A painful effect of cancer treatment.
Years ago, when I worked with patients being treated for head and neck cancer who had been admitted for one reason or another, I felt helpless in the face of their extremely uncomfortable oral mucositis. None of our topical concoctions seemed to bring much relief to these patients, who had often endured disfiguring surgery as well.
While there is as yet no perfect solution to this uncomfortable side effect from the radiation or chemotherapy used to treat head and neck cancers, a group of oncology staff nurses and their colleagues have demonstrated that a consistent, standardized approach to oral care for these patients may significantly alleviate the pain of this almost universal treatment effect.
Consistent, standardized oral care.
After reviewing the literature on oral care, Cullen and colleagues enhanced their usual patient teaching with oncology radiation center outpatients, worked with staff in all disciplines to ensure that their oral care messages were consistent, and assembled a specific oral care kit (containing such items as non-irritating toothpaste, lip salve, and simple ingredients for an oral rinse) for the patients to use.
The success of this quality improvement initiative in decreasing patients’ self-reported side effects may have been due as much to the staff’s consistent reinforcement of oral care and to the provision of the oral care kits to patients than to any specific contents in the kits.
“Patients reported greater compliance with oral care after they received the initial supplies during their [pretreatment] dental clinic visit.”
Patient surveys indicated not only a decrease in mucositis symptoms in the intervention group but also fewer complaints of dry mouth (another uncomfortable side effect with potentially serious sequelae). This simple, “unglamorous” emphasis on a basic but critical nursing intervention made a big difference for patients. Read more about this practical initiative in “Oral Care for Head and Neck Cancer Symptom Management” in this month’s AJN.