Oral cancer knowledge in adults evaluated through a phone survey in the context of SARS-COV2 pandemic

Introduction: Oral cancer is Colombia's 8th most common cancer, with an estimated survival rate of 52%. Lack of knowledge and awareness about oral cancer and its risk factors is associated with a delay in diagnosis. Objective(s): To evaluate adults' oral cancer knowledge through a phone survey in the context of the SARS-COV2 pandemic. Material(s) and Method(s): A cross-sectional questionnaire survey was conducted by phone during the COVID-19 pandemic on 268 patients attending at the dental school of Universidad de Antioquia, years 2020-2021. The collected data were analyzed using SPSS software. Result(s): The mean age was 58.9 years. 58.6% of participants had heard about oral cancer. social media was the primary source of information for 42% of participants, and 96.7% considered the screening important. Most patients did not feel worried (54.5%), fearful (59.7%), or anxious (56.3%) in case they were submitted to a screening for early detection of oral cancer. Lower socioeconomic status and educational level are correlated with lower awareness of oral cancer. The dimensions of experience and attitude towards screening were not associated with sociodemographic variables. Conclusion(s): The knowledge of oral cancer is still poor and is related to low socioeconomic and educational levels. However, this association was not observed in the attitude and experience dimensions toward screening for oral cancer. Therefore, there seems to be a need for more educational programs about knowledge of oral cancer, especially in socially disadvantaged groups, considering that there are no barriers related to screening.

The epidemiology of oral cancer during the COVID-19 pandemic in Northern Italy: Incidence, survival, prevalence.

Despite novel treatment approaches, oral cancer survival has not improved significantly and the disease often presents a disabling path for patients. The aim of this work was to describe the epidemiological data of oral cancers in a province of northern Italy. Incident cases in the period 1996-2020 and EU population standardized rates were reported for Oral Cavity cancer (OC) and OroPharyngeal cancer (OP). Annual percent changes (APC) were estimated with joint point analysis. The 5-year survival was calculated in three different periods: 1996-2000, 2001-2010 and 2011-2015. From 1996 to 2020, 771 cases of oral cancers (442 OC and 329 OP) were recorded with the age-standardized incidence rate 7.28 (10.74 in males and 3.97 in females): 3.82 for OC and 3.47 for OP. In males there is a significant increase in the incidence of OP up to 2017 (APC 11; 95% CI, 4.9-17.5), which then decreases; in females the rates are constant. In 2020 (the era of Covid-19), we did not see a decline in incidence compared to 2019. The 5-year survival (for cases diagnosed in 2011-2015) was 55.6%, 56.5% and 56% for OC, OP and OC + OP, respectively; it was somewhat higher in females and was undergoing some changes over the course of years. The number of prevalent cases as of 1 January 2021 is 314 (175 OC, 139 OP). The study showed a decline in cancers in men, particularly for OP; survival shows improvement in the long-term examined; Covid-19 had no negative impact on 2020 diagnoses.

Health Disparities in Oral Health

The world is becoming more diverse as the population of older adults continues to increase. According to the CDC, approximately 36% of the population belongs to a racial or ethnic minority group. Older adults are living longer and are expected to comprise an estimated 24% of the population by 2060. The older population is more likely to experience greater health challenges that include oral complications. Oral diseases such as tooth decay, tooth loss, gum disease, dry mouth, oral cancer and precancer, as well as chronic diseases are the most common. While there has been significant improvement in life expectancy, oral health, and overall health in the United States, there is a greater prevalence of oral disease and health disparities in minority and poor populations. Social determinants of health such as education, income, race, and access to care are contributing factors that are related to these health disparities among older adults. African Americans and other older adult people of color are disproportionately affected. Health literacy, dental coverage, and living conditions are other health disparities that contribute to the oral health of older adults. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Quality of Life Assessment With European Organisation for Research and Treatment of Cancer Questionnaire (Head and Neck Module 43) and Its Clinicopathological Correlation Among Patients Treated for Oral Squamous Cell Carcinoma: An Exploratory Study.

