Tuesday morning the Today Show aired an exclusive interview between Matt Lauer and Michael Douglas. As you know,with throat
cancer in August 2010. He underwent 7 weeks of radiation therapy and
intensive chemotherapy. Now Douglas says that he recently got the news
that the tumor is gone: “I think the odds are with the tumor gone and
what I know about this particular type of cancer that I’ve got it
beat.” Douglas says that he lost about 35 lbs. during his treatment and
has regained about 12 of those pound back by “eating like a pig" (which was a prescription described in another case we covered last summer).He also reports that, along with some residual fatigue, his salivary glands have “shut down” for at least a year or two, and that the resulting dry mouth especially affects him while sleeping. For now, the 66-year-old will follow-up with physicians each month. Three years is thought to be the benchmark for considering a patient with his type of disease truly cancer-free.
Dry mouth, or xerostomia, is a very common side-effect of head and neck radiation therapy. Side effects include problems with the teeth and gums, salivary glands and bones of the jaw. Oral side effects occur in virtually all patients receiving radiation for head and neck malignancies, in approximately 80 percent of transplant recipients, and in about 40 percent of patients receiving primary chemotherapy.
Oral Complications of Cancer Treatment (Source: )
General
- Oral mucositis/stomatitis
- Xerostomia/salivary gland dysfunction
- Pain
- Infection
- Xerostomia-associated cavities
- Taste alterations
- Nutritional compromise
- Functional disabilities
- Abnormal dental development in children
Chemotherapy
- Neurotoxicity
- Bleeding
- Radiation caries
- Trismus/tissue fibrosis
- Osteonecrosis
- Consider use of palifermin for patients with hematologic malignancies receiving chemotherapy/radiation and autologous stem cell transplantation. Palifermin (trade name Kepivance) is a human recombinant keratinocyte growth factor (KGF) produced in Escherichia coli. KGF stimulates the growth of cells that line the surface of the mouth and intestinal tract.
- Utilize salivary gland-sparing radiation techniques.
- Administer a radioprotectant, such as amifostine, to reduce risk of xerostomia in head and neck cancer patients. Amifostine is a cytoprotective adjuvant used in cancer chemotherapy and radiotherapy involving DNA-binding chemotherapeutic agents.Inside cells, amifostine detoxifies reactive metabolites of platinum and alkylating agents, as well as scavenges free radicals.
- Encourage patients to maintain the oral hygiene regimen recommended by the dentist.
- Work with the patient's dentist to prevent and control infections with appropriate treatment before, during, and after cancer therapy.
- Emphasize the importance of maintaining good nutrition.
- Encourage patients to sip water often.
- Suggest using liquids to soften or thin foods.
- Recommend using sugarless gum or sugar-free hard candies to help stimulate saliva flow.
- Suggest using a commercial saliva substitute.
- Consider prescribing a saliva stimulant.