1. 10
Dentist Experience of Post Treatment Oral and Maxillofacial Cancer Patients
Sam Harding & Prad Anand
Maxillofacial Department, Derriford Hospital, Plymouth, PL6 8DH
Introduction
It is well recognised that dental rehabilitation following treatment for oral cancer has a large impact on patients’ quality of life. Over the last few years there have been campaigns to raise the awareness of symptoms and diagnosis of oral cancers in both the general and medical populations. However to date the authors have been unable to find a study that investigates the frequency of exposure to this type of patient and the current knowledge and attitudes of General Dental Practitioner’s (GDP) in relation to the treatment and complications of these patients following oral cancer. This study investigated these areas and GDP requirements and requests for further training and education.
Methods
A questionnaire was constructed and posted to ten percent (N=183) of the GDP working in the South West (UK), with a stamped return addressed envelop. A subsequent posting was sent a month later to the non-respondents.
The analysis of numerical data was limited to descriptive statistics performed with SPSS V16. Free-text was analysed using content analysis with the aid of NUD*IST V5.
Results – Quantitative
A total of sixty-one percent (n=114) of potential participants responded. On average they had been qualified and registered as GDP’s for 20.5 years.
Questions one and two of the survey asked about the GDP experience of treating this type of patient and the training they had received. A surprisingly high percentage (76%, n=87) of respondents reported having seen or treated a person for Head and Neck Cancer. In relation to whether the respondents had received training regarding the complications of head and neck cancer patients whilst at dental school, 74% said that they had. The responses to questions three to seven and nine of the survey are listed in Table 1.
Question eight gave the respondents a number of choices as to how they would be most comfortable treating a patient with a history of Head and Neck cancer. Four main choices were selected; the responses are shown in Table 2.
Despite the minority of the dentists reporting that they would not be comfortable treating patients, a large majority (89%, n=101) of them said that they would ‘find it valuable if a lecture was provided on the treatment of this patient group
Table 1: Responses to questions 3-7 & 9 of Survey
Question ID
Question
No. of Dentists Responding ‘No’
% of Dentists Responding ‘No’ 3
Would you be comfortable treating patients with a Hemi Maxillectomy? 40
35.1 4
Would you be comfortable treating patients with a Hemi Maxillectomy with obturator? 43
37.7 5
Would you be comfortable treating patients with a Hemi Mandibulectomy? 6
Would you be comfortable treating patients with a Free flap or Pedicled flap intra orally? 39
34.2. 7
Would you be comfortable treating patients who had had prior radiotherapy? 13
11.4 9
Do you think the undergraduate dental curriculum provides adequate teaching on the provision of dental care for Head and Neck Cancer patients? 64
56.6
Results – Qualitative
A total of forty-one (36%) respondents provided additional free-text to the final question “Any other comments”. Content analysis produced three main categories: 1) Training, 2) Communication, and 3) Finance.
Within the category ‘Training’ the respondents commented that the training at undergraduate was “Poor” and that a “Lecture in this is a minimal requirement for continuing professional development”.
The ‘Communication’ category highlighted the respondents’ desire for ‘better’ links between the hospital and GDP’s during and after hospital treatment of the patient group concerned; “There is a lack of communication with the GDP following referral to your department.”
“I have referred and had patients treated for oral cancer but have never received information on their treatment or even if they survived treatment! We need to be treated as an equal partner in their care.”
The third category ‘Finance’ started to suggest that the “new NHS dental contract does not allow for the treatment of any patients who are not 'straight forward’”.
Table 2: Responses to question 8; “If a patient with a history of oro-facial cancer came to you which of the following options would you be most comfortable with?”
Response
No. of Dentists Responding
% of Dentists Responding
Treat patients independently in your practice 19
16.7
Treat patients and refer to hospital only for extractions 24
21.1
Treat patients with a prescription for treatment 51
48.8
Only have patients once they have been treated in hospital for restorative and maxillofacial needs 6
5.3
Discussion
The postal survey received a good level of response from the GDPs. A small but significant minority of respondents reported not feeling confident to treat patients following treatment for oral cancer. In trying to understand how GDPs would most like hospitals to communicate patient needs with them (Table 2). The majority of respondents indicated that a hospital written treatment prescription would be their preferred option. This would have the double benefit of clarifying the previous treatment of the patient with the required continued treatment, as well as providing specific contact details for the GDP if they want to contact the hospital. A clear prescription would also allow the GDP to discuss their level of comfort in relation to hospital expectations. It may be that hospital consultants' expectations differ from the services that a GDP can provide. This requires further investigation.
The analysis of the open ended free text produced three categories, and interestingly supports the assertion that a useful output from this research would be a series of lectures aimed at the postgraduate level. It is clear from the 76% of respondents that presentations about these patients would be well received by GDP. The free-text responses are helping to illuminate the reasons why GDP are not comfortable with certain types of patients and ascertain how they could change the situation. This feedback is proving useful in the construction of a lecture series to ensure its contents are relevant, useful and set at the right level of the GDP that attend them. Expanding the study to a larger sample and geographical areas would provide insight into the specifics required to construct a series of educational peer reviewed articles.
Conclusions
A majority of GDPs reported the need for further education on the treatment of these patients and for better communication between themselves and hospital consultants. The findings suggest the need for a larger study to validate this pilot and indicate future interventions with GDPs.