Introduction Oral cancer has a great impact on quality of life (QOL). Many risk factors influence the overall QOL. Our study was performed to evaluate the QOL among patients with oral cancer and to correlate it with age, gender, tobacco usage, and clinicopathological details. Methods We have used the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-HN43) and the Quality of Life Questionnaires for Core 30 (QLQ-C30) among the patients diagnosed with oral cancer after reporting to our institution. The Gpower calculation based on differences between two independent means reported by Meera et al. had a total sample size of 28 with an actual power of 0.9616. Thirty-five patients were included in the present study. Ethical clearance for this study was obtained, and there were no gender or age limits for enrollment. The patient demographic details and case history with relevant treatment information were collected from the DIAS (Dental Information Archival Software) of Saveetha Dental College, Chennai. After obtaining informed consent from the patients, the EORTC QLQ-HN43 and QLQ-C30 questionnaires were given to them. It was used both in Tamil and English. Various domains such as pain, appearance, and oral function were documented. The findings were correlated with clinical and histopathological findings. The collected data were tabulated and statistically analyzed with IBM Statistical Package for the Social Sciences (SPSS) version 20 (IBM Corp., USA). The mean ± SD were calculated for continuous variables, and frequency with percentage was determined for categorical parameters. Results The study included both men (57%) and women (43%) in the age range of 30-70 years, with a mean age of 50 years. Study samples included tobacco users (82%) and non-tobacco users (18%). Out of the 35 patients, 15 patients had lesions involving the buccal mucosa (42%) and 10 involving the tongue (28%). Oral squamous cell carcinoma (OSCC) was the most common type of lesion, and it was mostly treated surgically with resection and excision (82%), or just excision (18%). Seventy percent of our patients underwent reconstruction, while primary closure was done in only 30% of cases. All of the patients underwent neck dissection, including supraomohyoid neck dissection (52%), modified radial neck dissection (40%), and radial neck dissection (8%). Histopathology revealed that 49% had well-differentiated squamous cell carcinoma, 23% had moderately differentiated squamous cell carcinoma, and 28% had poorly differentiated squamous cell carcinoma. Out of the 35 included cases, five patients had died (14%). The primary site was buccal mucosa in all five cases, and surprisingly, three patients also had recurrences post-surgery or post-radiotherapy. We observed that the average rating of overall health and overall QOL at the time of diagnosis was 5.4. After one year of follow-up, the average rating of overall health and overall QOL was found to be 3.4. Conclusion The administration of EORTC QLQ-HN43 was found to be efficacious in our study on patients with OSCC. We could identify baseline data regarding the QOL of our patients treated for OSCC. We have identified critical domains of oral function that need to be focused upon to improve the overall QOL of OSCC patients through adjunctive therapies. We have also identified higher mortality and overall poorer QOL in patients with OSCC involving the buccal mucosa.

An American Perspective of the Dental and Public Health Initiatives in Cuba

Aim: To compare following the Cuban Revolution, Cuba's economy and civil society was transformed by the initiation of a program of nationalization and political consolidation. The Cuban government operates a national health system and assumes fiscal and administrative responsibility for the healthcare of its citizens. Other industrialized nations continue to surpass the US in health-related outcomes indicating areas of improvement in its healthcare system. Assessing the successes and failures as well as the advantages and disadvantages of other countries' healthcare systems may be instrumental in the development of modifications to the organization and delivery system of healthcare in the US. This paper aims to report the information attained from previous literature as well as from first-hand observations from a public health trip to Cuba in order to compare the healthcare systems in Cuba and the United States. Materials and Methods: A group of New York University College of Dentistry faculty and students traveled to Cuba in April 2019 for professional research and professional meetings (CFR 515.564). While in Cuba, the researchers took written notes of the lecture-based material and conversations. Upon return to the United States, published literature was searched for the collection of any additional data and all qualitative data and quantitative data was compiled and organized. Since 1959, Cuba has made continuous adjustments and improvements to its universal, free and accessible healthcare system. Results: There have been notable improvements to the country's public health status, such as the implementation of an immunization program and subsequent eradication of communicable diseases, such as polio and rubella. Additionally, the implementation of the National Program on Dentistry guarantees dental care to all Cuban children under the age of 19. Today, the Cuban National Health System (NHS) initiatives have evolved to combat the novel coronavirus (COVID-19) pandemic. Conclusion: Recognizing the advantages as well as the disadvantages of the Cuba's National Health System (NHS) would be useful for future policymakers in the United States. Cuban approaches to health could be tailored to the United States environment to improve healthcare effectiveness and population health status in the future. © 2022 Academy of Advanced Dental Research.

