Impact of cancer therapy on oral care utilization

Derek Smith; Emily Castellanos; Barbara A. Murphy

doi:10.1200/JCO.2017.35.15_suppl.e18010

Abstract only e18010 Background: Cancer therapy can result in lifelong detrimental changes to oral function. These changes often result in negative effects on patients' quality of life. The primary objective of this study is to evaluate attendance at dental visits among patients receiving a cancer diagnosis, and how attendance may change as patients move through pre-diagnosis, diagnosis and into survivorship. Methods: The Health and Retirement Study is a publically available dataset containing longitudinal survey data detailing financial and health information on 4195 patients, over 51 years old who received a new cancer diagnosis during the study. The odds of reporting a dental visit were examined as patients proceed through various phases of cancer therapy using a mixed-effects logistic regression model. A propensity score weighted analysis of the association between dental attendance in the survey wave in which the cancer was diagnosed and survival was also undertaken. Results: The odds of attending a dental visit were substantially lower in the diagnosis wave OR = 0.784 (0.700, 0.876) and the post-diagnosis waves OR = 0.734 (0.655, 0.823) compared to pre-diagnosis waves. This effect persisted in patients who survived for at least two years indicating that the decline in oral health visits was not due to extremely low expected survival. The decrease in oral health visits was not affected by age, race, gender, income, insurance coverage or education. After propensity score weighting, patients who attended a dental visit in their diagnosis wave demonstrated a reduced hazard of all-cause mortality HR = 0.825 (0.681, 0.979) compared with those with no attendance. Conclusions: Dental attendance decreases by a statistically and clinically significant amount both during and after cancer therapy despite indications for dental referral existing for many types of cancer therapy. Attendance at dental appointments during cancer therapy is associated with improved survival, which is likely due to a combination of direct and indirect effects. The fact that the decreases in care were not modified by socioeconomic factors suggests that it is not driven by strictly financial concerns and more research is necessary to identify barriers to adequate care.

Impact of cancer therapy on oral care utilization

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