Tooth Loss and Malnutrition Pervasive in Elderly Oral Cancer Patients

Oral cancer is the most common type of head and neck cancer, affecting 157,000 men and 87,000 women in the United States, according to the NIH. The majority of cases occur in adults aged 50 to >70. Health-related quality of life (QoL) among cancer patients can be compromised by the effects of treatment on nutritional status and oral comfort. A team of investigators from the School of Dentistry, University of Granada, Spain, and the Institute of Epidemiology and Health, University College London, conducted a cross-sectional study to examine whether oral health-related QOL is associated with nutritional status in patients being treated for oral cancer.

Their study included 133 patients with a mean age of 65.4 years. In these patients, the most common site of oral cancer was the tongue, with the cancer in clinical stages I or II. Most patients had undergone oral surgery  and were followed for a mean of 5 years. Approximately 23% of patients were found to have malnutrition and 20% were found to be at risk of malnutrition. (Malnutrition was defined according to the Mini Nutritional Assessment). The only significant difference between the nourished patients and the patients with malnutrition or risk of malnutrition was the number of functional teeth (anterior: 2.3 ± 2.7 vs 1.3 ± 2.3, P=.020; posterior: 2.8 ± 3.8 vs 1.1 ± 2.8; P=.026).

When assessing the impact of oral health on QoL per the Oral Impacts on Daily Performances (OIDP) index and the Oral Health Impact Profile (OHIP), the investigators found that 97% of all patients reported at least one oral impact on QoL in the past month, with eating and speaking being the most commonly affected QoL domain. Patients with malnutrition or risk of malnutrition reported worse QoL than nourished patients; the effect sizes of the differences in oral health-related QoL between nourished and malnourished patients were statistically significant. The effect sizes were 0.79 (0.36–1.15) for OHIP (mean ± SD=25.70±11.22 in the malnourished group, and 16.80±11.24 in the malnutrition risk group) and 0.70 (0.28–1.12) for OIDP (mean ± SD=31.90±17.99 in the malnourished group, and 19.67±17.40 in the malnutrition risk group).

"Our results indicate that those patients with malnutrition or at risk of malnutrition had considerably worse [oral health-related] QoL than those with adequate nutrition,” the researchers wrote in the study. “The unadjusted associations were strong and while the adjustment for age, sex, clinical stage, follow-up, social class, type of treatment, and functional tooth units resulted in an attenuation of the estimates, they remained large and significant.”

According to the investigators, this is the first study to their knowledge to assess this relationship. Based on their findings, which warrant corroboration by randomized clinical trials or prospective studies, the study authors concluded that a nutritional screening on oral cancer patients after treatment is necessary for addressing potential malnutrition and improving QoL.

The study was recently published in Supportive Care in Cancer.

-Allison Musante