The Impact of COVID-19 on Oral Cancer Diagnosis: A Systematic Review

The Coronavirus-19 pandemic has led to severe collapses in international health systems that have repercussions at all levels of disease prevention. Oral squamous cell carcinoma (OSCC) is the most common head / neck malignancy, and it is usually diagnosed late due to patients neglecting symptoms. The purpose of this systematic review is to verify the impact of Sars-Cov-2 pandemic on OSCC diagnosis. The search methodology follows the PRISMA statement performing a PubMed investigation from 2019 to 2021 using MeSH such as "Covid-19;oral cancer”. A multidisciplinary approach would be effective, with a broadening of the knowledge of health professionals to identify cancerous lesions. A timely diagnosis of OSCC is crucial and its management is fundamental also for dental specialists. With the aim to anticipate the diagnosis, it will be desirable to set prevention campaigns also by the assistance in telemedicine. © Pulcini, R., D'Agostino, S., Dolci, M., Bissioli, A., Caporaso, L., and Iarussi, F. (2022).

Principles of management for patients with oral cancer during the COVID-19 pandemic

The outbreak of coronavirus disease 2019 (COVID-19) affects the world. It is highly contagious and spreads quickly. COVID-19 severely increases the medical burden and interferes with our normal work. This article introduces our experience on treat oral cancer patients during the epidemic. The negative impact can be minimized through reasonable and orderly arrangement.Copyright © 2021 The Authors

Financial toxicity and mental well-being of the oral cancer survivors residing in a developing country in the era of COVID 19 pandemic - A cross-sectional study.

OBJECTIVES: The primary outcome measures evaluated the financial toxicity and mental well-being of the oral cancer survivors. METHODS: A cross-sectional study of oral cancer survivors who were disease-free for more than 6 months after treatment and visited the hospital for a routine follow-up is included in the study. Mental well-being and financial toxicity were evaluated using the Depression, Anxiety, and Stress Scale - 21 (DASS 21) and Comprehensive Score for financial Toxicity (COST- Functional Assessment of Chronic Illness Therapy) questionnaires. A literature review was done to compare the results with financial toxicity and mental health in cancer patients from the pre-pandemic era. RESULTS: A total of 79 oral cancer survivors were included in the study, predominantly males (M: F = 10:1). The age ranged from 26 to 75 years (The median age is 49). The full-time employment dropped from 83.5% in the pre-treatment period to 21.5% post-treatment. Depression was observed in 58.2% and anxiety in 72.2%. Unemployed survivors were observed to have more depression (OR = 1.3, 95% confidence interval (CI) = 0.3-5.4, p = 0.6), anxiety (OR = 3.5, 95% CI = 0.3-21.2, p = 0.1) and stress (OR = 1.6, 95% CI = 0.3-6.6, p = 0.5) than rest of the cohort. On univariate analysis, unemployed survivors (M = 11.8 ± 3.8, p = 0.01) had significantly poorer financial toxicity scores. Survivors with depression (M = 16.4 ± 7.1, p = 0.06) and stress (M = 14.4 ± 6.8, p = 0.002) had poor financial toxicity scores. On multifactorial analysis of variance, current employment (p = 0.04) and treatment modality (p = 0.05) were significant factors impacting the financial toxicity. CONCLUSION: There is a trend towards increased incidence of depression, anxiety, and stress among oral cancer survivors compared to the literature from the pre-COVID era. There is significant financial toxicity among either unemployed or part-time workers. This calls for urgent public/government intervention to prevent the long-term impact of financial toxicity on survival and quality of life.

Faster surgery initiation in oral cancer patients during the COVID-19 pandemic in Osaka, Japan.

