extent. According to studies, between 29 and 66% of patients undergoing radiation treatment for head and neck cancer developed severe CT-IOM [4]. Oral mucositis was also shown to be common in patients with cancer in the oropharynx, or nasopharynx and oral cavity; receiving concomitant chemotherapy or a total dosage above 5,000 cGy; or modified fractionation radiation protocols [5].
Mucosal damage results from a complex series of biological processes as radiation injury causes direct cell damage that results in breaks in the DNA strand. There are several routes that ultimately lead to the death of the epithelium's basal cells, despite the fact that they are the ultimate "end organ" responsible for tissue damage [6]. There are five phases in the development sequence of oral mucositis: initiation, ulceration, signal amplification, upregulation/activation, and healing. Free radical production and oxidative stress were originally identified as the beginning physiological processes that initiate the process. Moreover, nuclear factor erythroid 2-related factor 2 (NRF2) and the innate immune response activation offer distinct foundations [7]. Individuals with CT-IOM, shows symptoms of pain, anorexia, debilitation, and depression [8, 9]. But in addition to systemic symptoms, patients frequently have oral health problems such as candidiasis, gingivitis, ulcers, xerostomia, accumulation of plaque, dysphagia, and dysgeusia. These oral health issues are very likely to have a significant negative impact on quality of life, both psychologically in the form of anxiety, and sadness and functionally in the form of difficulty in speaking, and masticating food [10, 11].
A World Health Organization statement describes palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering employing early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual” [12]. Though, any treatment that reduces symptoms can be denoted as "palliative care," regardless of whether a terminally ill patient has hope for a cure through alternative means. Palliative care, which strives to intercept and alleviate morbidity by correct and early diagnosis and managing pain along with other spiritual, mental, and medical difficulties, is commonly provided to patients with advanced-stage oral malignancy through multidisciplinary teamwork [13]. Palliative care can also be introduced early to improve the quality of life and reduce pain in the latter phases of life.
The morbidity caused to the patient by oral mucositis can be better treated by oral health care professionals. It has been reported that oral physicians improve quality of life in addition to treating oral health problems by enhancing mastication and speech [14]. Dentists and dental hygienists should have a multidisciplinary collaborative approach to provide palliative for the proper management of oral hygiene and function [15]. However, palliative care teams and oral physicians seldom work together, and the teams are not informed about managing oral health in patients with oral mucositis. Consequently, oral physicians frequently have a low level of involvement in palliative care. For Indian patients and doctors, palliative cancer treatment is still a relatively new and unexplored area of medicine. Therefore, efforts should be made to raise oral physician's understanding of palliative care and knowledge regarding oral mucositis.
AIM:
The present study aimed to assess the knowledge, attitude and skills of oral health care professionals working in different setups regarding the management of CT-IOM.