BACKGROUND: We investigated the impact of the COVID-19 pandemic on oral cancer (OC), comparing diagnosis and number of pre-operative days in the diagnosis of OC in 2019 (pre-COVID-19) and that in 2020 (during the COVID-19 pandemic). METHODS: Using data from a cancer registry-based study on the impact of COVID-19 on cancer care in Osaka (CanReCO), we collected details of sex, age, residential area, cancer site, date of diagnosis, clinical stage at first treatment and number of pre-operative days in OC patients. RESULTS: A total of 1470 OC cases were registered. Incidence of OC before and during COVID-19 was 814 and 656 cases, respectively. During the first wave of the pandemic (March to May 2020), incidence was about half that in the same period in 2019 (2019; n = 271, 2020; n = 145). Number of pre-operative days (median number of days between the first hospital visit and surgery date) was significantly shorter during the COVID-19 year (24.5 days) than in the pre-COVID-19 year (28 days, p = 0.0015). CONCLUSIONS: Incidence of OC during the COVID-19 pandemic was lower than in pre-COVID-19. Despite disruption in the healthcare system, the number of pre-operative days for OC cases was shorter during the pandemic.

COVID-19 and oral cancer: Critical viewpoint.

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has marked the beginning of a new pandemic named coronavirus disease 2019 (COVID-19). The World Health Organization has announced it as a health emergency that is of international concern. The disease has been reported to cause respiratory illness, pneumonia and even hinder the immunity of an individual. Individuals with disturbed immune responses have been found to be quite susceptible to this viral infection. Oral cancer patients are also at high risk in this pandemic situation and might encounter severe detrimental outcomes. Angiotensin receptors, documented in studies as the path of entry of this virus, are highly expressed in the epithelial cells of oral mucosa, making the group of individuals with oral cancers even more vulnerable. Extracellular matrix metalloproteinase inducer is another potential target for SARS-CoV-2. An exhaustion of angiotensin converting enzyme 2 cell receptors leads to protumoral effects, whereas a downregulation of extracellular matrix metalloproteinase inducer leads to antitumoral effects. Thus, it causes a variation of the biological behavior of the tumor. This article focusses on the molecular mechanisms, effects and patho-physiology of COVID-19 in oral squamous cell carcinoma patients. The different molecular changes in oral squamous cell carcinoma in the background of COVID-19 will modify various environmental factors for this pathology and have an effect on the carcinogenesis process. Understanding the behavior of the tumor will help plan advanced treatment strategies for oral squamous cell carcinoma patients in the background of COVID-19.

American College of Epidemiology Annual Meeting Late-Breaker Abstracts, Virtual, 8-10 September 2021

This conference proceeding contain 39 articles that discuss epidemiology in the US. Topics include the Millenium Cohort Study, The CRONICAS Cohort Study, religious beliefs, coping mechanisms and type 2 diabetes, spatio-temporal modelling of COVID-19, cigarette smoking and spinal pain, self-perceived health status and obesity, oral cancer and smoking, renal impairment and diabetes, depression and BMI, affordable housing and COVID-19, opioid misuse among youth, emotions and cancer prevention, influenza vaccination among adults, blood lead levels and private wells, and air pollution and amyotrophic lateral sclerosis.

The Potential Role of Telemedicine in Early Detection of Oral Cancer: A Literature Review.

The 5-year survival rates of oral cancer have not improved significantly since many decades. It is believed that "diagnostic delay" plays a critical role in determining the prognostic outcomes. At present, the coronavirus disease (COVID-19) pandemic has led to drastic changes within a short period of time and has resulted in many serious consequences at different levels worldwide. Although it is evident that COVID-19 is a major concern when it comes to people's health, it carries with it a message of hope, a desire to survive, and an opportunity to address many unprecedented challenges. This has left the doors wide open to use "telemedicine" as an essential tool to counter the rapid shift in health-care services and to meet the high demands in different health specialties including oral medicine. The aim of this review is to explore the potential roles of telemedicine in early detection of oral cancer and to highlight both the benefits and the limitations of the available applications and technologies. The clinical applications of telemedicine show a great potential in early detection of oral cancer, but the evidence of their effectiveness is still not conclusive. This needs to be investigated, especially in the developing countries where "telemedicine" may prove to be highly valuable in the future.

Experiences of Newly Diagnosed Oral Cancer Patients during the First Wave of the COVID-19 Pandemic: A Qualitative Study from Pakistan.

The COVID-19 pandemic has resulted in the scaling back or postponement of non-emergency hospital services, including care of cancer patients. The present qualitative study explored the experiences of newly diagnosed oral cancer patients during the first wave of the COVID-19 pandemic in Pakistan. Patients who attended the Department of Maxillofacial Surgery, Khyber College of Dentistry in July 2020 were selected using a maximum variation purposive sampling method. Seventeen semi-structured interviews were conducted in Pashto, the local language of Khyber Pakhtunkhwa. All interviews were audiotaped, transcribed verbatim, and translated into English. Thematic content analysis yielded eight major themes: pain and generalised physical weakness, shock at diagnosis, psychological distress of the COVID-19 pandemic, faith and religion, double hit loss of employment, social isolation, social support from caregivers, and lack of support from health care professionals. In conclusion, the COVID-19 pandemic has a clear impact on the life experiences of newly diagnosed oral cancer patients. Distress due to delay in accessing health care and lack of support from health care providers are a matter of great concern. Appropriate interventions should be introduced to ensure psychological and social support strategies are in place for patients during interruptions of health care services.

Salivary Metabolomics for Oral Cancer Detection: A Narrative Review.

The development of low- or non-invasive screening tests for cancer is crucial for early detection. Saliva is an ideal biofluid containing informative components for monitoring oral and systemic diseases. Metabolomics has frequently been used to identify and quantify numerous metabolites in saliva samples, serving as novel biomarkers associated with various conditions, including cancers. This review summarizes the recent applications of salivary metabolomics in biomarker discovery in oral cancers. We discussed the prevalence, epidemiologic characteristics, and risk factors of oral cancers, as well as the currently available screening programs, in India and Japan. These data imply that the development of biomarkers by itself is inadequate in cancer detection. The use of current diagnostic methods and new technologies is necessary for efficient salivary metabolomics analysis. We also discuss the gap between biomarker discovery and nationwide screening for the early detection of oral cancer and its prevention.

CURRENT LEVELS OF KNOWLEDGE OF DENTISTRY STUDENTS ABOUT ORAL CANCER

Avoiding cancer risk factors such as smoking, being overweight, and not getting enough exercise may help prevent certain types of cancer. It is possible that increasing the protective factors, prevent this type of disease from proliferating. Some patients only go to the dentist when they suffer from a complication in the oral cavity. The students of this branch play a fundamental role in the treatment and timely detection of diseases in the oral cavity through their practical classes. It is up to the education system and its teachers to provide all its students with the necessary mechanisms so that they can help them and provide them with security and confidence. In times as convulsive as those we are experiencing today and with the appearance of Covid-19, face-to-face classes have been replaced by virtual ones, stealing the space for students to interact with patients, hence the importance of resuming classes practices that are the only ones that complete the preparation of future specialists and thus stop the increase in cases of oral cancer in the country's population.

Treatment with Angiotensin-(1-7) Prevents Development of Oral Papilloma Induced in K-ras Transgenic Mice.

Oral Squamous Cell Carcinoma (OSCC) is the most common malignant cancer affecting the oral cavity. It is characterized by high morbidity and very few therapeutic options. Angiotensin (Ang)-(1-7) is a biologically active heptapeptide, generated predominantly from AngII (Ang-(1-8)) by the enzymatic activity of angiotensin-converting enzyme 2 (ACE 2). Previous studies have shown that Ang-(1-7) counterbalances AngII pro-tumorigenic actions in different pathophysiological settings, exhibiting antiproliferative and anti-angiogenic properties in cancer cells. However, the prevailing effects of Ang-(1-7) in the oral epithelium have not been established in vivo. Here, we used an inducible oral-specific mouse model, where the expression of a tamoxifen-inducible Cre recombinase (CreERtam), which is under the control of the cytokeratin 14 promoter (K14-CreERtam), induces the expression of the K-ras oncogenic variant KrasG12D (LSLK-rasG12D). These mice develop highly proliferative squamous papilloma in the oral cavity and hyperplasia exclusively in oral mucosa within one month after tamoxifen treatment. Ang-(1-7) treated mice showed a reduced papilloma development accompanied by a significant reduction in cell proliferation and a decrease in pS6 positivity, the most downstream target of the PI3K/Akt/mTOR signaling route in oral papilloma. These results suggest that Ang-(1-7) may be a novel therapeutic target for OSCC.

Oral cancer diagnosis amid COVID-19 pandemic: Identifying tell-tale signs to avoid pitfalls in general dental practice.

This article details the unusual presentation of an oral squamous cell carcinoma (SCC) referred to secondary care during the COVID-19 pandemic. The patient's chief complaints were trismus and pain from a lower left partially erupted third molar, which was assumed to be pericoronitis-related on referral. Intra-oral examination was difficult due to the patient's symptoms, but radiographic assessment of an orthopantomogram (OPG) showed a pathological fracture and poorly defined radiolucency in the lower left third molar region. Oral SCC was diagnosed after biopsy, and surgery and radiotherapy were swiftly carried out despite COVID-19 restrictions. General dental practitioners (GDPs) remain the frontline healthcare professionals in the screening and detection of oral cancer through detailed history taking and examinations. Primary care dental practitioners should always remain vigilant with patients at risk of oral cancer. Prompt referral to secondary care for further investigations and management should be made when a suspicion of oral malignancy is raised, to ensure a better treatment outcome. Video consultations have had their merits in dentistry amid the coronavirus pandemic, but face-to-face consultations are essential to establish quality patient care.

Oral cancer awareness and education within the pharmacy profession.

The incidence of oral cancers are rising in the UK, with early detection a significant positive prognostic factor. The Covid-19 pandemic has negatively impacted patients access to dental services, reducing a potential avenue to diagnosis. Community pharmacists are well positioned to play an expanded role in supporting earlier detection. This study seeks to identify levels of awareness and knowledge of oral cancer amongst community pharmacists, to inform development of educational resources.A cross-sectional digital survey was distributed via social media between August and September 2021. Data were collected on participant's demographics, oral cancer awareness and educational resources relevant to oral cancer. The results obtained were analysed using descriptive statistics in IBM SPSS software.61 pharmacists completed the survey. The majority were female (n = 40; 65.6%) aged 18-30 (n = 33; 54.1%). Less than half of respondents reported feeling confident in recognising risk factors (37.7%; n = 23). A substantial minority (n = 8; 13.1%) incorrectly selected fluoride toothpaste use as a risk factor for oral cancer. Most respondents correctly suggested signposting patients with signs or symptoms of oral cancer to a General Medical or General Dental Practitioner (GDP) (n = 35; 57.3%, n = 46; 75.4%). 91.8% of respondents (n = 56) would welcome an educational resource to support professional development.This study demonstrates a need for further educational resources regarding oral cancer, specifically aimed at community pharmacists. Community Pharmacists have a crucial role in efforts to improve rates of early detection of oral cancers. Work should be completed to explore the establishment of direct referral pathways from community pharmacy to secondary care.

A Case of Salvage Maxillectomy for Recurrent Oral Cancer After Boron Neutron Capture Therapy During the COVID-19 Pandemic.

BACKGROUND: During the COVID-19 pandemic, pedicle flaps instead of free flap transfer were recommended for head and neck reconstruction to reduce infection risk. Boron neutron-capture therapy in Japan was clinically approved in 2020 as a salvage radiotherapy for recurrent head and neck cancer following chemoradiotherapy. The efficacy and safety of salvage surgery following boron neutron-capture therapy remain unclear. CASE REPORT: We describe a 57-year-old male with crT4aN0M0 oral cancer after three different forms of radiotherapy including boron neutron-capture therapy, treated by salvage partial maxillectomy with both buccal fat pad and nasoseptal flaps. His postsurgical course was successful, without tracheostomy, and he had no Clavien- Dindo grade 3 or 4 complications. The pathological diagnosis was T4a squamous cell carcinoma with a negative surgical margin. No recurrence or metastasis had occurred at 113 days postoperatively. No opioid consumption was needed postoperatively. CONCLUSION: Pathological negative margins were achieved in this case and there were no severe complications. Further accrual of cases salvage surgery following boron neutron-capture therapy is required to clarify treatment strategies for recurrent head and neck cancer.